TABLE OF CONTENTS
Arkansas has several health insurance options. You can sign up for insurance through your employer, buy your plan directly from an insurance provider, sign up for Medicare or Medicaid, use the Health Insurance Marketplace created by the Affordable Care act, or even look into low-income insurance programs for children.
This guide explains your insurance options in Arkansas in detail.
The Arkansas Insurance Department runs the state-based exchange for individuals and families who want to sign up for health insurance coverage. Generally, you’ll use HealthCare.gov to enroll in your coverage, an online enrollment platform that walks you through the enrollment process for marketplace coverage. However, there are alternatives:
To apply for coverage, you’ll create a marketplace account and enter some basic information about yourself for individual coverage or about yourself and your household/family members for family coverage. Even if a household member isn’t applying for health insurance coverage, you must still supply their information to determine whether you’re eligible for financial help.
Required information for every member of your household includes:
The following insurance providers were approved to do business in Arkansas in 2021:
Individual health insurance plans in Arkansas cover both individuals and families. It may take longer to compare your options for families versus an individual, especially since monthly premiums and deductibles are generally higher on family plans. Whether you’re buying coverage for yourself or your family, be sure you understand the basics.
Choosing individual health plans is easier when you know what to look out for when comparing your options. All plans include the same covered benefits, so the different categories don’t impact the care you’ll receive, just the cost of care. Younger, healthy adults may also opt for catastrophic health insurance, which has very low monthly premiums but very high deductibles.
No matter the plan, you must pay a monthly premium, even if you don’t require any medical services that month. Be sure to compare premiums and other out-of-pocket costs, such as deductibles, to understand the overall cost for every plan.
Common plan types include health management organization (HMO), preferred provider organization (PPO), point-of-service (POS), and preferred provider organization plans (PPO). Many types of plans limit your choices of health care providers and facilities you can use, but some let you use nearly any doctor or medical facility you want. However, most plans charge more if you go outside the plan’s network of providers.
When you’re comparing marketplace plans and prices, look at each plan’s summary of benefits, provider directory, and list of covered drugs to determine which best meets your needs. HealthCare.gov also lets you search for specific doctors, health care facilities, and prescription drugs if you have preferences for the service providers you use.
Individual insurance plans also work for families, so you’ll choose from the same insurance providers as listed above to find the ideal coverage for your entire household. Depending on the number of family members you’re insuring, choosing a plan can get complicated. You may cover everyone under one type of plan or have family members on different plans, particularly if someone in your household has provider preferences or conditions that require ongoing care.
All plans must cover essential benefits, but for families, it’s important to note that these benefits include preventive services for all family members and dental and vision coverage for children. Check plans to see if these benefits vary. Provider networks may be important to families because household members may see different types of doctors, even if you have a family doctor as your primary care provider. For example, children may also see a pediatrician, and women will likely see an OB/GYN.
Health insurance plans are divided into four metal categories, which indicate how costs are shared between you and your insurance provider. These categories are bronze, silver, gold, and platinum. Each metal category has different costs for your premium, deductible, and the portion of health care cost you pay compared to how much your plan pays, which are copays and coinsurance costs.
|Average premiums in Arkansas||2018||2019||2020||2021|
|Most affordable bronze plan||$296||$320||$320||$322|
|Most affordable silver plan||$340||$361||$358||$387|
|Most affordable gold plan||$409||$461||$461||$499|
Arkansas provides health care coverage for low-income adults and children through three programs under the state’s Medicaid program. Medicaid in Arkansas includes several types of health care coverage, including Medicaid, Arkansas Works, and ARKids First programs.
Medicaid in Arkansas provides medical coverage for certain people whose incomes are less than 100% of the federal poverty level. Medicaid is available to low-income residents who meet at least one of the following criteria:
Apply for Medicaid at your local DHS office or online at Access Arkansas. You may be able to apply over the phone or through the mail. If you apply for insurance through the Health Insurance Marketplace, the system tells you if you qualify for Medicaid. Call 1-800-482-8988 or your local county DHS office for more information.
