Health insurance Arizona
Blake Insurance Group LLC offers Arizona health insurance plans. We represent Health insurance companies in Arizona that provide ACA-compliant individual & family health plans available on and off the Exchange
companies, including Oscar, Banner Health, and Aetna Health Plan Inc., BCBS, UnitedHealth, and Ambetter. To compare details of the health insurance plans available in your area
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Navigating the world of health insurance can be a complex task, especially when considering the unique aspects of each state’s system. In Arizona, various options exist, from government programs like Medicare and Medicaid to private insurance plans. This article aims to provide a comprehensive guide to understanding health insurance in Arizona. We’ll delve into the Affordable Care Act’s impact on the state, explore the specifics of Medicare and Medicaid, discuss short-term health insurance plans, and examine the cost of premiums.
We’ll also provide information on assistance for paying Medicare costs and detail the various health plans accessible to Arizona residents. Whether you’re an individual seeking coverage, an employer looking to provide for your employees, or simply interested in understanding the landscape of health insurance in Arizona, this guide is designed to help you navigate your options.
Understanding the Affordable Care Act (ACA) in Arizona
The Affordable Care Act (ACA), also known as Obamacare, has significantly impacted Arizona’s health insurance landscape. Enacted in 2010, the ACA aimed to increase healthcare accessibility, affordability, and quality. It introduced state-based Health Insurance Marketplaces, offering a range of insurance plans, often with subsidies to aid lower-income individuals and families.
In Arizona, the ACA has led to an expansion of Medicaid eligibility, providing coverage to more low-income adults and significantly reducing the uninsured rate in the state. The ACA also introduced vital consumer protections, such as coverage for pre-existing conditions and essential health benefits, and offered subsidies to make insurance premiums more affordable.
Arizona residents can apply for ACA health insurance plans during the annual Open Enrollment Period, which usually occurs from November 1 – December 15 each year. All ACA plans are required to cover 10 essential benefits, including emergency services, maternity care, and prescription drugs.
The ACA has allowed almost 400,000 people with low incomes in Arizona to gain health coverage, and it reduced the state’s uninsured rate by 33 percent between 2010 and 2019. Despite the elimination of the individual mandate in 2019, the ACA’s impact on healthcare in Arizona remains substantial, ensuring improved access to healthcare services and coverage options.
However, it’s important to note that the ACA has faced challenges in Arizona. For instance, there have been attempts to allow the sale of “junk” insurance plans, which deprive patients of key ACA protections, and legal challenges seeking to invalidate the ACA. Despite these challenges, the ACA continues to play a crucial role in providing health coverage for many Arizonans.
In terms of health insurance plans, Arizona residents have several options. These include Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, which are types of Medicare Advantage plans. HMOs and PPOs are both network-based plans. In an HMO, you typically must get your care and services from doctors, other health care providers, or hospitals in the plan’s network, except for emergency care, out-of-area urgent care, or out-of-area dialysis. In a PPO, you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Arizona health insurance market Place
Eight private insurance companies offer coverage through Arizona’s health insurance Marketplace. These companies provide a variety of plans, each with different benefits, premiums, and deductibles.
Arizona Complete Health (formerly Health Net of AZ)
Banner Health and Aetna Health Plan Inc.
Blue Cross Blue Shield of AZ
Cigna Healthcare of AZ
Imperial Insurance Companies, Inc.
Medica Community Health Plan
Oscar Health Plan, Inc.
UnitedHealthcare of Arizona, Inc.
The cost of health insurance varies significantly based on several factors, including the type of plan, the individual’s age, and whether they use tobacco. For example, the lowest monthly premiums for a SHOP health insurance plan in Arizona range from $225.76 for a 21-year-old enrollee to $612.70 for a 60-year-old enrollee.
It’s important to note that these are just estimates, and the actual cost of premiums can vary. Premium estimates show any savings you qualify for based on the basic information you entered. The actual Marketplace application asks for more details, and you’ll get exact prices after you fill it out.
