Frequently Asked Questions
Who pays for the medical care provided through UtahCares?
Everybody in Utah will contribute to UtahCares through a tax on the gross receipts of for-profit businesses. There will be no payroll tax on individuals for medical coverage and no premiums deducted from paychecks. UtahCares will consolidate the payment for every Utahn’s health care into one public trust fund.
Would I pay less for health care than I do now?
Most Utah residents would pay less for health care than they do under the current system.
Who will be eligible for UtahCares?
All residents of Utah, as defined under Utah law, who are not eligible for federal healthcare programs.
Will administrative costs be reduced?
Yes. UtahCares will greatly simplify the overly complex administrative processes in the current health insurance industry and reduce hospital and provider administrative costs.
Is this government-run healthcare?
No, but it is a single-payer health care system. UtahCares is public financing for private health care delivery. UtahCares will simply collect the funds already raised to pay for health care and then reimburse providers directly for necessary medical services.
Who will own UtahCares?
UtahCares will be a nonprofit organization owned by all Utahns similar to existing agencies such as the Utah Transit Authority.
Would UtahCares lower the cost of prescription drugs?
Yes. UtahCares will have the market power to negotiate prices of expensive drugs with big pharmaceutical companies, along with bulk purchasing and a formulary that would encourage prescribing low-cost generic drugs.
Will UtahCares reduce the cost of hospital care?
Yes. Receiving reimbursement from only one source, rather than many, will greatly simplify how hospitals are paid and greatly decrease the administrative costs associated with collecting payments, which will reduce the cost of running hospitals.
Will there be copays, deductibles and coinsurance requirements?
None for visits to primary care providers or preventive care such as vaccines. Out-of-pocket requirements in other cases would be low enough to avoid creating barriers to receiving the service or product.
Will UtahCares cover care for mental health and substance abuse?
Yes
Would there be annual or lifetime caps on how much UtahCares would pay?
Generally no, but there could be some exceptions around dental care and annual quantity limits on durable medical equipment and corrective lenses.
Who would own the hospitals?
Nothing would change. Hospitals would continue be owned by their same for-profit or nonprofit owners, be publicly or privately owned, as they are now
Who would employ the health care providers?
Nothing would change. Physicians and other professional caregivers would continue to be employed by their hospital systems, provider groups, or remain self-employed.
What if I am already on Medicare?
Utah residents currently on traditional Medicare or Medicare Advantage will have the option of signing up for UtahCares Medicare Advantage. UtahCares will also develop its own Medigap Plan for those on traditional Medicare
What if I am eligible for health care benefits with the Veterans Administration, Indian Health Service, or TRICARE?
You will receive those benefits. UtahCares will work to collaborate with all these federal programs to determine if it can be helpful in improving these benefits for Utah residents where there are unmet needs.
Will Workers Comp still be around to cover health care benefits for injured employees?
Yes, initially. But the UtahCares statute would require the UtahCares board, in collaboration with the Utah Industrial Accidents Division, to study the coordination/incorporation of essential health benefits for injured workers under UtahCares.
Will telemedicine be paid for?
Yes. And the UtahCares board will be required to ensure payment parity between telemedicine and in person services.
Will UtahCares eliminate so-called “balance billing?”
Yes. Any provider who does accept payment from UtahCares for a service included in UtahCares must accept that payment, along with applicable copays, as payment in full.
Could I choose not to participate in UtahCares?
Every Utahn will be expected to participate in paying for UtahCares through the gross receipts tax. While residents may choose other coverage similar to existing programs, why would they want to?