Health Insurance in Utah: Marketplace, Medicaid, Student Plans (2026)

Living September 2, 2026 16 min read ✓ Updated September 2, 2026

JoAnn Giordano Editor-in-Chief, Provo.com

Health insurance in Utah is four systems wearing one name, and the county's residents move between them constantly: a UVU student on a parent's plan turns 26 and lands on the marketplace; a young couple's first baby qualifies for CHIP while the parents stay on an employer plan; a laid-off tech worker in Lehi spends six months on Medicaid expansion and then buys a marketplace plan when the new job's coverage does not start for ninety days; a BYU student who never thought about it discovers a charge on the tuition bill for a plan she did not know she had. Each of those transitions has a deadline, a form, and a way to get it wrong.

This guide is the map, written for a Utah County resident looking at the 2027 plan year. It covers the marketplace and the open-enrollment window that a court fight has left unsettled, the subsidy change that raised so many premiums this year, Medicaid expansion and the work requirement that is coming, what happened to the Primary Care Network, CHIP, the two universities' very different student-plan rules, the free navigators in the county, and the doors that stay open after the window closes. It is not advice about which plan to buy; a navigator or a broker will do that with your actual numbers. It is the structure they will assume you already understand.

The Four Systems

Employer coverage is where most Utah County households are, and this guide mostly leaves it alone: your employer's open enrollment, usually in the fall, on its own schedule and rules.

The individual marketplace — HealthCare.gov, because Utah uses the federal exchange rather than running its own — is for people without employer coverage who earn too much for Medicaid: the self-employed, the early retirees, the gig workers, the students over 26, the family whose employer plan covers the worker but prices the dependents out. It has one annual window and income-based tax credits.

Medicaid and CHIP — run by the state through the Department of Workforce Services — are for adults up to 138% of the poverty line since expansion, and for children and pregnant women at higher thresholds. Year-round enrollment.

The student plans are their own small world, and in Provo they matter more than almost anywhere, because BYU requires coverage and enrolls you if you do not prove you have it.

Utah also runs Avenue H, a state exchange for small employers, which is where a Utah County small business buys a group plan; it is separate from the individual marketplace and outside this page.

The Marketplace and the 2027 Window

The window. Open enrollment for 2027 coverage opens November 1, 2026. Its end date was unsettled as this was written: a 2025 federal rule shortened the annual window to end December 15 rather than January 15, a federal judge struck the rule down in June 2026, and the government appealed in July. Depending on the appeal, the window ends either December 15, 2026 or January 15, 2027. The advice that is right in both cases is to enroll by December 15, which has always been the deadline for coverage starting January 1; a January enrollment under the longer window means a February 1 start and a month uninsured. Check HealthCare.gov for the confirmed date when the window opens.

The carriers. Utah's individual market has consolidated. The plans on HealthCare.gov for Utah County in 2026 came from SelectHealth (Intermountain's insurer), Regence BlueCross BlueShield, BridgeSpan, University of Utah Health Plans, and Molina in some areas, after Aetna's exit from the market; the 2027 lineup is set each fall. Which carrier's network includes your doctor is the first question, and it is not a small one in a county where Intermountain's Utah Valley Hospital and its clinics dominate; our Utah Valley Hospital guide and pediatrician guide explain the network map.

The metal tiers. Bronze, silver, gold, platinum, in ascending order of premium and descending order of deductible. The silver tier is where the cost-sharing reductions live — extra help with deductibles and copays for households up to 250% of the poverty line — which makes a silver plan the best value for anyone in that band and often a poor value above it.

The premium tax credit, and the cliff. This is the part that changed. From 2021 through 2025, a federal enhancement made the marketplace's premium tax credits larger at every income and removed the income ceiling entirely, so that a household at 500% or 600% of the poverty line still got some help and a household under 150% paid nothing for a benchmark silver plan. That enhancement expired December 31, 2025, after Congress declined to extend it. For 2026 — and for 2027, unless new legislation passes — the original rules apply: credits for households between 100% and 400% of the federal poverty level, smaller at every income than the enhanced version, and nothing above 400%.

