The Affordable Care Act (ACA) and Medicaid expansion have lowered the number of uninsured in Arkansas, bringing it closer to the national average. Residents have access to health care through the various available forms of insurance.
The 2.9 million residents of Arkansas receive health insurance through employers, the private individual market, or programs such as Medicaid, Children’s Health Insurance Program (CHIP), Medicare, or ACA (Obamacare).1
The sources of health insurance coverage in the state are:2
- Employer 42%
- Nongroup 6% (individuals and families who bought or are covered as a dependent by nongroup insurance)
- Medicaid 27%
- Medicare 16%
- Military 1%
- Uninsured 8%
In 2018, the average annual premium for employer-sponsored coverage for families was $17,995, and the deductible was $3,144.3
During 2019, only about 2% of the state’s residents enrolled in a plan from the Health Insurance Marketplace. Compliant plans include such essential health benefits as inpatient hospital care, prescription drug coverage, and free preventive care.4
Medicaid is an essential source of insurance for its residents. Arkansas accepts federal money for Medicaid expansion provided through the ACA but uses it to buy private insurance for many of its eligible low-income residents.5 In 2017, 326,900 adults (11%) were enrolled in the Medicaid expansion in Arkansas.6
Read below for an overview of the Arkansas health insurance landscape and available coverage options.
Obamacare’s Impact in Arkansas
Under Obamacare, residents of Arkansas can buy nongroup coverage and possibly qualify for premium tax credit assistance through its Health Insurance Marketplace. About 89% of its enrollees received an Advanced Premium Tax Credit (APTC) to help pay their premium, just slightly more than the national average of 87%.7
About Arkansas’s Health Insurance Marketplace
The ACA’s open enrollment for its Health Insurance Marketplace runs from November 1 to December 15 each year for coverage that starts the following January 1. You need to re-enroll during each year’s open enrollment to avoid a break in coverage.
If you miss the Open Enrollment Period, you will not be able to apply until the next open enrollment unless you experience a qualifying life event (QLE). Any event that leaves you uninsured or changes the size of your family (such as loss of job or health insurance, changes in residence or household size, or a marriage, birth or adoption of a child) triggers a Special Enrollment Period. Such an event opens a short window for you to obtain your insurance.8
Today Arkansas has a state-based Marketplace-Federal Platform. In 2019, the Arkansas Insurance Department created a division called the Arkansas Health Insurance Marketplace (AHIM). This division manages and implements the state-based health insurance exchange following state and federal law.9 However, the state relies on the federal website Healthcare.gov for eligibility and enrollment functions.10
You can buy ACA-compliant coverage through the exchanges or certified agents and brokers. For families and individuals, Obamacare may be the best low-cost health insurance due to the available subsidies that lower premiums. If you are self-employed with no employees, you can access the same health insurance options as families and individuals.
Individual Health Insurance Companies in Arkansas
According to the Arkansas Insurance Department, four health insurance companies offer on-Marketplace Individual Qualified Health Plans through the Arkansas exchange:
- Arkansas Blue Cross & Blue Shield
- Ambetter from AR Health & Wellness
- QualChoice Life and Health
- QCA Health Plan
The initial rate requests for individual on-marketplace qualified health plans (QHPs) for Plan Year 2020 are
For Plan Year 2020, those companies were granted rate increases ranging from 0.51% to 2.89%, for a combined average increase of only 2.08%.13
Arkansas Health Insurance Premiums
Qualified plans available on and off the Marketplace are organized by levels of cost-sharing, referred to as metal tiers.
Arkansas health insurance premiums for qualified plans have increased moderately over the past three open enrollment seasons (2018-2020). Following is the average monthly cost for a 40 year old for bronze, silver, and gold plans sold through the Arkansas Marketplace.14
|Average Premiums for Arkansas Marketplace Plans||2018 Plan Year||2019 Plan Year||2020 Plan Year|
|Average Lowest Cost Bronze Premium||$296||$320||$320|
|Average Lowest Cost Silver Premium||$340||$361||$358|
|Average Lowest Cost Gold Premium||$409||$461||$461|
The “benchmark” silver plan is used to calculate subsidies. It represents the second-lowest-cost silver premium for a 40 year old.15 This benchmark has stayed relatively stable in Arkansas over the past three open enrollment periods.
|Average Benchmark Premiums for Arkansas Marketplace Plans||2018 Plan Year||2019 Plan Year||2020 Plan Year|
|Average “Benchmark” Silver Plan (second-lowest silver premium)||$364||$378||$365|
Arkansas Marketplace Subsidies
If you earn between 100% and 400% of the Federal Poverty Level (FPL), you are eligible for a subsidy to help you pay for any metal plan. To qualify in 2020, a family of three would have to earn between $21,720 and $86,880. Subsidies are only available for plans purchased through the Marketplace.16
In 2019, 89% of people enrolled in the Arkansas Marketplace plans received subsidies known as Advanced Premium Tax Credits (APTC). This figure was up slightly from 2017.17
The average monthly APTC received in 2019 was $396. That is considerably lower than the U.S. average of $514.18
Here are some examples of cost savings with subsidies
A 28 year old in Little Rock, Ark., who earns $24,000 a year could get a 2020 silver plan for $122 per month after subsidies.19 The same policy would cost $311 per month without the premium tax credits that cover 61% of the cost.
A family of three in Jonesboro, Ark., with an income of $50,000 a year could pay $322 a month after subsidies for a 2020 silver plan.20 This policy would cost $815 per month without the premium tax credits that cover 61% of the cost.
