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Health Insurance Advisor

A subject matter expert in insurance since 2008, Gabriel Segrera specializes in health, life, property and casualty insurance. Gabriel’s practice services self-employed, small businesses, individuals, and families across the United States to access innovative and affordable coverage solutions that meet their specific needs.

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.

What to know about insurance in Arizona

  • Open Enrollment: The normal open enrollment period for the Health Insurance Marketplace begins November 1st of each year and ends on December 15th. If you’ve missed this period, you’ll need to wait for a special enrollment period. In 2021, the open enrollment period has been extended to August 15th.
  • Special Enrollment: You can trigger a special enrollment period with a new marriage, the birth of a child, being laid off from work, or moving into a new home with a different zip code. If you’ve experienced any of the above and lost qualified coverage, you can sign up for new coverage within 60 days of the event as a special enrollment period.
  • Marketplace plans: You can use the federal Health Insurance Marketplace to find individual health insurance plans that conform to Affordable Care Act standards. You’ll also find out if you qualify for an Advanced Premium Tax Credit. If you don’t purchase a plan through the exchange, you’ll miss out on this benefit.
  • Direct enrollment: You can purchase a medical insurance policy directly from an insurance company of your choice. However, you can’t qualify for a premium tax credit unless you sign up for a plan through the marketplace.
  • Coverage types: Just over 45% of Arizonans are covered through workplace policies, while 21% of Arizona residents are enrolled in Medicaid. Another 16% are enrolled in Medicare, and about 5% are enrolled in private policies. Just over 11% of those in the state are uninsured.

How do I enroll in Arizona’s health insurance marketplace?

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:

  • Your marital status
  • How many people you claim as dependents on your yearly taxes
  • Your household income
  • Whether you wish to apply for financial assistance

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:

  • Ambetter from Arizona Complete Health
  • Blue Cross Blue Shield of AZ
  • Bright Health Company of AZ
  • Oscar Health Plan, Inc
  • UnitedHealthcare

How do I enroll in Arizona individual and family insurance?

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:

  • Monthly premium
  • Your deductible, including family deductible
  • Copayment requirements
  • Special medical needs

Insurance for individuals in Arizona

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:

  • Health Maintenance Organization (HMO) plans: HMO plans offer lower premiums while putting more restrictions on your care. You’ll need to get a referral to see a specialist and only see local doctors in the network to receive coverage.
  • Preferred Provider Organizations (PPOs): PPO plans don’t require approval to see the specialist of your choice. PPOs also offer nationwide coverage and out-of-network benefits. You’ll likely pay more in premiums for a PPO than an HMO, though.
  • Point-of-Service (POS) plans: POS plans compromise the advantages and disadvantages of HMOs and PPOs. You still need a referral to see a specialist, but if you’re willing to pay a little more, you can still see out-of-network providers.

Insurance for families in Arizona

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.

How much does health insurance cost in Arizona?

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

  • Bronze plans are the cheapest policies on paper but come with high deductibles, and you’re required to pay up to 40% of the cost of any medical treatment. These plans are usually best if you have no ongoing need to visit doctors for a chronic condition and primarily want coverage in case of an emergency. The most affordable bronze plan in Arizona costs $342 per month in 2021.
  • Silver plans are mid-level plans that cost more per month than bronze but provide greater coinsurance and a lower annual deductible. You may qualify for a discount on a silver plan based on your income, which could make a silver plan’s premium less than a bronze equivalent. You can expect to pay 30% of the cost of medical care on a silver plan after you have met your yearly deductible. The least expensive silver plan in Arizona costs $418 per month in 2021.
  • Gold and platinum plans are most appropriate if you or a family member requires ongoing care and treatment. These plans have much higher premiums but also cover a lot more. You can expect to only pay 20% with a gold plan or 10% with a platinum plan, which can save you on coverage, potentially enough to make higher premiums worth it. The least expensive gold plan in Arizona costs $553 per month in 2021.

What kind of low-income health insurance is available in Arizona?

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.

Medicaid in Arizona

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:

  • Have a disability, which can include blindness
  • Care for someone with a disability
  • Care for one or more children under the age of 18
  • Are 65 or older
  • Are pregnant
  • Have been diagnosed with breast or cervical cancer or precancerous cervical lesions

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 KidsCare

Arizona provides health coverage to children from families with income under the qualifying threshold. To enroll in KidsCare, a child:

  • Can’t be covered by an existing health insurance policy
  • Must either have a Social Security number or have a submitted application for one
  • Must be ineligible for Medicaid
  • Must be under the age of 19

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.

What are Arizona’s Medicare options for seniors and people with disabilities?

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.

  • Original Medicare’s Medicare Part A provides coverage for inpatient care, while Medicare Part B is used for preventive care, testing, transportation, medical supplies, and other outpatient services.
  • Medicare Advantage Plans must cover everything offered by Medicare Part A and B, allowing you more flexibility to choose an insurance company, additional coverage, and different pricing options. Medicare Advantage Plans commonly offer prescription drug coverage.

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.

Medicare Resources

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.

Are there short-term health insurance plan options in Arizona?

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:

  • Cancer
  • Autoimmune disorders
  • COPD
  • Heart disease
  • Kidney disease
  • Seizures
  • Congestive heart failure
  • Asthma

Arizona Insurance FAQs

Does Arizona require health insurance?

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.

Do I have to use the Health Insurance Marketplace in Arizona?

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.

What types of alternative health insurance plans (like cost-sharing plans) are available in Arizona?

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.

How many health insurance carriers offer insurance through the marketplace in Arizona?

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.

Do I need health insurance if I have HSA/FSA?

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.

Do I need short-term disability coverage in Arizona if I have health insurance?

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.

Do I need long-term disability coverage in Arizona if I have health insurance?

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.

What does KidsCare cover?

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.

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