The 400% line under the poverty figures used for 2026 sits at roughly $62,600 for a single person and $128,600 for a family of four. Below it, the credit caps your premium for a benchmark plan at a percentage of income that rises with income; above it, you pay the full premium. That is the cliff: a household a dollar over the line loses the entire credit, which for a family of four in their 50s can be several hundred dollars a month. Utah's individual-market premiums also rose by double digits for 2026. The combination is why so many Utah County households saw the same plan cost far more this year, and why anyone near the line should look at whether a pre-tax retirement contribution or an HSA deposit — both of which reduce the income the credit is calculated on — keeps them under it. A navigator or a tax preparer can run that; our tax prep guide covers the county's options.

Reconciliation. The credit is advanced monthly against an estimate of your income and reconciled on your tax return. Underestimate and you repay; overestimate and you get a refund. Report income changes to HealthCare.gov during the year rather than discovering the difference in April.

Medicaid Expansion, and the Requirement That Is Coming

Utah expanded Medicaid fully in January 2020, after a 2018 ballot initiative and a 2019 legislative rewrite, and the expansion covers adults 19 to 64 with household income up to 138% of the federal poverty level — roughly $21,600 for one adult and $44,400 for a family of four under the 2025 figures, adjusted every spring. The state's name for the expansion program, the Utah Premium Partnership, sounds like a private plan; it is Medicaid, administered through the state's managed-care plans, and the benefit is comprehensive.

Two consequences matter for Utah County. First, there is no coverage gap here: an adult below the poverty line gets Medicaid rather than nothing, which is not true in the states that did not expand. Second, Medicaid enrolls year-round through the Department of Workforce Services, online, by phone or at the Provo office, so a job loss in March does not mean waiting for November.

The work requirement. The 2025 federal budget law requires every expansion state to impose a work or community-engagement requirement on expansion adults by January 2027, with exemptions for parents of young children, students, people with disabilities and others, and with monthly documentation of hours worked, studied, trained or volunteered. Utah asked federal regulators in July 2025 to start earlier, targeting mid-2026. As of the most recent reporting we could verify, the requirement had not taken effect in Utah; whether the early start was approved and implemented by the time you read this is a question for Workforce Services, and anyone on expansion Medicaid should read every piece of mail from the department through 2026 and 2027. Utah ran a work requirement for a few months in early 2020 before the pandemic suspended it; the lesson from that period, and from other states, is that the people who lose coverage under these rules are mostly those who qualified for an exemption and did not file the paperwork.

Children and CHIP. Children qualify for Medicaid at higher income levels than adults, and above that for CHIP, Utah's Children's Health Insurance Program, up to about 200% of the poverty line, with modest premiums and copays. A family whose adults are on a marketplace plan may still have children on CHIP; the marketplace application screens for it automatically. Our having a baby guide covers the newborn enrollment steps.

What Happened to the Primary Care Network

For about fifteen years before expansion, Utah ran the Primary Care Network — PCN — as a limited benefit for uninsured adults who did not qualify for Medicaid: doctor visits, prescriptions, some dental and vision, emergency-room care, but no hospital coverage, enrolled through occasional open-enrollment windows that closed when the slots were full. A generation of Utah County clinic patients remember it, and old flyers for it still turn up.

It is gone. When the state expanded Medicaid in 2019 and 2020, it moved PCN members into full Medicaid — which covers everything PCN did and hospital care besides — and the state's own eligibility manual lists the PCN rules as obsolete as of August 31, 2020. There is no current PCN enrollment. Anyone who thinks they need PCN should apply for Medicaid; the income limit is higher than PCN's was and the benefit is far broader.

