author-img
Medicare Advisor, insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

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.

What to know about insurance in Arkansas

  • Marketplace plans: You’re eligible to purchase plans on the Arkansas Health Insurance Marketplace if you are a U.S. citizen (or legally residing in the country), if you don’t have Medicare coverage, or if you aren’t incarcerated.
  • Open enrollment: Open enrollment in Arkansas runs from November 1 to December 15. If you miss Open Enrollment, you can’t buy a marketplace plan until the next year unless you qualify for a Special Enrollment Period.
  • Special enrollment: Special enrollment periods occur when you have a major life event that affects your location, family size, or income. Life-altering events can include loss of health insurance, job loss, getting married or divorced, having or adopting a baby, moving, gaining citizenship, etc.
  • Expanded eligibility: The American Rescue Plan Act of 2021 extended eligibility for health insurance subsidies to people with incomes over 400% of the federal poverty level and increased the amount of financial assistance available to people with lower incomes for the next two years.
  • Health Insurance Marketplace: You can purchase Arkansas exchange plans on the Health Insurance Marketplace at HealthCare.gov.
  • Premium tax credit: You can purchase non-exchange plans through individual insurance agents, brokers, or companies, but you won’t get help with insurance costs if you sign up for coverage through the federal marketplace.
  • Coverage types: About 9% of Arkansas residents are uninsured, 42% are insured through an employer. About 26% have Medicaid coverage, nearly 16% have Medicare coverage, almost 1.5% have medical benefits through the military, and nearly 5.5% purchased health coverage directly from an insurance company.

How do I enroll in Arkansas Health Insurance Marketplace?

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:

  • You can enroll in-person with a local insurance agent/broker or assister
  • You can apply online using a certified enrollment partner’s website
  • You could call the Marketplace Call Center at 1-800-318-2596
  • You can apply through the mail using a paper application

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:

  • Date of birth
  • Social security number
  • Home and/or mailing address
  • Employer and income information
  • Details about other health insurance coverage

The following insurance providers were approved to do business in Arkansas in 2021:

  • Celtic Insurance Company (Ambetter)
  • HMO Partners, Inc. dba Health Advantage
  • QCA Health Plan, Inc.
  • QualChoice Life and Health Insurance Company, Inc.
  • USAble Mutual Insurance Company (AR Blue Cross & Blue Shield)

How do I enroll in Arkansas individual and family insurance?

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.

Insurance for individuals in Arkansas

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.

Insurance for families in Arkansas

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.

How much does health insurance cost in Arkansas?

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

  • Bronze plans have the lowest monthly premiums, but your deductible is generally higher than other levels. You also pay more out-of-pocket when you get care because you pay 60%, while the plan pays 40%. The average lowest cost of bronze plans has remained relatively the same over the last four years, at $322 in 2021.
  • Silver plans have higher monthly premiums than bronze plans but your deductible is lower. Out-of-pocket expenses are slightly lower with your coinsurance at 30%, while the plan pays 70%. You may also qualify for cost-sharing reductions with a silver plan. The average cost of a silver plan in 2021 is $387.
  • Gold and platinum plans have higher premiums but lower deductibles, and plans pay 80% to 90% when you get medical care. The most affordable gold plan in 2021 is $499.

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

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

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:

  • At least 65 years old
  • Pregnant
  • Responsible for a minor child
  • Have a disability

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

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 in Arkansas

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.

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

Arkansas has several Medicare options available to older adults and people with disabilities.

  • Original Medicare is the basic form of Medicare managed by the federal government. It consists of Part A (inpatient care), and Part B (preventive care and outpatient medical services). It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs. These plans are known as Medicare Part D.
  • Medicare Advantage Plans can be purchased through a health insurance provider approved by the federal government to offer MA plans. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as dental and vision.

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.

Eligibility

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).

Enrollment

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:

  • Initial enrollment: Your initial enrollment period runs the three months before your 65th birthday, your birth month, and the three months following your 65th birthday.
  • Medicare Advantage open enrollment: You can enroll in Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: If you miss your initial enrollment period, open enrollment occurs every year between October 15 and December 7.
  • Special enrollment periods: You may also qualify for a special enrollment period anytime if you’re covered under a group health plan and lose this coverage.

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.

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

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.

Arkansas Insurance FAQs

Does Arkansas require health insurance?

No, Arkansas does not require you to have health insurance.

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

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.

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

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.

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

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.

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

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.

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

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.

What does Arkansas Works cover?

Insurance provided through the Arkansas Works program covers:

  • Doctor visits
  • Emergency services
  • Hospital stays
  • Lab tests
  • Maternity care
  • Mental health care
  • Outpatient services
  • Prescription drugs
  • Preventive services
  • Substance abuse services

In addition, all ARWorks recipients are referred to the Arkansas Division of Workforce Services for free job assistance services.

What Does ARKids First cover?

ARKids First covers a wide range of services that include but aren’t limited to:

  • Chiropractic services
  • Community health centers
  • Dental care
  • Durable medical equipment
  • Doctor visits
  • Emergency ambulance service
  • Emergency room services
  • Hearing and vision care
  • Home health services
  • Hospice care
  • Hospital stays
  • Immunizations
  • Lab tests
  • Mental health services
  • Physical or occupational therapy
  • Podiatry services
  • Prescription drugs
  • Speech therapy
  • Well-child care
  • X-Rays

Some benefits have limits and some require a referral from your primary care provider.

Sources