When the Affordable Care Act (ACA) was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. Avenue H is the internet portal for Utah’s exchange.
Avenue H is different from most other state exchanges. It’s intended solely for small businesses with 50 or fewer employers. Employers choose the amount they wish to contribute, and employees select the health plan they prefer. A 35 to 50 percent tax credit for health contributions encourages employers to participate. Contributions from employees are pre-tax.
Individual plans are available through the National Association of Health Underwriters, not through Avenue H. Per the ACA, no one can be turned down for health reasons.
Avenue H providers
Avenue H offers about 70 health insurance plans for small businesses from three providers: HSA Healthplan, SelectHealth, and United Healthcare.
It also offers dental plans from these four providers:
- Alpha Dental
- Delta Dental
Health Savings Account (HSA) plans are also available from HealthEquity, National Benefit Services, and Optum Bank.
The federal Health Insurance Marketplace is the national exchange for individual insurance coverage. Visit http://www.healthcare.gov/get-coverage to find an individual health care plan.
Three insurers operating in Utah offer individual plans on the federal health insurance marketplace:
- University of Utah Health Plans
The ACA requires that all plans offer the following essential services:
- physician office visits
- emergency services
- laboratory services
- maternity and newborn care
- mental health treatment
- pediatric services
- prescription drugs
- preventive and wellness services
- rehabilitative and habilitative care
Four basic plans with varying levels of coverage are available.
|Plan||Expenses paid by plan|
Lower plans have the lowest premiums (the basic amount you must pay for coverage), but higher out-of-pocket costs (including deductible, copays, and coinsurance). A catastrophic plan is available for people under age 30. This has a high deductible (the amount you must pay before your insurance covers costs).
The ACA protects against outrageous medical bills. For 2017, it mandates a maximum annual out-of-pocket cost of $7,150 for individuals and $14,300 for families. This may reduce bankruptcy rates attributed to uncovered medical bills.
Tax credits and assistance
People living anywhere from 55 to 133 percent of the federal poverty level (FPL) can qualify for Medicaid in Utah, depending on their circumstances. The 2016 FPL guidelines include the following income guidelines for poverty:
- $11,880 for single adults
- $16,020 for a family of two
- $24,300 for a family of four
There are also two kinds of subsidies people may use for health care costs. The first is a cost-sharing subsidy. This subsidy is for silver plans only. It reduces the total out-of-pocket cost of a plan. People who have household incomes between 130 and 190 percent of the FPL may be eligible.
The second type of subsidy is the premium tax credit. You may qualify for this credit if your income is less than 400 percent of the FPL but you do not qualify for Medicaid. This subsidy would help pay for part of your insurance. On average, individuals who earn about $47,520 a year or less qualify. For a family of four, the eligible income level increases to about $97,200 or less.
The percentage of your costs that this subsidy would cover depends on income level and the cost of a second-tier silver plan where you live. This silver plan is used as a baseline because the ACA was designed so everyone could afford a silver plan, regardless of how expensive the healthcare rates may be where you live.
For example, if your income is $32,500 a year (273 percent of the FPL), the most you’ll have to pay for a second-tier silver plan is about 9 percent of your income. This averages to about $2,925 a year, or $244 a month. You can choose a plan other than the second-tier silver plan and use your tax credit, but the subsidy amount will stay the same. This means a gold plan would cost you more, even if you use a subsidy to cover some of the cost.
The Kaiser Family Foundation has a free calculator that can also help you determine subsidies.