Ambetter Health Insurance in Arizona 2026: Everything You Need to Know
When you’re thinking about enrolling in federal health insurance coverage, one of the top insurers offered through the Affordable Care Act (ACA) marketplace is Ambetter. Ambetter is a top ACA marketplace insurer for Arizona residents and offers state-to-state healthcare coverage. Ambetter could be a good option for frequent travelers or for those who split their residence between homes, such as Arizona snowbirds.
At AZ Health Insurance Brokers, we recently helped a family in Scottsdale obtain an Ambetter policy that better fit their family’s health insurance needs. Ambetter’s contracts with Arizona healthcare providers include HonorHealth, Banner Health and others, which makes them one of the strongest health insurers in terms of doctor and provider coverage.
If you’re considering ACA healthcare coverage, you may qualify for a special enrollment period, due to life changes such as moving or having a baby. A special enrollment period enables you to sign up any time of year, as long as you meet the requirements.
Otherwise, ACA open enrollment kicks off November 1 for coverage for the following year, and lasts through January 15. If you want your ACA health coverage to start January 1, sign up by December 15 of the previous year. Otherwise, enrolling between December 16 and January 15 means your coverage will start February 1.
As you compare your healthcare coverage options on the ACA marketplace, use this guide to Ambetter family and
individual health insurance in Arizona to see if it’s a fit for you. If you want to see
what ACA plans you qualify for in Arizona, fill out this free form for personalized service.
Key Takeaways
- Ambetter is one of the United States of America’s top ACA marketplace insurers. Ambetter is one of the best ACA insurers for Arizona residents, because it offers coverage for some of the most prominent healthcare providers in the state.
- Ambetter offers state-to-state reciprocity, meaning if you have an Ambetter plan in Arizona and spend the summer or other time in a different state, you can visit a doctor who’s contracted with Ambetter in that state. That makes Ambetter a great choice for Arizona snowbirds who need health insurance.
- Ambetter offers some unique health rewards programs in Arizona, including access to full memberships at YMCA. Members can also receive up to $500 to be used towards deductibles and copays through Ambetter’s My Health Pays® rewards program.
What Is Ambetter?
Ambetter is an ACA marketplace product offered by Arizona Complete Health. Ambetter AZ health insurance plans offer coverage for essential health services, and you don’t need a referral to see a specialist on an Ambetter health insurance plan in Arizona.
There are Ambetter plans offered in each of the ACA metal tiers that determine how much the insured is responsible for, versus what the insurance company’s responsible for. Ambetter plans include the following options:
- Ambetter Bronze: This bronze tier plan covers essential healthcare needs. People who are insured on this tier typically see lower monthly premiums, but may experience potentially higher out-of-pocket costs for increased amounts of care.
- Ambetter Silver: These silver tier plans require slightly higher monthly premiums compared to bronze plans, but they also lessen out-of-pocket costs when you do need care.
- Ambetter Gold: Gold tier plans from Ambetter require the highest monthly premium payment amount but also limit out-of-pocket costs when you need care.
Ambetter 2025 Plans: A Closer Look
Ambetter offers a variety of plans in Arizona for 2026, each with different costs and benefits. Based on Maricopa County averages, here’s a look at how rates have changed year over year for the most affordable Bronze, Silver, and Gold plans (without subsidies):
| Metal Tier | 2025 Avg. Bronze Plan | 2026 Avg. Bronze Plan | % Change |
|---|---|---|---|
| Bronze | $386 | $568 | +47% |
| Silver | $486 | $748 | +54% |
| Gold | $581 | $867 | +49% |
These figures represent unsubsidized rates and can vary slightly by age, location, and specific carrier. Families receiving premium tax credits may see smaller changes depending on their 2026 subsidy eligibility.
To help you understand your options, here’s a closer look at the plan categories.
- Ambetter Everyday: This popular Bronze plan offers copays for common services, like primary care physician (PCP) visits, specialist visit, lab work, urgent care and mental health. Expenses beyond these copays apply towards the deductible.
| AMBetter Everyday Bronze |
|---|
| Deductible | OOP Max | PCP Co Pay | Spec Co Pay | Urgent Co Pay | |
|---|---|---|---|---|---|
| Bronze | $8,450 | $10,150 | $40 | $90 | $50 |
- Ambetter Choice: This Expanded Bronze plan is an exclusive provider organization plan that enables members to use a health savings account with the plan. Once the deductible is met, all PCP, specialist and urgent care copays are paid by the insurance company.
| Ambetter Choice Bronze HSA |
|---|
| Deductible | Out-of-pocket maximum | PCP copay | Specialist copay | Urgent care copay | |
|---|---|---|---|---|---|
| Bronze | $7,250 | $7,250 | After meeting the deductible, no charge | After meeting the deductible, no charge | After meeting the deductible, no charge |
- Ambetter Standard: This plan category offers Bronze, Silver and Gold options, giving you more choices to find the right balance of premiums and out-of-pocket costs.
| AMBetter Standard Gold, Silver, & Bronze |
|---|
| Deductible | Out-of-pocket maximum | PCP copay | Specialist copay | Urgent care copay | |
|---|---|---|---|---|---|
| Gold | $2,000 | $8,200 | $30 | $60 | $45 |
| Silver | $6,000 | $8,900 | $40 | $80 | $60 |
| Bronze | $7,500 | $10,000 | $50 | $100 | $75 |
- Ambetter Complete: Available in Silver and Gold options, Ambetter Complete offers more flexibility and lower copays compared to the Standard plans.
| AMBetter Complete Gold & Silver |
|---|
| Deductible | Out-of-pocket maximum | PCP copay | Specialist copay | Urgent care copay | |
|---|---|---|---|---|---|
| Gold | $1,450 | $7,500 | $15 | Deductable | $35 |
| Silver | $5,950 | $8,850 | $30 | $30 | $60 |
- Ambetter Elite:
This premium Gold plan offers a $0 deductible, low copays and a low out-of-pocket maximum, providing comprehensive coverage.
| AMBetter Elite Gold |
|---|
| Deductible | Out-of-pocket maximum | PCP copay | Specialist copay | Urgent care copay | |
|---|---|---|---|---|---|
| Gold | $0 | $6,500 | $5 | $60 | $35 |
Remember, these are just highlights. Be sure to review the full plan details, and consider your individual needs and budget before making a decision.
