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Arizonans have numerous ways to obtain health care coverage. Many people receive health benefits through an employer. Still, depending on your income, employment, and other qualifications, you may opt to enroll in Medicaid, Medicare, choose a marketplace plan, or purchase a plan directly from a health insurance company.
Read this guide to understand your Arizona health insurance options.
Arizona doesn’t have a state website for health insurance enrollment, so you’ll use Healthcare.gov to enroll. You’ll need to create an account to get started. Make sure to follow the instructions and provide accurate contact information. Once you apply online or over the phone, Healthcare.gov will determine your eligibility for Medicaid and other assistance programs. The marketplace will also inform you if you qualify for a subsidized premium with the Advanced Premium Tax Credit. Have essential information on hand when you fill out your application, such as the Social Security number, full name, birth date, and income for all family members on your plan. The additional information you’ll need to provide includes:
After you’ve made it through these steps, you can shop marketplace plans. You’ll be able to review what the monthly premium is for each plan, what your deductible and copayments will look like, and additional details that will help you decide which plan is right for you. Healthcare.gov makes it easier by allowing you to compare plans side-by-side. From there, all you need to do is pick a plan and complete your enrollment. The following insurance companies provide individual insurance plans in Arizona:
There isn’t a different enrollment process for individuals and families, but you should consider everyone’s needs if you’re shopping for a family policy. You’ll want to consider:
If you’re shopping just for yourself, you’ll have more options, especially if you’re young and healthy. You can save on monthly insurance premiums by selecting a plan with a higher deductible and copayment. Before you select a plan, understand the differences between each type of plan:
There are more factors to consider when purchasing insurance for your entire family. Do any members of your family need access to better services than others? If your family members need ongoing care, this may sway your decision toward a specific type of coverage or plan. If you need regular access to health care, paying more for a lower deductible plan can help manage your family’s care costs. Paying less in monthly premiums could cost you more in the long run if you need to meet a large deductible before benefits kick in. Also, consider whether you want more choice over your doctors and specialists when deciding between an HMO, PPO, or POS plan.
The Health Insurance Marketplace places policies into four tiers based on how much the plans cost per month, annual deductibles, and copayments. The four tiers are bronze, silver, gold, and platinum.
|Average premiums in Arizona||2018||2019||2020||2021|
|Most affordable bronze Plan||$397||$359||$363||$342|
|Most affordable silver Plan||$487||$452||$435||$418|
|Most affordable gold Plan||$629||$592||$579||$553|
The Arizona Health Care Cost Containment System (AHCCCS) is Arizona’s Medicaid program. Arizona has two government-funded health care programs run by AHCCCS to assist low-income residents with health coverage: Medicaid and KidsCare. Eligibility will depend on your income, how many members are in your household, each member’s age, and whether you have or are caring for someone with a disability.
The Medicaid program in Arizona is called the Arizona Health Care Cost Containment System, but it serves the same purpose as other state Medicaid agencies throughout the country. To qualify for Medicaid in Arizona, you must have low income and qualify as any of the following:
The income threshold for individuals seeking Medicaid is $17,131 per year, but that threshold increases if your household includes other people. For a family of three, your income must not exceed $29,207, for example. Pregnancy allows you to add another member to your household income calculation even before the baby is born. If you would like to apply for Arizona Medicaid, you can do so through the online application portal or apply through the Health Insurance Marketplace.
Arizona provides health coverage to children from families with income under the qualifying threshold. To enroll in KidsCare, a child:
Coverage requires a monthly premium, ranging from $10 per month to $70 per month. Native American children from a federally recognized tribe can get KidsCare without a monthly premium.
Qualifying Medicare recipients can choose from a traditional Original Medicare plan, which offers Part A and B, or a Medicare Advantage Plan from an insurance company.
You can enroll in a Medicare Part D plan regardless of whether you have Original Medicare or a Medicare Advantage Plan. You can add a Medicare Supplement Insurance plan to cover some of your out-of-pocket Medicare expenses.
|Eligibility and Enrollment|
|Eligibility||Arizona offers Medicare coverage to seniors over the age of 65 and younger people with qualifying disabilities. You may qualify for dual coverage with a Medicare plan and Medicaid if your income is under the qualifying threshold.|
|Enrollment||The initial enrollment period begins three months before your 65th birthday and ends three months after your birthday. If you missed your initial enrollment period, there’s an open enrollment period that begins the first day of each year and lasts until March 31. Every year, there’s a general enrollment period between October 15 and December 7 when you can make changes to your plans.|
You can contact the Arizona Department of Insurance and Financial Institutions for assistance reviewing available Medicare and Medicare Advantage Plans and assistance with enrollment. Get in touch by calling 1-800-325-2548.
Short-term health insurance plans are useful if you’ve recently moved, lost your job, are waiting to be enrolled on a new employer plan, or are otherwise between insurance plans. These plans don’t qualify for minimum essential coverage: you can be denied coverage for a preexisting condition, and your medical history may influence premiums. Arizona allows short-term plans to have terms of up to one year, with up to three renewals. You might be denied coverage if you’re being treated for any of the following conditions:
Federal law mandates health insurance for every U.S. citizen, but the mandate is no longer enforced with a financial penalty. Arizona doesn’t have any separate law requiring you to have coverage, so you won’t be affected if you choose not to have insurance.
There are many pathways to insurance; the marketplace is just one of them. The main benefit of purchasing a policy through the marketplace is the potential to qualify for the Advanced Premium Tax Credit. If you’re unable to qualify for the credit or don’t want to receive it, you’re free to purchase insurance from any insurance company you choose.
You can see significant savings on your health care if you enroll in a cost-sharing plan, which may be offered by religious groups. Cost sharing plans are not insurance and are not required to meet minimum essential coverage standards, nor are the plans legally required to pay your claims.
Insurance companies are seeing an increased demand for insurance offered through the marketplace. There are now five insurance companies that offer insurance through the marketplace in Arizona. For comparison, only two insurance companies offered coverage through Healthcare.gov to Arizonans in 2018.
Flexible savings accounts and health savings accounts will help you put away money to cover medical expenses but are not viable replacements for health coverage. These accounts are most useful when combined with a health insurance policy so that you can cover out-of-pocket expenses.
Short-term disability coverage isn’t health insurance. It covers bills that don’t traditionally fall under medical coverage, like your rent or mortgage, groceries, and other day-to-day expenses. A short-term disability policy can help if you’re concerned a disability could impede your ability to work.
Long-term disability coverage is very similar to short-term disability coverage and pays you for household expenses. Disability coverage can’t replace the benefits you receive through health insurance, but it can be useful for protecting your finances if you’re unable to work due to disability.
KidsCare provides coverage for routine doctor’s visits, physical examinations, diagnostic testing, immunizations, and medical treatment as needed when your child is injured or diagnosed with an illness. It also covers emergency treatment and hospital care. The AHCCS will connect enrollees with the health providers and services that are covered under the program.