Arizona Health Insurance and You
What could be more amazing than Arizona’s Grand Canyon is having access to affordable health insurance. Many Arizona residents qualify for financial assistance to get private medical insurance under Obamacare. You could even get free or low-cost health insurance in Arizona through public programs like Medicaid.
To help you better understand the Arizona health insurance market and your coverage options, you can navigate to the sections below to learn more.
The Affordable Care Act’s Impact in Arizona
Like most states, Arizona experienced a rise in the number of insured residents with the passing of the Affordable Care Act (ACA) also called Obamacare. Back in 2013 when the first open enrollment in the Health Insurance Marketplace began, Arizona had 1.1 million uninsured residents. By 2016, that number dropped to 681,000–resulting in a 39.1 percent decrease in Arizona’s uninsured population.1
Arizona’s uninsured population is now at 11 percent (as of 2018), which is slightly higher than the U.S. average of 9 percent.2
Another way the ACA has helped Arizona residents is through Medicaid expansion. In 2014, Arizona accepted federal funding to expand its Medicaid program to people with incomes up to 138 percent of the federal poverty level (FPL). Because of the expansion, 432,100 more adults have access to low-cost or free health insurance through the state’s Medicaid program known as the Arizona Health Care Cost Containment System (AHCCCS).3
Enrollment in the Arizona Health Insurance Marketplace
Arizona uses the federally-run Marketplace at Healthcare.gov for open enrollment, which takes place each year from November 1 to December 15. This enrollment period is for private individual and family health insurance plans regulated by the Affordable Care Act (ACA). You also have access to these plans if you’re a self-employed entrepreneur with no employees.
Arizona’s Marketplace enrollment has declined every year since 2015 when sign-ups peaked at nearly 206,000. For the 2019 coverage year, a little over 160,000 residents enrolled in Arizona Health Insurance Marketplace plans—slightly less than the previous year when almost 166,000 people enrolled.4
Besides enrollment through the public exchange at Healthcare.gov, you can get ACA-qualified coverage in the private Marketplace. This includes buying health insurance directly from a private insurer or connecting with a licensed insurance agent.
Arizona Companies Offering Individual and Family Plans
As of October 2019, there are five Arizona health insurance companies that offer individual and family plans both in and outside of the federal Marketplace:
- Arizona Complete Health: Available in Gina, Graham, Greenlee, Maricopa, Pinal, Pima, and Santa Cruz counties.
- Blue Cross Blue Shield of Arizona: Available statewide
- Bright Health Company of Arizona: Maricopa and Pima counties
- Cigna Healthcare of Arizona: Maricopa County only
- Oscar Health Plan: Maricopa County only
For 2020, these Arizona insurance carriers offer bronze, silver, gold, and catastrophic health insurance plans.
Arizona residents in several counties will have access to more plan options for 2020. For instance, Arizona Complete Health only offered plans in Maricopa and Pima counties for the 2019 plan year. But it has expanded coverage to five more counties (see counties above) for 2020. Blue Cross Blue Shield of Arizona, which offers 2020 plans across all 15 Arizona counties, is returning to the Maricopa county Marketplace since dropping out in 2016.5
Arizona Health Insurance Costs
Overall, Arizona residents aren’t likely to experience any increase in costs for 2020 individual and family plans compared to the previous year.5
The average monthly premium in Arizona for a 2020 Marketplace silver plan is $442, down from $471 for 2019. You could pay much less if you qualify for government subsidies.
For example, a 30-year-old in Mesa, AZ earning $30,000 a year could pay $199 after subsidies ($355 before subsidies) for an Obamacare silver plan.6
Obamacare Subsidies for Low-Income Residents in Arizona
If your income is low, you could get affordable private health insurance in Arizona with the help of Obamacare subsidies from the federal government. This includes premium tax credits to reduce your monthly premium on any metal plan. You may also qualify for cost-sharing reductions to lower your out-of-pocket expenses on silver plans.
You qualify for premium tax credits if you enroll in a Marketplace plan and your income is between 100 to 400 percent of the federal poverty level. This amounts to $12,140 to $48,560 a year for an individual. You can view our Obamacare subsidy chart to see income limits for larger households.