The Student Plans: BYU Requires, UVU Does Not

BYU. Every student enrolled three-quarter time or more — nine credit hours a semester, or four and a half in a term — and every F-1 and J-1 visa student must have health coverage, and BYU enforces it by default: students who have not submitted proof of another acceptable plan by the deadline each year are enrolled automatically in the BYU Student Health Plan, administered by DMBA, and the premium (single or married rate) is charged to the student account. Acceptable alternatives are a group plan through a parent's, spouse's or own employer that covers care in Utah, or an ACA-compliant individual plan from a U.S. insurer; plans from insurers outside the United States are not accepted, which catches international students every fall. The student plan runs the academic year — from the first day of fall semester to the end of the following August, including spring and summer terms — and covers spouses and children at a family rate. Care routes through the campus Student Health Center, with referrals to DMBA's community network for what the center cannot do and an annual cap on off-campus benefits backed by a separate large-claims plan. About a fifth of the student body is on it in a typical year.

The practical point for a BYU family: if the student is on a parent's plan, submit the waiver before the deadline every year, or the charge appears. If the parent's plan is an HMO that does not cover Utah, the student plan is the answer.

UVU. No mandate. UVU students are covered by a parent's plan until 26, by an employer, by the marketplace, by Medicaid — a large share of UVU students qualify — or by nothing. UVU's Student Health Services sees enrolled students regardless of coverage for a fee schedule that is lower than the market's. A UVU student over 26 with no employer coverage is a marketplace customer, and one whose income is low enough is a Medicaid customer; both should apply. Our student health guide covers both campuses' clinics.

The 26 rule. Under federal law, a child can stay on a parent's plan until turning 26, regardless of student status, marriage or where they live — with the one catch that an HMO or narrow-network plan from another state may not cover routine care in Utah. Turning 26 is a qualifying life event that opens a marketplace special enrollment period.

Reading the Network Before the Price

The mistake Utah County shoppers make most often is buying on premium and discovering in February that the plan's network does not include the hospital ten minutes away. The county's care is concentrated: Intermountain's Utah Valley Hospital, its Orem hospital and its clinics on one side; the independent and university-affiliated practices, the Timpanogos and Mountain Point hospitals under other systems, and the growing University of Utah Health footprint on the other. SelectHealth plans lean toward Intermountain; University of Utah Health Plans lean toward its own system; Regence and the others contract across both with gaps. Before comparing prices, type your doctor, your child's pediatrician and the nearest hospital into each carrier's provider directory for the specific plan — not the carrier in general, because a carrier's marketplace network is often narrower than its employer network — and eliminate the plans that miss. Then compare price among what is left. Our therapist guide makes the same point about mental-health networks, where the gaps are widest.

The Free Help

Take Care Utah is the statewide network of certified navigators and assisters — free, federally funded, and legally barred from steering you to a plan for commission — with appointments in Utah County through community health centers and nonprofits, in English and Spanish, in person and by phone. It is the first call for anyone confused by the marketplace or Medicaid.

Mountainlands Community Health Center, the federally qualified health center with clinics in Provo, Payson and elsewhere in the county, has enrollment help on site and treats patients on a sliding scale whether or not the enrollment succeeds. It is also the answer for the months between coverage.

211, the United Way's line, refers to enrollment help and to the county's other safety-net clinics; our food help guide lists the same organizations for the other half of the problem.

Brokers. A licensed health insurance broker helps with marketplace and off-marketplace plans at no cost to you — the insurer pays a commission — and is the right call for a household above the subsidy line comparing plans on network and deductible rather than on price. Anyone who charges you a fee to enroll in a marketplace plan is not a broker; enrollment is free.

After the Window Closes

Medicaid and CHIP enroll year-round. A qualifying life event — losing other coverage, a move from another state or county, marriage, birth, adoption, or an income change that alters subsidy eligibility — opens a 60-day special enrollment period on HealthCare.gov, and losing a job's coverage is the common one; note that voluntarily dropping coverage does not qualify. A new job's group plan enrolls on its own schedule. BYU's student plan enrolls at the start of any semester. Short-term plans, which Utah permits, cover catastrophic events for a few months but exclude pre-existing conditions and do not meet the ACA's standards; they are a bridge between jobs, not a plan. Utah has no state tax penalty for going without coverage. The urgent care vs. ER guide explains what a gap month costs when something goes wrong.

