Utah’s Health Insurance Landscape Under the ACA

In Utah, about one in eight people get their health insurance through the ACA marketplace. This statistic surpasses the number of individuals receiving coverage through Medicaid, making Utah the fourth-highest state in terms of ACA enrollment. Interestingly, less than 10% of the population relies on Medicaid for coverage.

A recent report highlights that only Florida, Georgia, and Texas have a higher percentage of residents enrolled in the ACA market than Utah. In Florida, for instance, one in five residents is insured through this program.

According to the findings, over 421,900 Utahns are covered this way, which is 11.8% of the state’s population. A majority reside along the Wasatch Front and in Washington County.

“The ACA, which became law in 2010, created a national framework for health insurance,” noted Melanie Beegley, a senior health research analyst at the institute. “This marketplace, along with tax credits, aims to make health insurance more affordable for those in Utah who lack coverage through employment or public health programs.”

Those utilizing this marketplace include small business owners, their employees, and self-employed individuals.

The largest demographic in Utah’s marketplace consists of children under 18, making up 27.9% of the total registered. Most individuals enrolled have incomes below 200% of the federal poverty level, translating to under $64,300 for a family of four or under $31,300 for a single person in 2025.

While Utah has the option to establish its own marketplace, it currently relies on the federal marketplace run by the U.S. Department of Health and Human Services. This arrangement allows the federal government to provide tax credits and cost-sharing reductions for eligible insurance purchasers, which can lower both coverage and out-of-pocket expenses.

According to the report, the federal government has allocated around $1.7 billion in premium tax credits to Utahns covered under the ACA market. The average tax credit reduces the monthly premium to about $70. Most individuals opt to have this credit applied directly to their health plan, although they can also choose to pay the premium upfront and claim the credit during tax season.

For small and medium-sized businesses, which employ about 710,000 people in Utah, providing health insurance is not mandatory unless they have over 50 employees. Only around 40% of these businesses offer health insurance to their workers.

ACA Marketplace Overview

The report reveals that the introduction of enhanced premium tax credits through the American Rescue Plan has notably increased Utah’s ACA marketplace enrollment, especially among those earning less than 200% of the federal poverty level. Enrollment in this income bracket saw a rise from 98,100 in 2020 to nearly 270,000 in 2025.

However, these enhanced premium tax credits are set to expire at the end of the year.

As detailed in the report, the marketplace consists of four plan levels:

• Bronze plans usually have lower premiums but come with higher deductibles and out-of-pocket costs.
• Silver plans are considered “benchmark plans,” being the second-lowest cost based on a sliding income scale. Individuals with household incomes up to 150% of the federal poverty level may pay no premiums, while those earning at least 400% of the poverty level pay up to 8.5% of their income.
• Gold plans fall between Silver and Platinum plans.
• Platinum plans involve higher premiums but lower out-of-pocket expenses.

The institute suggests that more affordable insurance options could benefit those who currently lack reasonable choices, and the ability for small businesses to voluntarily contribute to employee costs may assist in retaining their staff.