If you earn up to 250% of FPL and receive premium tax credits, you may also qualify for Cost-Sharing Reductions (CSRs), which lower your out-of-pocket costs. You must be enrolled in a silver plan in the Marketplace to qualify.21
In 2019, 60% of enrollees in Arkansas Marketplace plans received the CSR subsidies.22
Low-Cost and Free Coverage Through Medicaid and CHIP
Forty percent of Arkansas residents earn less than twice the federal poverty level. That group represents over 1,168,000 people.23 Of the adults aged 19-64, 25% are insured by employers, 7% by individual insurance, 41% by Medicaid, 8% by other public programs, and 19% are uninsured.24
In November 2019, 761,000 people were enrolled in Medicaid and 91,000 in CHIP in Arkansas.25 They represent nearly one-third of the population.
Income eligibility for Medicaid and CHIP varies for different groups and is stated as a maximum percentage of the FPL. (For reference, the FPL for a family of three in 2020 is $21,720.) Those percentages are:26
- Parents: 138%
- Pregnant women: 214%
- Children: 216%
- Seniors or Disabled: 80%
Arkansas’s combined Medicaid/CHIP enrollment rose by 53%, compared with that in late 2013 when Obamacare was introduced. National enrollment increased by 24% in the same period.27
In 2014, Arkansas implemented the Medicaid expansion under the ACA to cover nearly all nonelderly adults earning under 138% of poverty. In 2019, 326,900 adults were enrolled in the Medicaid expansion group.28
Children under age 19, a parent or other caretaker relative of children under age 18, and pregnant women may qualify for low- or no-cost Medicaid coverage, depending on income.
If you are between ages 21 and 64 with a physical disability, or over age 65 with specific needs, you may be eligible for ARChoices. It is a Medicaid program that includes home and community-based services that help with everyday activities.29
If you are pregnant, support is available for you and your baby. The number of births financed by Medicaid in Arkansas is high: 68% in 2018.30
Pregnant women earning up to twice the federal poverty level and who meet other criteria may be eligible for limited coverage, including prenatal, delivery, postpartum, and conditions that may complicate the pregnancy. Coverage runs through the pregnancy and to the end of the month that includes the 60th day of postpartum.31
CHIP (Known as ARKids First)
Low-income children younger than 19 have access to health insurance through ARKids First. More than 70,000 children across the state receive well-child checkups, eye exams, dental checkups, and more.32
ARKids First has two plans, neither of which charges premiums or deductibles. The program’s ARKids A plan offers coverage through Medicaid. It charges no copayments for children under 18, and nominal copays for those who are age 18. The annual income limit is $36,568 for a family of four.
ARKids B plan covers children without employer-sponsored or group health insurance and who have not had insurance for at least 90 days. There is usually a $10-per-visit copay, with an annual out-of-pocket limit of 5% of the family’ s gross income before taxes. The annual income limit for a family of four is $54,337.33
If you’re not sure whether your child is eligible for either plan, call (888) 474-8275 for help.34
Arkansas Medicare Plans for Seniors and Disabled Individuals
If you are over age 65, are younger with long-term disabilities, or have end-stage renal disease, Medicare is a federal program that helps you cover health costs. Over one in five of Arkansas’s population receives Medicare benefits. The Medicare Open Enrollment Period runs from October 15 through December 7 each year.
In 2017, nearly a quarter of Medicare beneficiaries were also enrolled in Medicaid. That year, one-quarter of those on Medicare with Part D prescription drug coverage received low-income premium and cost-sharing subsidies.35
Of the 646,100 Medicare beneficiaries in Arkansas, 22.2% choose to get their benefits through the private Medicare Advantage plans instead of the federal government’s Original Medicare program.36 In both plans, enrollees receive Part A hospital and Part B medical insurance that include emergency room care and doctor’s visits.
Medicare Advantage (or Part C) offers extra benefits, such as Part D prescription coverage. Under Original Medicare, you would have to purchase a separate Medicare Part D drug plan from a private insurer. Ten companies provide Medicare Advantage plans in Arkansas:37
If you have Original Medicare, private Medicare Supplement insurance (Medigap) can be added to your benefits to pay the portion Medicare does not pay. The 10 available Medigap plans are standardized. The benefits remain the same for all plans, but the premiums may vary by company.
Arkansas is one of the few states that uses the advantageous ‘no age rating’ method to calculate Medigap premiums. Insurers cannot increase premiums for enrollees over age 65 because of age.40
The Arkansas Insurance Department requires Medigap insurers to offer at least one plan to enrollees under age 65 (eligible due to a disability or end-stage renal disease). Still, it does not provide the same premium protections as for over-65 beneficiaries.41
The Senior Health Insurance Information Program (SHIIP) helps Arkansans save money and make informed decisions about Medicare. Topics include Medicare, Medigap policies, Medicare Advantage, Medicare Part D (drug plans), and long-term care insurance. SHIIP offers phone and in-person appointments at (800) 224-6330 or (501) 371-2782.
If you are a Medicare beneficiary having difficulty paying Medicare premiums, deductibles, or coinsurance, Arkansas participates in four Medicare Savings Programs: ARSeniors, Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI).42
Buying Short-Term Health Insurance in Arkansas
Short-term health insurance can be useful in filling temporary insurance gaps. These could be periods between jobs, aging off your parent’s health insurance when you turn 26, or after missing the Obamacare enrollment window.
Limited-duration plans do not offer the same comprehensive health coverage as ACA-qualified plans. Policies can exclude covering preventive care or pre-existing conditions.
Arkansas has some state-mandated medical benefits for short-term plans such as children’s preventive healthcare, autism spectrum disorders, diabetic supplies, alcohol and drug dependency treatment, mammograms, and colorectal and prostate cancer screenings.44
Be sure to read the fine print and understand what coverage is guaranteed by any policy you consider.