Arkansas Works is a Medicaid program for low-income adults aged 19 to 64 with household incomes that are between 100% and 138% of the federal poverty level. It offers individual health insurance coverage from Arkansas BlueCross BlueShield, Arkansas Health & Wellness, and QualChoice. Depending on your income, you may pay a monthly premium and/or a small copay. Apply for ARWorks through your local DHS office or online at Access Arkansas. Call the DHS helpline at 855-372-1084 or your local county DHS office for more assistance.
ARKids First provides health care coverage to children up to age 19. ARKids “A” is Medicaid for children in low-income families, and ARKids “B” is for children whose families earn too much to qualify for Medicaid but not enough to pay for health insurance. ARKids B enrollees pay copayments for prescriptions and some medical care, but preventive care is free. Apply for both programs at your local DHS office, which will determine whether or not your child qualifies for either program. You can also apply online at Access Arkansas or through the mail by calling 888-474-8275 and requesting an application form be mailed to you.
Arkansas has several Medicare options available to older adults and people with disabilities.
If you choose Original Medicare, you may want supplemental insurance, called Medigap, to cover some of your out-of-pocket expenses. Several companies are licensed to sell Medigap plans in Arkansas. Providers of Medicare Supplement Plans must outline the coverage and summarize the benefits of each plan offered. In Arkansas, insurance providers aren’t allowed to add a one-time policy fee. When calculating premiums, Arkansas requires companies to use the no age rating method, which means the premium is the same for everyone who buys the same policy, regardless of age.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months’ worth of payments from the Social Security Disability Insurance program. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
You can get help signing up for Medicare at your local Social Security office, by visiting Medicare.gov, or by calling 800-633-4227. The Arkansas Senior Health Insurance Information Program can connect you to certified counselors who offer free in-person or over-the-phone guidance on Medicare, Medicare Advantage, Medigap, and prescription drug coverage.
Arkansas defaults to the federal regulations on short-term plan duration but has some state mandates. You can enroll in a short-term health insurance plan, also called a limited duration plan, any time because there aren’t any enrollment periods. This is one of the major appeals of these policies and sometimes makes them a good choice for temporary insurance. For example, if you’re waiting for Medicare coverage to kick in or if you missed the Health Insurance Marketplace open enrollment deadline.
Short-term insurance plans aren’t right for everyone. These plans aren’t compliant with the Affordable Care Act, so plans are often missing essential health benefits. However, if you’re a healthy applicant, you can usually secure coverage for yourself and your family immediately with some plans kicking in as early as the next day. Talk to an AR SHIIP counselor to see if short-term insurance is right for you.
No, Arkansas does not require you to have health insurance.
No, insurance plans are the same on the marketplace or off the marketplace. You are able to purchase plans through an individual insurance company, but you won’t qualify for a premium subsidy unless you sign up through the Health Insurance Marketplace.
Health care sharing plans are available in Arkansas. With these cost-sharing plans, members share medical expenses, often with a lower monthly payment than a traditional insurance plan’s premium. However, these plans are not insurance and are not ACA-compliant. The plans are not required to cover pre-existing conditions and not legally bound to pay claims.
A health savings account or flexible spending account can help you manage health care costs, but it’s not a replacement for insurance. You should have an insurance plan to buffer health care costs and use your health savings account to pay for out-of-pocket costs your plan doesn’t cover.
Because Arkansas doesn’t require employers to provide short-term disability coverage, you may want to buy your own policy even if you have health insurance. Short-term disability insurance covers a portion of your income if you can’t work because of a non-job-related illness or injury, while health insurance covers your medical expenses.
Arkansas doesn’t require you to have long-term disability insurance, but it helps replace your income if you can’t work due to a long-term illness or injury. Health insurance only covers your medical costs, so LTD insurance complements this coverage by covering your living expenses.
Insurance provided through the Arkansas Works program covers:
In addition, all ARWorks recipients are referred to the Arkansas Division of Workforce Services for free job assistance services.
ARKids First covers a wide range of services that include but aren’t limited to:
Some benefits have limits and some require a referral from your primary care provider.