The Short Version

Open enrollment for 2027 opens November 1 on HealthCare.gov; enroll by December 15 regardless of where the court fight over the end date lands. The enhanced subsidies are gone: credits run 100% to 400% of the poverty line and stop cold above it, and premiums rose by double digits, so check whether a pre-tax contribution keeps you under the line. Medicaid expansion covers adults to 138% of the poverty line, year-round, with a work requirement arriving by January 2027 and possibly sooner — read your mail. PCN closed in 2020; apply for Medicaid instead. BYU requires coverage and enrolls you if you do not waive; UVU does not. Take Care Utah and Mountainlands will help you for free. And if you missed the window, a job loss, a move, a marriage or a baby opens it again for 60 days.

Related Guides

Frequently Asked Questions

When is open enrollment for 2027 coverage in Utah?

It opens November 1, 2026, and its end date was, as of early September 2026, legally unsettled. Utah uses the federal marketplace at HealthCare.gov, and the federal government adopted a rule in 2025 shortening the annual window to end December 15 instead of January 15; a federal judge struck that rule down in June 2026 and the government appealed in July, leaving the 2027 window either November 1 to December 15 or November 1 to January 15 depending on the outcome. The practical advice from every enrollment organization is the same regardless: enroll by December 15. That has always been the last day to pick a plan that starts January 1, so even in the longer window, a January enrollment means a February start and a month without coverage. Confirm the current end date on HealthCare.gov when the window opens.

What are the enhanced subsidies everyone is talking about, and are they gone?

Gone, as of the 2026 plan year. From 2021 through 2025, a federal enhancement made marketplace premium tax credits larger and removed the income ceiling on who could get them; Congress did not renew it, and it expired December 31, 2025. For 2026 and, absent new legislation, 2027, the original Affordable Care Act rules apply: tax credits are available to households between 100% and 400% of the federal poverty level, the credit is smaller at every income than the enhanced version was, and above 400% — roughly $62,600 for a single person and about $128,600 for a family of four under the 2025 poverty figures used for 2026 — there is no credit at all. That last point is the 'subsidy cliff': a household $1 over the line pays full price. Combined with double-digit premium increases in Utah's individual market for 2026, this is why the same plan cost many Utah County households substantially more this year than last.

Who qualifies for Medicaid in Utah?

Adults 19 to 64 with household income up to 138% of the federal poverty level, since Utah's full Medicaid expansion took effect in January 2020 — about $21,600 a year for a single adult and about $44,400 for a family of four under the 2025 figures, adjusted each spring. Children qualify for Medicaid or CHIP at higher income levels; pregnant women, people with disabilities and seniors have their own categories. Enrollment is year-round through the Department of Workforce Services, not tied to the marketplace window, and coverage is comprehensive. The state's own name for the expansion program is the Utah Premium Partnership, which confuses people because it sounds like a private plan; it is Medicaid. Because Utah expanded, there is no 'coverage gap' here: a Utah adult below the poverty line gets Medicaid rather than nothing, which is not true in every state.

Is there a Medicaid work requirement in Utah?

Not as of this writing, but one is coming. The 2025 federal budget law requires every expansion state to impose a work or community-engagement requirement on expansion adults by January 2027, and Utah asked federal regulators in July 2025 for permission to start earlier, with a target of mid-2026. Whether that early start was approved and implemented by the time you read this is something to check with the Department of Workforce Services directly; as of the most recent reporting we could verify, the requirement had not taken effect. When it does, the rule as written will require most expansion adults to document a set number of hours of work, school, training or service per month, with exemptions for parents of young children, students, people with disabilities and others. Utah briefly ran a work requirement in early 2020 before the pandemic suspended it. Anyone on expansion Medicaid should watch their mail from Workforce Services closely through 2026 and 2027.

