Nearly one-eighth of Utahns are insured through Affordable Care Act Marketplace, per Kem C. Gardner Policy Institute report.That’s 421,900 Utah residents, 11.8% of the total population, most of them along the Wasatch Front and in Washington County.Children are the largest demographic enrolled through the marketplace and Utah has the largest share of children enrolled.
Nearly 1 in 8 Utahns purchase health insurance through the Affordable Care Act Marketplace — more than receive coverage through Medicaid and the fourth-highest share in the nation. Fewer than 1 in 10 Utahns are covered by Medicaid.
That’s according to a data report from the Kem C. Gardner Policy Institute at the University of Utah, which has so far produced 13 summaries showing state and federal economic ties. The report notes that only Florida, Georgia and Texas have a greater share of residents who get their insurance through the ACA Marketplace than do those in Utah. In Florida, nearly 1 in 5 access health insurance coverage that way.
The report says more than 421,900 people in Utah are insured that way — 11.8% of Utah’s population. Most of them live along the Wasatch Front and in Washington County.
“The ACA, signed into law in 2010, established the framework for health insurance marketplaces nationwide,” Melanie Beagley, senior health research analyst at the institute, said in a written statement. “The Marketplace and the accompanying tax credits help make health insurance coverage affordable for Utahns who do not have access to health insurance coverage through work or public health care coverage programs.”
She said the folks who use the marketplace to access health insurance include small business owners, their employees and self-employed workers.
The largest share of Utahns enrolled in the marketplace are children under age 18 (27.9%) and Utah has the highest share of minor enrollees in the country. Most of those enrolling in the marketplace have incomes below 200% of the federal poverty level, which in 2025 means they earn less than $64,300 for a family of four or $31,300 for an individual.
States have the option of operating their own marketplace, but Utah uses the Federally Facilitated Marketplace, which is managed by the U.S. Department of Health and Human Services. The federal government also pays for tax credits and cost-sharing reductions for eligible people who buy their insurance through the marketplace, reducing both the cost of coverage and out-of-pocket expenses.
Per the report, the federal government paid roughly $1.7 billion in premium tax credits for Utahns getting insurance in the marketplace. The average tax credit for Utahns in the marketplace is $463 toward the cost of their premium, which puts the average cost of the monthly premium at $70, per the report. Most enrollees choose to have that credit sent directly to the health plan to reduce their monthly cost, though there’s the option to pay the premium themselves and claim the credit at tax time.
Small businesses — those with fewer than 50 employees — aren’t obligated to provide health insurance for employees, though some do. About 710,000 Utahns work for small businesses, but just 4 in 10 of those businesses offer health insurance.
ACA marketplace basics
The report said that the “introduction of enhanced premium tax credits through the American Rescue Plan doubled Utah’s marketplace enrollment, particularly among individuals with incomes below 200% of the federal poverty level. Enrollment among individuals with incomes below 200% of that poverty level increased from 98,100 in 2020 to nearly 270,000 in 2025.”
Enhanced premium tax credits are set to expire at year’s end.
There are four levels of health plans in the marketplace, as explained in the report:
Bronze typically has lower premiums but higher deductibles and cost sharing.Silver is the “benchmark plan,” and is the second-lowest cost, while being based on a sliding income scale. Those with household incomes up to 150% of the federal poverty level pay nothing for the premium, while those with incomes of at least 400% of poverty pay up to 8.5% of household income.Gold falls in between the silver benchmark plan and the platinum plan.Platinum plans have the highest premiums but low out-of-pocket costs.
Among benefits of the marketplace, the institute said that insurance becomes more affordable for people who might not otherwise have an affordable option, the ability of small businesses to voluntarily contribute to employees’ costs helps retain employees, state budgets pay less for programs or services for those who are uninsured, hospitals and health systems provide less uncompensated care and health and economic opportunity on a population level improves.