The Affordable Care Act (ACA), commonly known as Obamacare, has brought significant changes to the healthcare landscape in the Grand Canyon State. In this guide, we will provide you with a thorough overview of Obamacare in Arizona, including its history, how it works, and the healthcare options available to residents. Whether you’re a long-time resident or new to Arizona, understanding your healthcare choices under the ACA is essential. Let’s dive in and explore the world of healthcare in Arizona.

Overview of Obamacare (Affordable Care Act)

The Affordable Care Act (ACA), commonly known as Obamacare, is a pivotal piece of healthcare legislation enacted in the United States in 2010. This landmark law aimed to enhance healthcare accessibility and affordability for millions of Americans. It established state-based Health Insurance Marketplaces, offering a range of insurance plans, often with subsidies to aid lower-income individuals and families. The ACA expanded Medicaid eligibility in some states, providing coverage to more low-income adults, introduced vital consumer protections, such as coverage for pre-existing conditions and essential health benefits, and offered subsidies to make insurance premiums more affordable. Although the individual mandate was eliminated in 2019, the ACA’s impact on healthcare in Arizona and the nation remains substantial, ensuring improved access to healthcare services and coverage options. For more information, view all of our ACA articles.

Healthcare Marketplace in Arizona

The healthcare landscape in Arizona is characterized by a diverse mix of healthcare providers and insurers. The state operates its Health Insurance Marketplace, known as the Arizona Health Insurance Exchange, where individuals and families can explore and purchase health insurance plans that comply with the Affordable Care Act (ACA). Arizona has seen an expansion of Medicaid eligibility, providing coverage to more low-income adults. This expansion has significantly reduced the uninsured rate in the state. Multiple insurance carriers participate in Arizona’s Marketplace, offering a variety of plans to cater to different healthcare needs and budgets. Additionally, subsidies and tax credits are available to eligible individuals to help make insurance premiums more affordable. Overall, Arizona’s healthcare market continues to evolve under the ACA, striving to provide accessible and comprehensive coverage options for its residents.

Finding Affordable Health Insurance in Arizona

1. Assess your personal needs: Think about whether or not you need Rx coverage? Do you have a doctor you like? Reflect on the medical care you – and your family – have needed in the past and what services you may want to plan for the upcoming coverage year.
2. Research available options in your Arizona: Start at eHealth.com to compare Obamacare plans, short-term plans and other alternatives.
3. Understand which options you can qualify for: You can enroll in any Obamacare plan during open enrollment – or outside of open enrollment if you qualify for a special enrollment period. For short-term health insurance and other medical insurance alternatives, you can apply any time, but you typically need to answer medical questions and may be declined.
4. See if you qualify for discounts: ACA plans may be available to you with a tax credit, which can save you hundreds and sometimes thousands of dollars on monthly premiums.
5. Make sure your prescriptions are covered: eHealth.com provides a prescription drug coverage comparison tool that helps you find the plan that covers your drugs with the lowest out-of-pocket cost.
6. Make sure your doctor is covered: eHealth has a physician finder tool that lets you compare plans using your preferred doctor.
7. Enroll online: eHealth makes it easy to complete your health insurance application online during Open Enrollment in Arizona, even if you qualify for a tax credit.

If you’re looking to purchase health insurance during the Open Enrollment Period in Arizona, you’re probably wondering how much health insurance plans cost in your area.

According to the Kaiser Family Foundation, these are the average marketplace premiums by “metal” tier in 2024:

Location	Average Lowest-Cost Bronze Premium	Average Lowest-Cost Silver Premium	Average Benchmark Premium	Average Lowest-Cost Gold Premium
United States	$364	$468	$477	$488
Arizona	$373	$403	$403	$475

Medicaid in Arizona

Medicaid is a state and federally funded program designed to provide healthcare coverage to eligible low-income individuals and families. In Arizona, the Medicaid program goes by the name Arizona Health Care Cost Containment System (AHCCCS).

Eligibility for AHCCCS coverage in Arizona is determined based on various factors, including income, household size, and individual circumstances. This program covers a wide range of low-income individuals, including children, pregnant women, parents, seniors, and individuals with disabilities.

Medicare in Arizona

Medicare is a federal health insurance program available to eligible individuals aged 65 and older, certain younger individuals with disabilities, and those with end-stage renal disease (ESRD). It comprises several parts, each covering specific healthcare services. Part A helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Part B provides medical insurance, covering doctor services, outpatient care, preventive services, and durable medical equipment. Beneficiaries typically pay a monthly premium for Part B coverage.