What was the Primary Care Network, and where did it go?

PCN was Utah's pre-expansion program for uninsured low-income adults: a limited benefit — primary care, prescriptions, some dental and vision, emergency room visits, but no hospital coverage — enrolled through occasional open-enrollment windows for about fifteen years. It closed. When Utah expanded Medicaid in 2019 and 2020, the state moved PCN members into full Medicaid, which covers everything PCN did and hospitals besides, and the state's own policy manual lists the PCN eligibility rules as obsolete as of August 31, 2020. Anyone who remembers PCN, or reads about it on an old flyer at a clinic, should apply for Medicaid instead; the income limit for expansion Medicaid is higher than PCN's was and the benefit is far broader. There is no current PCN enrollment.

Do BYU and UVU require students to have health insurance?

BYU does; UVU does not. BYU requires every student enrolled three-quarter time or more — nine credits a semester — and every F-1 and J-1 visa student to have coverage, and automatically enrolls students who do not submit proof of another plan by the deadline into the BYU Student Health Plan, administered by DMBA, with the premium added to the student account. Acceptable alternatives are a parent's, spouse's or employer's group plan that covers care in Utah, or an ACA-compliant individual plan; plans from insurers outside the United States are not accepted. The student plan runs the academic year from the start of fall semester through the end of the following August, covers spouses and children at a family rate, and routes care through the campus Student Health Center with a referral network for what it cannot do. UVU has no coverage mandate; UVU students are covered by a parent's plan (until 26), the marketplace, Medicaid, an employer, or nothing, and UVU's Student Health Services sees students regardless. Our student health guide covers the campus clinics.

Where can I get free help enrolling in Utah County?

Take Care Utah is the statewide network of certified navigators and assisters — free, federally funded, and legally required to give unbiased help rather than sell you a plan — with in-person appointments in Utah County through community health centers and nonprofits; its site and phone line book appointments in English and Spanish. Mountainlands Community Health Center in Provo and its other Utah County clinics have on-site enrollment help and treat patients on a sliding scale regardless of coverage. Utah Community Action and the United Way's 211 line refer to enrollment help. Licensed insurance brokers also help with marketplace plans at no charge to you (they are paid by the insurer), and are the right call for someone above the subsidy line comparing off-marketplace plans. Avoid anyone who charges a fee to 'enroll' you in a marketplace plan; enrollment is free.

I missed open enrollment. What now?

Four doors remain open. Medicaid and CHIP enroll year-round, so if your income qualifies, apply any time. A qualifying life event — losing other coverage, moving, marriage, a birth, a change in income that changes your subsidy eligibility — opens a 60-day special enrollment period on HealthCare.gov; losing a job's coverage is the most common one, and a new Utah County resident who moved from another state qualifies. Students at BYU can enroll in the student plan at the start of any semester; a new job's group plan enrolls on its own schedule. And short-term plans, which Utah permits, cover catastrophic events for a few months but exclude pre-existing conditions and do not meet the ACA's standards; they are a bridge, not a solution. Going without coverage in Utah has no state tax penalty, but the first emergency-room visit makes the arithmetic clear.

JoAnn Giordano

Editor-in-Chief

JoAnn Giordano is the editor-in-chief of Provo.com. Having lived in and around Utah Valley for years, she leads the site's editorial direction with a focus on the comprehensive, honest local coverage that helps residents, students, and newcomers feel at home. When she's not shaping Provo.com's restaurant and neighborhood coverage, she's exploring the valley's trails and tracking down the best new spots on Center Street.

Health Insurance in Utah, Explained: The Marketplace, Medicaid Expansion, What Happened to PCN, and the Student Plans — Who Qualifies for What Before Open Enrollment (2026)