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Healthy U is a state and federally-funded program offering health insurance coverage for Utah's low-income residents. As one of Utah's Medicaid programs, Healthy U offers various healthcare and prescription drug services.
Utah residents who meet specific citizenship, income, and health-related criteria can apply to participate in Healthy U. As of June 2023, 484,149 Utahns were enrolled in Medicaid.
If you're a Utah resident needing affordable healthcare, Healthy U through Utah Medicaid is worth considering. In this comprehensive guide, you'll learn about Healthy U, its benefits, eligibility requirements, and other details about Utah Medicaid so you can make an informed decision about your healthcare.
Combining Utah Medicaid with extended healthcare coverage from a private insurer is the best way to protect yourself and your family from unexpected healthcare costs. You and your loved ones can receive access to much-needed healthcare services at affordable prices. To prevent shouldering the debt of unexpected medical expenses, many Utahns extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Healthy U is a Utah Medicaid plan that receives state and federal funding to provide healthcare services to pregnant women, low-income adults, senior citizens, disabled individuals, parents, and women with cervical or breast cancer. Healthy U is one of Utah Medicaid's Accountable Care Organizations (ACOs), which are groups of hospitals, medical professionals, and facilities that voluntarily provide high-quality care to Medicaid patients.
The U.S. Department of Health and Human Services and the Utah Department of Work Force Services (DWS) regulate Medicaid in the state.
The Healthy U program provides vulnerable Utah residents with access to affordable healthcare. Low-income adults with and without children, pregnant women, seniors, and people with disabilities who meet the state's income and eligibility requirements can apply for benefits to cover the costs of doctor visits, prescription drugs, preventive care, and other services.
In Utah, many forms of Medicaid are available; Healthy U is one of them. Coverage can fall into the traditional Medicaid category, which covers children, pregnant women, seniors, blind people, disabled adults, and women in the state's cancer program. Non-traditional Medicaid covers eligible members who are adults with dependent children and adult caretakers with Family Medicaid.
With Healthy U, healthcare can be free or low-cost. Most fees are due to copayments, but not all Medicaid members or services require them.
The Healthy U Medicaid card is the medical identification that you'll use to receive medical services in Utah. If you're approved for Healthy U, you will get your personal Medicaid card with your name, unique Medicaid ID number, and birthdate. The back of the card will have contact information for your benefits provider.
You must show your Healthy U Medicaid at doctors' offices and pharmacies to receive benefits. If multiple members of your household have Utah Medicaid, everyone will have their own Healthy U Medicaid card with different identification numbers.
(Please note that the card shown may differ in appearance depending on the carrier which you receive Medicaid through.)
If you're ready to apply for Healthy U or another Utah Medicaid program, you can do so online through the Utah Department of Health & Human Services website. Online applications are the easiest way to apply for benefits, but you can also use other methods to apply for Healthy U if internet access isn't available.
For example, you could download the medical application, fill it out, and mail it to the Department of Workforce Services at PO Box 143245, Salt Lake City, UT 84114-3245.
Another way to apply for Healthy U healthcare coverage is by faxing the DWS office at 801-526-9505. In-person help is available at any local DWS office. You can contact DWS in Salt Lake County at 801-526-0950 or toll-free at 866-435-7414 to have the office send you a paper application if you can't download one.
For additional help with your Medicaid application, you can reach out to Take Care Utah.
To be eligible for Utah Medicaid, you must be a U.S. citizen or legal alien and fall beneath a specific household income threshold before taxes. Monthly income requirements depend on your Medicaid category, usually between 55% and 133% of the federal poverty level.
For example, individuals with and without dependent children and pregnant women can get Utah Medicaid if their household income is up to 139% of the federal poverty level. Income eligibility for aged, blind, and disabled individuals is 100% of the federal poverty level.
Here is a closer look at the annual household income limits for Utah Medicaid eligibility:
After applying for Utah Medicaid, DWS will review your application to determine if you qualify for Healthy U. If you are, they'll send your new Healthy U Medicaid Card to your current mailing address. Whenever you visit a doctor and want to use your Healthy U coverage to pay for the visit, you'll show this card to the healthcare provider.
If you lose or damage your Healthy U Medicaid card, contact DWS immediately to receive a replacement. Call 866-435-7417 to get a new card.
When it comes to renewing your Utah Medicaid coverage, you'll have to wait until your local DWS office notifies you about your eligibility. You will have an assigned review month to determine your Medicaid eligibility, but your case will remain open until that time. When DWS completes its review, it will send you a letter explaining whether you still qualify and how to renew your benefits.
What is Healthy U Coverage? Healthy U coverage refers to the benefits you'll receive when you join the Utah Medicaid program and select Healthy U as your plan. This coverage extends to everything from routine checkups with a primary care physician to emergency care. Below, you can explore the types of coverage available through Healthy U and Utah Medicaid.
Unfortunately, Healthy U doesn't cover dental benefits, but you could receive dental coverage if you're eligible for Medicaid fee-for-service benefits or Medicaid Dental plans. Fee-for-service Medicaid accommodates your healthcare needs if you don't have a membership with an ACO or if your ACO doesn't cover a service that Medicaid generally does.
