Types of Health Insurance Plans Available

Marketplace plans are divided into four “metal” tiers, each with different cost-sharing arrangements:

Catastrophic Plans: Available to those under 30 or with a hardship exemption. These plans have low premiums and high deductibles, covering essential benefits after the deductible is met. They are best suited for healthy individuals who want protection against worst-case scenarios.

Plan Types: HMO vs PPO vs EPO

• HMO (Health Maintenance Organization): Lower premiums, limited network, requires referrals for specialists.

• PPO (Preferred Provider Organization): Higher premiums, broader network, no referrals needed for specialists.

• EPO (Exclusive Provider Organization): Larger network than HMO, but no out-of-network coverage except emergencies, usually lower premiums than PPO.

Eligibility for Subsidies and Cost Assistance

Premium Tax Credits: Available to households with incomes between 100% and 400% of the federal poverty level, though recent federal changes have temporarily removed the upper limit for some years. Most Arizona Marketplace enrollees receive premium subsidies.

Cost-Sharing Reductions (CSR): For those with incomes up to 250% of the federal poverty level who select a Silver plan, CSRs lower out-of-pocket costs like deductibles and copays.

Medicaid (AHCCCS) and CHIP (KidsCare): Arizona expanded Medicaid to adults with incomes up to 138% of the federal poverty level. Children and pregnant women have higher income limits, and KidsCare covers children up to 205% of the federal poverty level.

How to Compare and Choose a Plan in Arizona

When comparing plans, consider:

• Premiums: Monthly cost regardless of care usage

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Ensure your preferred doctors/hospitals are in-network

• Drug Formularies: Check if your medications are covered and at what cost

Tips:

• Self-employed: Deduct premiums on taxes; check for HSA-eligible plans

• Families: Consider pediatric dental/vision and family out-of-pocket limits

• Retirees: Marketplace coverage bridges the gap until Medicare at 65

Top Insurance Providers on the Arizona Exchange

For 2025, eight insurers offer Marketplace coverage in Arizona, though availability varies by county:

• Blue Cross Blue Shield of Arizona (statewide, only statewide PPO)

• Ambetter (best overall HMO option)

• Oscar (best for low premiums)

• Cigna

• Aetna CVS Health/Banner Health

• UnitedHealthcare

• Arizona Complete Health (Health Net)

• Antidote Health Plan (new for 2025)

Some regional providers, like Banner – University Health Plans, serve specific counties and populations.

Navigating Arizona’s Online Enrollment Portal

How to Apply:

Visit HealthCare.gov to create an account and start your application.

Enter household and income information to see eligibility for subsidies.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Use HealthCare.gov’s “Find Local Help” tool for free, in-person assistance from Navigators or certified application counselors.

• Local brokers and community health centers also offer assistance.

Alternatives to the Marketplace

• Short-term health plans: Temporary coverage for gaps, but not ACA-compliant and may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available.

• Faith-based health-sharing ministries: May be available but are not insurance and lack ACA protections (availability varies by state).

Common Mistakes to Avoid During Enrollment

• Failing to update income, which can affect subsidy eligibility and lead to tax repayment.

• Missing enrollment deadlines, resulting in loss of coverage or waiting until the next Open Enrollment.

• Choosing the wrong metal tier for your needs (for example, picking Bronze for low premiums, but facing high out-of-pocket costs if you need care).

State-Specific Health Programs or Initiatives

• Medicaid Expansion: Arizona expanded Medicaid to adults earning up to 138% of the federal poverty level.

• KidsCare (CHIP): Covers children up to 205% of the federal poverty level.

• Local Navigator Programs: Arizona Association of Community Health Centers provides Navigator services for enrollment help.

• Premium Subsidies: Enhanced by federal laws, resulting in lower average premiums for most enrollees.

For more details, visit HealthCare.gov or contact local health insurance Navigators for free assistance. Arizona’s Department of Insurance and the Arizona Health Care Cost Containment System (AHCCCS) are also valuable resources for state-specific questions and Medicaid eligibility.