In addition, some Americans may qualify for premium tax subsidies, which could reduce the cost of monthly premiums. Some may even qualify for $0 premium bronze and silver plans.
To get a more accurate estimate of the cost of health insurance in Arizona, you can use tools like the Health Insurance Marketplace Calculator or the Premium Tax Credit Estimator. These tools can provide you with a more personalized estimate based on your specific circumstances.
In addition to these, there are several major insurance carriers offering healthcare plans in Arizona, each offering a range of plans with different benefits, premiums, and deductibles. It’s important to research and compare plans from different carriers to find the best fit for your needs. The Arizona Department of Insurance offers a variety of resources, including a health insurance marketplace and consumer guides to help individuals and families navigate their options.
Arizona ACA Health Insurance Plans
The Affordable Care Act (ACA), or Obamacare, requires all non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB). These include ten categories of services: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health, and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services, and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care.
In Arizona, all ACA plans are required to cover these ten essential benefits, which include emergency services, maternity care, and prescription drugs.
Eligibility for premium tax subsidies is based on household income and other factors. To be eligible for the premium tax credit, your household income must be at least 100 percent and, for years other than 2021 and 2022, no more than 400 percent of the federal poverty line for your family size. Subsidy eligibility is also based on the cost of the benchmark plan relative to the person’s income. A subsidy is generally available if it’s more than 8.5% of the person’s income.
Some Americans may qualify for $0 premium bronze and silver plans. Those with incomes between 100% and 150% of the federal poverty level (FPL) may qualify for a zero-dollar premium silver plan (after tax credits). They may also qualify for a zero-dollar premium bronze plan (after tax credits). However, it’s important to note that while these plans may have $0 premiums, cost-sharing (deductibles and coinsurance) may be higher.
Medicare in Arizona: Medigap and Medicare Advantage
Medicare in Arizona offers beneficiaries a choice between Original Medicare with the addition of Medigap (Medicare Supplement Insurance) or Medicare Advantage plans, often including additional benefits such as prescription drugs, dental, and vision care.
Medigap in Arizona
Medigap plans are supplemental policies that work alongside Original Medicare (Parts A and B) to cover copayments, coinsurance, and deductibles. These plans are standardized by Medicare but are sold and administered by private insurance companies. In Arizona, Medigap plans are available to those enrolled in Medicare Part A and B, and the most popular and comprehensive plans are F and G. However, Plan F is unavailable to new Medicare enrollees after December 31, 2019. Medigap plans in Arizona can range from approximately $75 to $471 per month, depending on the specific plan, the enrollee’s age, and the insurance provider.
Medicare Advantage in Arizona
Medicare Advantage (Part C) plans are an alternative to Original Medicare and are offered by private insurance companies approved by Medicare. These plans must cover all the services that Original Medicare covers but can also provide additional benefits, including prescription drug coverage, dental care, and vision care.
In Arizona, a variety of Medicare Advantage plans are available, with 155 plans offered in 2024. The average monthly premium for a Medicare Advantage plan in Arizona in 2024 is $12.14. These plans can vary significantly in coverage and cost, so beneficiaries must compare options to find the best option.
Medicare Advantage plans can include coverage for dental and vision health items; most also have prescription drug coverage. However, the specifics of what is covered and any associated costs will depend on the beneficiary’s chosen individual plan.
Help with Paying Medicare Costs
Medicare beneficiaries with limited income and resources may qualify for programs that help pay Medicare premiums, deductibles, co-payments, and co-insurance. These programs are often referred to as Medicare Savings Programs (MSPs) and are administered by state Medicaid offices.
Qualifications for Assistance
Applicants must meet certain income and resource limits to qualify for these programs. The specific limits can vary by state and by the type of MSP. For example, the Qualified Medicare Beneficiary (QMB) program helps pay for Part A and B premiums, deductibles, coinsurance, and co-payments. The income limits for this program are typically set at a percentage of the Federal Poverty Level (FPL) and are adjusted annually.