You can still get dental coverage if you're a Medicaid member who is disabled, pregnant, blind, or eligible to participate in the Child Health Evaluation and Care (CHEC) program. Through Utah Medicaid dental coverage, your plan will pay for:
Utah Medicaid’s dental coverage is comprehensive, it may not provide enough coverage for those requiring more serious dental services. Investing in private dental plans in Utah is recommended.
Through Healthy U, you can access a broad range of prescription drugs, but you'll likely pay a copay for your medication. The prescription drug copay is only $4, with a monthly maximum of $20. Healthy U also pays for approved over-the-counter drugs.
Some prescription medications with "enhanced benefits" require no copays.
You can explore the full list of preferred drugs and prescription drugs with enhanced benefits for this healthcare program to see if it covers your medication. The list is subject to change at any time. For questions or concerns about getting prescription medication as a Healthy U member, call the Pharmacy Customer Service hotline at 855-856-5694, which is available 24/7/365 for your convenience.
Utah has several Medicaid ACOs in addition to Healthy U, like Molina Healthcare and Select Access. As a Healthy U Medicaid member, your plan will cover many services, including specialty services like diabetes care. Healthy U covers everything from diabetes education to diabetes supplies for traditional and non-traditional Medicaid members.
In addition to diabetes care, general Utah Medicaid also includes services for your mental and emotional well-being through behavioral health services. Whether you need help overcoming anxiety, diagnosing depression, or treating a substance abuse disorder, you can get the help you need. Extended services for mental health and substance abuse disorders include:
Another important factor to consider is what happens to your finances should a temporary or permanent illness occur? Those who qualify for Utah Medicaid will receive assistance for the drugs and equipment required to manage, however not to replace your finances. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
Unfortunately, Healthy U doesn't provide coverage for non-emergency medical transportation, which some people use to get to and from medical appointments if they don't have other means. Yet, the service is part of Utah's fee-for-service Medicaid plan for traditional Medicaid members. Call 800-662-9651 for additional medical transportation information and ride requests.
Depending on your situation, you'll have several transportation options under Utah Medicaid:
Medicaid generally doesn't allow you to use your Healthy U benefits outside of Utah because each state has its own plans and eligibility requirements in addition to federal guidelines. However, you can get care from out-of-network healthcare providers if you or a family member experiences a medical emergency or if you have additional health insurance that extends your network beyond Utah.
If you have questions about your network and where you can use your Healthy U benefits, call 801-213-4104 to speak with a representative from Member Services.
If you are traveling outside of Utah or the U.S.A. for leisure, always invest in proper travelers insurance.
Though Healthy U Medicaid doesn't explicitly offer benefits for students, anyone who meets the income and eligibility requirements is free to apply, including full-time students.
With Healthy U traditional Medicaid coverage, seniors over 65 who require nursing home care can receive coverage for up to 30 days. Once the 30 days are up, Utah's fee-for-service Medicaid plan will handle payments.
However, neither Healthy U nor fee-for-service Medicaid will cover non-traditional Medicaid members who need nursing home help. Yet, general Utah Medicaid will cover the cost of long-term nursing home care for eligible members who require a nursing facility level of care. The program also covers:
Utah Medicaid and Healthy U provide access to healthcare to a wide range of people who would benefit the most from affordable healthcare. Coverage extends beyond seniors, low-income families, and disabled persons in Utah.
Indian Health Services (IHS) is a separate agency within the Utah Department of Health and Human Services. The agency provides federal healthcare services to Native Americans.
If you are a Native American who is eligible for Medicaid, you can apply for healthcare benefits, but you must confirm your Native status with DWS at 866-435-7414. With your confirmed status, you won't have to pay copays to receive your benefits. You can also get services from an Indian healthcare program with your managed care plan.
Members of the U.S. armed forces have access to several healthcare programs, including TRICARE. TRICARE is one of the top healthcare programs for active and retired military personnel and their immediate families. If you're an active duty member or a veteran who qualifies for Utah Medicaid, you can use both healthcare plans to extend your coverage beyond what Healthy U offers.
Considering the many services that Healthy U covers, it might seem like you could get all of your healthcare services through the program, but that's not true. Here are some of the services Healthy U will not cover for all members:
Utah Medicaid and Healthy U also won't cover services that aren't medically necessary. For example, it won't pay for cosmetic procedures or weight loss drugs.
Funerals are also not covered by Utah Medicaid. Considering the rising cost of funerals and related costs, it’s wise to consider securing your family in the event of your passing. Becoming secured with comprehensive funeral insurance alleviates the financial burden of funeral expenses.
Healthy U's eligibility and coverage options can be confusing due to the different tiers of Medicaid coverage that Utah offers.