In Arizona, individuals usually become eligible for Medicare when they turn 65, although some may qualify earlier due to certain disabilities or medical conditions. It’s essential to enroll in Medicare during the Initial Enrollment Period (IEP) to avoid late enrollment penalties. Medicare beneficiaries in Arizona have access to a wide range of healthcare providers, including hospitals, doctors, specialists, and pharmacies. Many may also choose to enhance their Medicare coverage through Medicare Advantage plans, which can offer additional benefits and services beyond Original Medicare. Understanding the various parts of Medicare and the enrollment process is crucial for beneficiaries to make informed decisions about their healthcare coverage in Arizona.

Enrollment process for Arizona Obamacare plans

Enrolling in an Arizona Obamacare plan starts during the Open Enrollment Period, typically from November 1 to December 15 each year. If you experience major life changes like marriage, relocation, or loss of health coverage outside this period, you may qualify for a Special Enrollment Period. The enrollment process involves comparing available plans through the Arizona health insurance marketplace, assessing your needs and budget, and completing an application which may require details about your income and household size to determine your eligibility for subsidies or Medicaid.

Open Enrollment Period in Arizona

The annual Arizona open enrollment period is when people who need health insurance coverage can sign up for or renew one of Arizona’s many Affordable Care Act (AZ Obamacare) compliant healthcare plans. Arizona residents will have from November 1, 2024 to January 16, 2025  to enroll in health insurance. If you’re not from Arizona, you can also see a list of open enrollment dates for each state. Otherwise, continue reading to learn more about Arizona 2025 open enrollment dates.

How can I enroll?

To enroll in individual or family health plans during the Open Enrollment Period (OEP) in Arizona, you have several options. You can visit the official Health Insurance Marketplace website, which is operated by the federal government, and follow the enrollment process there. Additionally, you can contact the Marketplace’s call center for assistance or seek help from certified brokers or agents who are trained to navigate the enrollment process and provide guidance on available plans.

For added convenience, you can utilize online insurance marketplaces like eHealth to explore a wide range of health insurance plans, compare coverage options, and easily enroll in a plan that suits your needs during the OEP. eHealth’s user-friendly platform simplifies the enrollment process, making it more accessible and convenient for individuals and families in Arizona looking to secure health insurance coverage during the designated OEP period.

Healthcare Coverage Options

Navigating healthcare coverage options can be complex, with various plans catering to different needs and budgets. This table simplifies the process by comparing the key features of several insurance types, including employer-sponsored plans, individual marketplace plans, Medicaid, and Medicare. It highlights differences in coverage, costs, eligibility, and provider networks, providing a clear overview to help you make an informed decision. Whether you’re looking for comprehensive coverage or specific benefits, understanding these options ensures you choose the best plan for your healthcare needs.

Insurers in Arizona with Plans Available on eHealth.com	Short-Term Health Insurance	Major Medical Health Insurance	Medical Insurance Packages
Companion Life Insurance	Yes	No	No
Independence American	Yes	No	Yes
National General Accident & Health	Yes	No	No
United Healthcare	Yes	No	Yes
QualChoice	No	Yes	No
Blue Cross Blue Shield of Arizona	No	Yes	No
Ambetter	No	Yes	No

 Essential Benefits

Some of the key essential benefits consumers may need in Arizona include:

1. Ambulatory Patient Services: Coverage for doctor’s office visits, outpatient care, and preventive services such as vaccinations and screenings.
2. Emergency Services: Coverage for emergency room visits and treatment for severe injuries and illnesses.
3. Hospitalization: Coverage for inpatient care, including surgeries, hospital stays, and necessary treatments.
4. Maternity and Newborn Care: Coverage for prenatal care, labor and delivery, and postnatal care for both the mother and newborn.
5. Mental Health and Substance Use Disorder Services: Coverage for mental health services, counseling, therapy, and treatment for substance use disorders.
6. Prescription Drugs: Coverage for a wide range of prescription medications prescribed by healthcare providers.
7. Rehabilitative and Habilitative Services and Devices: Coverage for therapies, rehabilitation, and devices that help people with injuries, disabilities, or chronic conditions regain or improve their physical and mental skills.
8. Laboratory Services: Coverage for various medical tests and lab services, including blood tests, diagnostic imaging, and screenings.
9. Preventive and Wellness Services and Chronic Disease Management: Coverage for preventive measures, wellness visits, and management of chronic conditions like diabetes and hypertension.
10. Pediatric Services, Including Oral and Vision Care: Coverage for children’s healthcare needs, including dental and vision care.

