Some critics have argued that charges don't matter, since virtually no insurer pays what healthcare providers charge.
While it's true that those with insurance are shielded from hospital charges, the uninsured aren't. Intermountain's lower charges are a benefit to Utah's uninsured.
Intermountain hospitals use a sliding scale that considers an individual's family income and family size, total amount of medical bills, and available liquid assets. Individuals whose family income falls below 150% of the Federal Poverty Guidelines may qualify for full assistance, minus a small co-pay per episode of care. The sliding scale extends to 500% of Federal Poverty Guidelines. The estimated ability to pay model attempts to determine what portion, if any, of an individual's income may be available to go towards paying for medical debt. As the sliding scale increases, more of an individual's income is potentially available to pay for medical services.
In addition, individuals with catastrophic medical bills may qualify for assistance. Intermountain hospitals currently define catastrophic assistance as situations where all medical bills (not only Intermountain medical bills) exceed 35% of a family's income.
Utah's Health Insurance Premiums
For those who do have insurance, Utah's health insurance premiums are comparatively low
The Kaiser Family Foundation report reflects average premiums for plans sold to individuals and excludes employer-based plans, public plans, and other products. However, Kaiser says the results are a useful indicator of insurance affordability: "Given the fragmentation of the market and the lack of public data available about individual insurance premiums across the nation, the analysis provides an important baseline that consumers and policymakers can use to gauge the state of insurance affordability prior to the full implementation of health reform."
There are a variety of reasons why premiums might vary, the report stated:
- Plans' effectiveness at controlling costs
- Plan benefits
- Healthcare costs
- Patient cost-sharing required
- Cost of living
- State demographics
- Risk pools: In some states that have instituted insurance market reforms-such as Massachusetts, New York, and New Jersey-people with pre-existing conditions are allowed to enroll, which puts upward pressure on premiums, the study said. Meanwhile, states that allow medical underwriting may feel less pressure because the risk pools include a healthier-than-average population.
SelectHealth contributes to Utah's positive performance. SelectHealth is known for its excellent service, high member satisfaction, and efficiency.
SelectHealth consistently ranks as the overall leader among similar Utah health plans in terms of the Healthcare Effectiveness Data and Information Set (HEDIS) metrics. Moreover, high member satisfaction is demonstrated by the annual surveys of plan members conducted by the Utah Department of Health. Another indication of member satisfaction is the proprietary J.D. Power and Associates U.S. Member Health Insurance Plan Studies in which SelectHealth consistently receives the highest numerical score among commercial health plans in the Arizona-Utah region.