Here's a deeper breakdown of common healthcare services and procedures that Utah Medicaid covers to give you a better understanding of what you could expect with a Healthy U plan.
| Dental | |
|---|---|
| X-Rays and Dental Exams | If you have Utah Medicaid, your dental coverage will pay for dental exams and X-rays. Your plan will pay for X-rays, exams, and teeth cleanings every six months. |
| Wisdom Teeth | Wisdom teeth impaction can lead to pain and infections in some cases. Fortunately, Utah Medicaid will cover teeth extractions to relieve pain and protect your oral health, but the Healthy U plan won't. |
| Vision | |
|---|---|
| Eye Exams | Healthy U will cover your eye exams if you have a medical problem that could contribute to poor vision like diabetes. As a healthy adult, you can also get coverage for one annual eye exam without a copay through Healthy U. |
| Glasses | If you have traditional Healthy U Medicaid, the plan will cover your eyeglasses if you are a pregnant woman or if you qualify for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits. |
| Laser Eye Surgery | Elective laser eye surgery generally doesn't apply to Utah Medicaid or Healthy U benefits. However, the programs may cover the service if your ophthalmologist considers it necessary to treat an eye disease like cataracts. |
| Surgery | |
|---|---|
| Rhinoplasty | A rhinoplasty or nose job surgery is a common cosmetic procedure that enhances the shape and appearance of your nose. Coverage for this service isn't available with Healthy U, but Utah Medicaid may pay for it if the procedure is medically necessary to correct a breathing issue and not solely cosmetic. |
| Breast Reduction | Like rhinoplasties, Utah Medicaid only covers medically necessary breast reduction surgeries. The program will also pay for breast reduction or reconstruction due to cancer. |
| Hospital | |
|---|---|
| Hospital stays | If an illness or injury requires admission to a Utah hospital, you can be confident Healthy U will pay for your stay. Each hospital stay may require a $75 copay. |
| Ambulance transportation | Though Healthy U provides coverage for emergency and urgent care services, it doesn't pay for ambulances. Still, the benefit is available through Fee-for-Service Medicaid. |
| Giving birth | Maternity care is available through Healthy U, including childbirth care. Copays aren't necessary for these birth-related services. |
With Utah Medicaid's fee-for-service plans, you can get help for mental, emotional, and behavioral problems. The program will cover individual and group therapy as well as inpatient mental health services. Psychological testing, personal services, and transportation to mental health appointments are also part of the benefits.
To receive mental health services through Utah Medicaid, you must go through healthcare professionals participating in the Medicaid program. Refer to your primary care physician or call the number on the back of your health plan card to find your mental health service provider.
| Sexual Health | |
|---|---|
| Gynecologist visits | Through Health Choice Utah, another form of Utah Medicaid, or Healthy U women can receive women's health care services from a gynecologist, including annual pap smears, mammograms, and STI screenings. |
| Erectile Dysfunction | Federal Medicaid guidelines don't include payments or reimbursements for medication that treats sexual or erectile dysfunction. |
| Birth Control | As part of Healthy U's family planning services, women can receive coverage for birth control-related physician appointments and products like IUDs, diaphragms, Depo-Provera, condoms, morning-after pills, rings, and sterilization. |
| Fertility Treatment | As a Utah Medicaid member, you may receive limited coverage for fertility treatment if you are at risk of infertility due to a cancer diagnosis or cancer treatment including chemotherapy and radiation. |
| Specialist Services | |
|---|---|
| Dermatology | Utah Medicaid may cover some dermatology services, but check with your plan provider to see what procedures are covered. |
| Physiotherapy | Traditional and non-traditional Utah Medicaid members can get coverage for medically necessary physiotherapy or physical therapy after an injury or illness. Healthy U also covers occupational therapy. |
| Massage Therapy | In most cases, Healthy U and Utah Medicaid won't cover massage therapy because it usually isn't medically necessary. However, your healthcare plan may cover homeopathic treatments like massage therapy if you have approval from the Department of Health and Human Services. |
| Podiatry and Foot Care | As an adult, you have limited benefits for podiatry and foot care services through Healthy U. The copay is typically around $4 with a maximum out-of-pocket limit of $100 per year. |
| Allergist and Allergy Testing | Utah Medicaid may cover allergy testing if medically necessary. |
| Sleep Physician Services and CPAP Machines | Utah Medicaid will cover a CPAP machine rental for 12 months to treat obstructive sleep apnea, but it won't cover the cost if the equipment is for comfort instead of a medical necessity. |
Healthy U provides reasonable access to healthcare to the state's vulnerable or low-income residents and children, but it's not always enough. Many residents find that having a third-party private healthcare insurance plan in addition to Healthy U is the best way to get comprehensive care for themselves and their loved ones.
Before looking at private healthcare to supplement your Healthy U membership, consider these possible benefits of having multiple policies. Extended health insurance coverage can help you:
At Insurdinary, it is easy to compare your insurance options to find the right policy for you at the right price. Our network of partners is here to help you find the best supplemental health care policy to complement your Healthy U membership. On Insurdinary, you can browse plans for health and dental care and critical illness insurance to compare rates and coverage.
Let us help you extend your Utah Medicaid benefits. Complete our convenient free quote form online today to begin your search.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