Types of plans available

Health insurance plans are often grouped into four categories known as metal tiers: Bronze, Silver, Gold, and Platinum. These tiers help you understand how costs are split. Bronze plans have the lowest monthly premiums but you pay more when you see a doctor. Silver and Gold plans require higher premiums, but your out-of-pocket costs are lower when you get care. Platinum plans charge the highest premiums but cover the most when you need medical treatment. Choosing the right plan depends on how often you expect to need medical care and what you can afford to pay.

 In the 2024 plan year, the following insurers are offering individual and family health insurance in Arizona.  

Insurer Name	Offers Marketplace Plans (healthcare.gov) and Plans Outside the Marketplace
Arizona Complete Health (formerly Health Net of AZ) (HMO) www.azcompletehealth.com	Cochise, Coconino, Gila, Graham, Greenlee, Maricopa, Pinal, Pima, Santa Cruz
Banner Health and Aetna Health Plan Inc. (HMO) www.banneraetna.com	Cochise, Coconino, Gila, Maricopa, Pima, Pinal, Yuma
Blue Cross Blue Shield of AZ (HMO & PPO) www.azblue.com	Statewide
Cigna Healthcare of AZ (HMO) www.cigna.com	Maricopa, Yavapai
Imperial Insurance Companies, Inc. (HMO)	Coconino, Maricopa, Pima, Pinal, Santa Cruz, Yavapai
Medica Community Health Plan (HMO) www.medica.com	Maricopa
Oscar Health Plan, Inc. (HMO) www.hioscar.com	Maricopa, Pima, Pinal, Santa Cruz
UnitedHealthcare of Arizona, Inc. (HMO) www.uhc.com	Maricopa, Mohave, Pima, Pinal

Arizona Open Enrollment FAQs

When is Arizona health insurance marketplace open enrollment this year?

Arizona open enrollment starts on November 1st, 2024 and ends on January 16th, 2025. If you sign up for coverage before January 1st, your healthcare coverage will start on January 1st.

If you sign up for coverage from January 1st to the 15th, then your healthcare coverage will typically start on February 1st.

Those who miss Arizona open enrollment will have to wait until the next enrollment period. However, some exceptions exist if you qualify for a special enrollment period, such as if you lose your essential health coverage, move to a new coverage area, have a child, or get married.

Does open enrollment for Arizona Obamacare apply in all AZ cities?

All Arizona residents of all 15 counties have access to Obamacare Arizona plans. However, location can dictate which insurers you have available.

Not all insurance companies offer their plans in all counties. Every plan in the Arizona health insurance marketplace must adhere to Federal laws and standards established by the Affordable Care Act, as well as to the laws and standards of the state of Arizona.

How much does health insurance cost in Arizona?

Many factors play a role in pricing, but the Arizona health insurance marketplace allows for price comparison and even “window shopping” for those who just want to get an idea of what’s available to them. Costs will depend on age, the type of policy you choose, the number of people you want to cover, and where you live.

The exchange splits plans into tiers:

• Bronze—Lowest premium, highest costs for care
• Silver—Moderate premium, moderate costs for care
• Gold—High premium, low costs for care
• Platinum—Highest premium, lowest costs for care

It can help to explore the health insurance marketplace and what different plans offer. This will give you a good idea of the costs associated with these plans. Remember that health insurance is a lot more than just the premium cost, so you need to take into consideration all the additional costs before choosing a health insurance plan.

How do I qualify for subsidies or tax credits?

To qualify for subsidies or tax credits on your health insurance, your eligibility is primarily determined by your household income and size. These financial aids are designed to help make health insurance more affordable for those within certain income brackets. When you apply for coverage through the health insurance marketplace, you’ll need to provide information about your income and the number of people in your household. This data is then used to calculate the amount of subsidy or tax credit you’re eligible for, which can significantly lower the cost of your premiums.

Find health insurance in Arizona with eHealth

Whether you’re in the market for short-term health insurance or individual health insurance in Arizona, you can find the right plan for you with eHealth. Our team of licensed agents are available to answer any questions you may have about the cost of health insurance, open enrollment dates, and more. Get in contact with an eHealth agent today and find the health insurance coverage you’ve been looking for.

Short-Term Notice 2024