For 2019, 84 percent of Arizona Marketplace enrollees received subsidies while 48 percent received cost-sharing reductions.7 The average subsidy amount equaled $496, reducing monthly premiums to an average of $112 per month.
Arizona Public Health Insurance for Low-Income Adults and Children (Medicaid & CHIP)
Low-income households earning less than 200 percent of the federal poverty level ($24,984 or less per year) make up just a third of Arizona’s population3. This is the typical income level required to qualify for public health insurance through Arizona’s Medicaid and Children’s Health Insurance Program (CHIP).8
About 22 percent of Arizona’s population is covered through Medicaid and CHIP.3 The state and the federal government jointly fund these programs.
Among Arizona residents, ages 19 to 64, one in five get benefits through Medicaid. For children, two in five have Medicaid coverage.3 The state’s Medicaid program is called the Arizona Health Care Cost Containment System (AHCCCS). Depending on your income, you may qualify for free or low-cost coverage through AHCCCS.
Below is a list of who qualifies for Arizona health insurance through AHCCCS:
- Childless adults
- Caretaker relatives of children
- Pregnant women
- Women seeking screening for breast and cervical cancer
- Adults over 65
- People with developmental or physical disabilities
- Individuals who need nursing home care
- Certain individuals enrolled in Medicare
Arizona KidsCare Children’s Health Insurance Program (CHIP)
If you have uninsured children (18 and younger) in your household who don’t qualify for Medicaid, they could receive low-cost health insurance through Arizona’s KidsCare program.
Income and household size determine eligibility. If you have a family of four, for example, you must earn no more than $51,504. If approved, you’ll pay up to $50 a month for one child or up to $70 per month regardless of the number of children.
Arizona Medicare Coverage for Elderly and Disabled Individuals
Nearly 1.3 million Arizonans are enrolled in Medicare as of 2018.9 Among those Medicare beneficiaries, 87 percent qualify based on age (65 or older). The other 13 percent qualify because of a disability, who are generally under 65.10
Arizonans have several options for Medicare benefits. The default option is Original Medicare, which includes Part A hospital and Part B medical insurance. Original Medicare is managed directly by the federal government and some people are enrolled automatically.
Almost 783,000 residents get coverage through the Original Medicare program.9 Many Original Medicare enrollees also add on separate plans sold by private insurance companies. For example, about 455,000 Arizona residents enrolled in a standalone Medicare Part D Prescription Drug Plan in 2018.11 Another option is Medicare Supplement (also called Medigap), which helps pay some or all of Original Medicare’s out-of-pocket medical costs.
An alternative to Original Medicare is private health insurance through Medicare Advantage, which also includes Part A and Part B. Medicare Advantage also offers extra benefits beyond Original Medicare such as prescription drugs, routine dental and vision coverage. Currently, about 486,000 Arizonans are enrolled in Medicare Advantage.9
Arizona Short-Term Health Insurance
For the 743,500 uninsured Arizona residents, a short-term health plan can be a cheap way to get basic health insurance to fill a temporary need.12 In Arizona, this type of coverage is called “short-term limited duration (STLD) health insurance”. Through Senate Bill 1109, the Arizona Legislature made it legal to get STLD health insurance up to 364 days with the option to renew coverage for up to 36 months.
You should take note that short-term health insurance plans are not compatible with the Affordable Care Act (ACA). So they don’t count as a qualified, major medical coverage that must offer all 10 essential health benefits. You can also be denied a short-term insurance policy based on your health status or a pre-existing condition.
However, there are many situations when enrolling in Arizona short-term health insurance can be beneficial, such as when:
- You don’t have health insurance or can’t afford major medical coverage
- You’re in between jobs
- You’re waiting for coverage to become effective at a new job
- You’ve aged out of your parent’s health plan because you turned 26
- You missed the open enrollment period (OEP) to get ACA health insurance
- You don’t qualify for a Special Enrollment Period to buy an ACA plan at any time throughout the year