Income Limits for Applicants
In Arizona, the income limits for individuals to have their Medicare Part A & B premiums, co-payments, and deductibles paid are as follows:
– For an individual applicant: a gross monthly income limit of $1,215
– For an applicant with a spouse: a gross monthly income limit of $1,644
If an individual’s income exceeds these limits, they may still qualify to have just their Medicare Part B premium paid if their income is below:
– For an individual applicant: a gross monthly income limit of $1,641
– For an applicant with a spouse: a gross monthly income limit of $2,219
Deductions for Work Expenses
For those who are working, the Arizona Health Care Cost Containment System (AHCCCS) may subtract an amount for work expenses from their income when determining eligibility for MSPs. The standard work expense deduction is $65.00, which is deducted from earned income after previous deductions
Applying for Assistance
To apply for help with Medicare costs, individuals should contact their State Medical Assistance (Medicaid) office. It’s important to apply even if the individual’s income or resources are slightly higher than the listed amounts, as some states have more generous eligibility criteria or do not count certain types of income or resources.
In Arizona, residents can access various health plans, including the AHCCCS Complete Care Health Plan, Mercy Care, and Care 1st.
AHCCCS Complete Care Health Plan
The Arizona Health Care Cost Containment System (AHCCCS) Complete Care Health Plan is an integrated health plan for most AHCCCS members. This plan includes physical and behavioral healthcare service providers, aiming to provide comprehensive managed care for the whole person. The benefits of this integration include a single plan, payer, and provider network, making it easier for members to navigate.
Mercy Care
Mercy Care is a not-for-profit health plan serving AHCCCS members throughout Arizona. It provides coverage for people who qualify for AHCCCS and offers services and support through five Medicaid or Medicaid/Medicare plans. These plans include coverage for general mental health and substance use concerns, long-term care and services for developmental or cognitive disabilities, and physical and behavioral health care coverage for children and youth in foster care.
Care 1st
Care 1st Health Plan Arizona is part of the Arizona Complete Health family of health plans. It serves families in Apache, Coconino, Mohave, Navajo, and Yavapai Counties. Care 1st is one of two Medicaid plans under the Arizona Complete Health family, with Care 1st serving northern Arizona and Arizona Complete Health-Complete Care plan serving central and southern Arizona.
Enrollment in Health Plans
AHCCCS members may enroll in any health plan that serves their county. This allows members to choose a plan that best fits their needs and ensures access to healthcare services within their local area.
Arizona’s State Health Insurance Assistance Program (SHIP) is a free health benefits counseling service for Medicare beneficiaries. Its mission is to empower, educate, and assist Medicare-eligible individuals, their families, and caregivers through objective outreach, counseling, and training to help individuals make informed health insurance decisions that optimize access to care. SHIP provides unbiased help to Medicare beneficiaries, their families, and caregivers, offering information on Medicare, AHCCCS, Medigap, Medicare Fraud, Error and Abuse, and Part D-Prescription Drug Plan.
Shop Health Insurance Premiums in Arizona
In Arizona, the Small Business Health Options Program (SHOP) offers health insurance plans for small businesses with 1 to 50 full-time equivalent employees. Arizona’s lowest monthly SHOP health insurance premiums vary by age group. For example, the lowest premiums for a 21-year-old enrollee start at $225.76, while for a 60-year-old enrollee, they start at $612.70.
Employers can choose to share the cost of these premiums with their employees. This can be done by the employer paying a portion of the premium and the employee covering the rest. The employer’s contribution amount is at their discretion, but certain conditions must be met to qualify for the Small Business Health Care Tax Credit.
To be eligible for this tax credit, which can cover up to 50% of the employer’s contribution to premiums, the business must have fewer than 25 full-time equivalent employees with average annual wages of less than $50,000 (adjusted annually for inflation). Additionally, the employer must pay at least 50% of the full-time employees’ premium costs, and the insurance must be purchased through the SHOP Marketplace.
