Check your eligibility, estimate potential subsidies, and enroll in a Marketplace health insurance plan for Utah residents.
The Open Enrollment Period (OEP) is the main time each year when individuals and families can enroll in a new Marketplace health insurance plan or change their existing plan for the upcoming calendar year. For coverage that began in 2025, the OEP ran from November 1, 2024, through January 15, 2025. This Open Enrollment Period is now closed. During OEP, there were typically deadlines that determined when coverage started; for example, enrolling by December 15th usually meant coverage started January 1st, while enrolling by January 15th meant coverage started February 1st. For most people, OEP is the only time to sign up unless they qualify for a Special Enrollment Period (SEP) due to a specific life event during the rest of the year. The next Open Enrollment Period, for health plans starting in 2026, is expected to begin around November 1, 2025.
While you typically enroll in a Marketplace health insurance plan during the annual Open Enrollment Period (usually November 1st to January 15th), certain major life events allow you to sign up for or change your coverage outside of this timeframe. This opportunity is called a Special Enrollment Period (SEP). SEPs exist to ensure people who experience significant changes don't have unnecessary gaps in health coverage. Common Qualifying Life Events (QLEs) that trigger an SEP include losing existing health insurance (like from a job), getting married, getting divorced and losing coverage, having a baby or adopting a child, moving to a new zip code or county within Utah (or moving into Utah), or experiencing certain changes in income that affect subsidy eligibility. If you experience a qualifying event, you usually have 60 days from the date of the event to choose and enroll in a new plan. You will likely need to provide documents to verify your qualifying life event when you apply. If you believe you qualify for an SEP, it's important to act promptly to explore your plan options and complete your enrollment within the deadline.
If you work for yourself and don’t have employer coverage, the Marketplace offers individual and family plans with subsidy options.
Many self-employed Utah residents qualify for lower premiums through ACA tax credits.
If your employer’s plan is too expensive or doesn’t meet your needs, you may qualify for an affordable Marketplace plan with lower monthly costs
If you lost job-based insurance, COBRA is too expensive, or you’re aging off a parent’s plan at 26, you may qualify for a Special Enrollment Period.
If you make too much for Medicaid but aren’t yet eligible for Medicare, an ACA plan can be a cost-effective option for coverage.
Most Utah residents qualify for subsidies that make health insurance more affordable! Even if you already have a plan, you can compare new options for better savings.
This is the fixed amount you pay each month to keep your health insurance active, similar to a membership fee. You must pay your premium even if you don’t use medical services that month.
The amount you need to pay out-of-pocket for covered health care services before your insurance plan starts paying its share. For example, if your plan has a $2,500 deductible, you’ll pay the first $2,500 of most covered medical bills yourself. (Note: Marketplace plans cover preventive services like checkups even before you meet the deductible).
A fixed dollar amount (like $30) you pay for a specific covered service, such as a doctor’s visit or a prescription drug, usually after you’ve met your deductible. Some plans might have copays for certain services even before the deductible is met.
Your share of the cost for a covered health service, calculated as a percentage (like 20%) of the allowed amount for that service. You typically pay coinsurance after meeting your deductible. If your coinsurance is 20% for a $100 service (after deductible), you would pay $20, and the insurance company would pay $80.
The absolute most you are required to pay for covered medical expenses in a plan year through deductibles, copays, and coinsurance. Once you reach this limit, your insurance plan pays 100% of the costs for covered services for the rest of that year. Your monthly premiums generally do not count towards this maximum.
The list of doctors, hospitals, clinics, labs, and other healthcare providers that your insurance plan has contracted with to provide services. Using providers within your plan’s network usually results in lower costs for you. Going “out-of-network” might mean higher costs or no coverage, depending on your plan type (like HMO vs. PPO).
A list of prescription medications covered by your health insurance plan. Drugs on the formulary are often grouped into tiers, with different copays or coinsurance amounts for each tier (e.g., generic drugs might be Tier 1 with the lowest cost).
Financial assistance available through the Marketplace (Healthcare.gov) to help lower your monthly premium cost. Eligibility is based on your estimated household income. You can have it paid directly to the insurance company each month or claim it when you file your taxes.
Discounts available through the Marketplace (Healthcare.gov) that lower the amount you pay for deductibles, copays, and coinsurance. To qualify for CSRs, your income must be within a specific range, and you must enroll in a Silver-level plan.
Marketplace plans are categorized by how costs are shared between you and the insurer, not by quality of care. Bronze plans usually have lower premiums but higher out-of-pocket costs when you need care. Platinum plans have higher premiums but lower costs when you get care. Silver plans are in the middle (and are the only ones eligible for Cost-Sharing Reductions). Gold plans fall between Silver and Platinum.
Approval required from your insurance plan before you receive certain medical services, treatments, or medications (except in emergencies) for the costs to be covered. Your doctor usually handles this process.