It’s important for employers to consider the benefits of offering health insurance, such as attracting and retaining employees, and the potential tax advantages. Employers interested in providing SHOP plans can get a custom premium quote by answering a few questions to see available plans with premium estimates based on their specific situation.
Short-term Health Insurance Plans in Arizona
Short-term health insurance plans in Arizona are designed to provide temporary coverage and can be a suitable option for individuals who are in transition or between standard health insurance policies. These plans are available for initial durations of up to 364 days and can be renewed for a total duration of up to 36 months.
Availability and Duration
As of the latest information, at least seven insurers offer short-term health insurance plans in Arizona. These plans can be purchased month-to-month, allowing for flexibility in coverage duration. Individuals can enroll in a plan for just a few months if they only need coverage until they are enrolled in Medicare, an employer’s plan, or another form of long-term insurance.
When to Consider Short-term Health Insurance
Short-term health insurance may be beneficial in several scenarios:
– If you are between jobs and need temporary coverage until you can access an employer’s health plan.
– When waiting for other coverage, such as Medicare or a new employer’s health plan.
– If you missed the open enrollment period for ACA plans and need coverage to protect against unexpected medical expenses.
– For young adults no longer eligible for coverage under a parent’s plan.
– If you are seeking an affordable solution to more traditional health insurance for a limited time.
Coverage and Limitations
Short-term health insurance plans typically cover preventive care, doctor visits, urgent care, and emergency care. Some plans may also offer prescription coverage and cost savings for using in-network providers. However, these plans often do not cover pre-existing conditions, maternity care, or mental health services, and they are not required to cover the essential health benefits mandated by the ACA.
It’s essential to read the plan details carefully, as short-term health insurance differs from typical ACA-compliant coverage. The affordability of short-term plans is a major appeal, as they are often less expensive than traditional health insurance plans, especially for those who do not qualify for ACA subsidies.
Supplementary Health Insurance Plans in Arizona
In Arizona, supplementary health insurance plans provide additional coverage options beyond traditional health insurance. These plans can offer services like telemedicine, discounts on medical procedures, and preventive care. Two examples of such plans are offered by Ally Health and Safeguard Health Plans.
Ally Health Plans
Ally Health offers telemedicine-based health services, which can benefit individuals seeking convenient and affordable healthcare options. The Ally Health Basic Plan includes:
– 24/7 phone or video access to doctors, coaches, and therapists.
– Unlimited doctor and pediatrician consultations.
– Virtual consultations with specialists and second opinions.
– Health and wellness coaching.
– Tools and services for saving on prescriptions, lab tests, medical imaging, and surgical procedures.
One of the key advantages of Ally Health’s services is the absence of co-pays, deductibles, or per-call charges, making it a cost-effective option for those who may struggle with the costs associated with traditional healthcare services.
SGH SecureHealth Insurance Plans
Safeguard Health Plans offers SGH SecureHealth insurance plans designed to be affordable and flexible. Critical features of SGH SecureHealth Plans include:
– Coverage for preventive care services such as annual check-ups, immunizations, and cancer screenings at no additional cost.
– Access to the PHCS PPO Network.
– A variety of plan options to suit different needs and budgets, from SecureHealth Value for budget-conscious individuals to SecureHealth Elite for more comprehensive coverage.
SGH SecureHealth Plans are recommended for comprehensive and affordable health insurance coverage, providing various benefits to help manage healthcare costs effectively.
Enrollment and Considerations
When considering supplementary health insurance plans like those offered by Ally Health and Safeguard Health Plans, it’s important to evaluate how they complement existing health insurance coverage. These plans can be particularly useful for individuals who need additional services not covered by their primary health insurance or those seeking more budget-friendly options for non-emergency healthcare services.
Prospective enrollees should review the details of each plan, understand the coverage limits, and consider how the plan fits into their overall healthcare strategy. It’s also advisable to compare these supplementary plans with other available options in the Arizona market to ensure the best fit for individual healthcare needs and financial situations.