All plans, no matter what metal tier they’re in, offer essential health benefits. These include coverage for essential medical care and wellness services, including:
- Emergency care
- Outpatient or ambulatory care
- Preventive and wellness care
- Mental health and substance abuse care
- Laboratory services
- Prescription drugs
- Hospitalization
- Maternity and newborn care
- Therapy services
- Pediatric care
- Virtual 24/7 care
Ambetter members can use the Ambetter mail-order pharmacy program for medications or get prescriptions from in-network retail locations.
Ambetter also offers a Start Smart for Your Baby® maternity health program, which offers support for maternity provider search, mental health, breastfeeding and baby development.
Ambetter members can also access a health savings account (HSA) from Fidelity. Ambetter members can add savings to their HSA tax-free and use that money to pay for covered healthcare services.
Benefits of Ambetter Plans
Ambetter offers some unique health and wellness rewards programs for its members, as well as a discount program with perks for members. Some Ambetter benefits include:
- Ambetter Perks Member Discount Program: Members can enjoy special rates and discounts on products and services such as restaurant dining, travel, entertainment, technology, gym memberships and food delivery programs.
- My Health Pays®: My Health Pays® is a points-based rewards system that rewards members up to $500 for completing actions such as getting an annual wellness screening.
- YMCA & YMCA360 Membership: Ambetter members have access to full memberships to in-person YMCA locations, as well as can access YMCA360, the virtual version of YMCA.
Ambetter health management programs in Arizona also provide telephone support, behavioral health services, educational tools, tobacco cessation programs and management programs for chronic conditions, including asthma, diabetes, low back pain, depression, hypertension and coronary artery disease.
Who Ambetter Is Best For in Arizona
Ambetter can be a strong fit for many Arizona residents, but it tends to work best for:
- Families whose doctors are in the Banner Health or HonorHealth systems
- Snowbirds who split time between Arizona and another state and want network reciprocity
- Individuals who like earning wellness rewards through programs like My Health Pays® or YMCA
- People who are comfortable with HMO-style networks and value strong telehealth options
Each of these groups can take advantage of Ambetter’s combination of network access, preventive care benefits, and reward programs while staying within budget-friendly ACA plan tiers.
Tayler Busack with AZ Health Insurance Brokers
“We’ve seen Ambetter remain one of the stronger Marketplace carriers in Arizona. Especially for families who want access to major hospital systems like Banner and HonorHealth, without having to worry about getting a referral to see a specialist.”
With lots of member resources and a variety of pricing options, you might find that an Ambetter plan through the ACA marketplace makes sense for your budget and the unique healthcare needs of your family.
How to Get Individual & Family Insurance Coverage Through Ambetter
You can enroll directly with Ambetter or through a licensed Arizona health insurance broker. Working with a local broker ensures you get personal help comparing every plan available.
If you’re interested in signing up for Ambetter, or you want to compare all your ACA marketplace plan choices in Arizona, use our free link to see your ACA healthcare options. A professional representative from AZ Health Insurance Brokers will reach out to show you what’s available and answer any questions you have, so you can feel confident you’re signing up for the best plan.
If you have questions about health insurance in general, the AZ Health Insurance Brokers team is here to help. We have private health insurance options available, as well. Contact us for free, at 602.617.4107, by quotes@azhealthinsurance.com or online.
Compare Ambetter vs Other Marketplace Carriers
Not sure if Ambetter is the best fit for your needs?
See our
2026 Marketplace Comparison Guide to compare Ambetter with BCBS, Cigna, Oscar, and other Arizona carriers. It breaks down key differences in network size, plan types, and out-of-pocket costs to help you make the best decision for your family.
Ambetter Individual & Family Insurance FAQs
What metal tiers are covered in Ambetter ACA marketplace plans for Arizona?
Ambetter offers bronze, silver and gold metal tier plans in the ACA Marketplace.
What essential health benefits are covered under Ambetter plans?
Ambetter ACA marketplace plans cover essential health benefits, including maternity and newborn care, emergency care, hospitalization, outpatient and ambulatory care, preventive and wellness care, pediatric care, mental health and substance abuse care, therapy services, laboratory services and prescription drugs.
What is the Ambetter My Health Pays® Rewards Program?
The Ambetter My Health Pays® Rewards Program gives members up to $500 in rewards for completing healthy actions on the points-based system. These include actions like attending an annual wellness screening and adopting healthy fitness and nutrition habits.
When is open enrollment for Ambetter health insurance on the ACA marketplace?
Open enrollment for Ambetter health insurance on the ACA marketplace is between November 1 and January 15 each year. If you enroll by December 15, coverage will start January 1 of the following year. If you enroll after December 15 and by January 15, coverage will begin February 1.
What special enrollment periods apply to Ambetter ACA marketplace plans?
You may qualify for a special enrollment period to sign up for Ambetter on the ACA marketplace if you experience a special qualifying event, such as losing health insurance through work, having a baby, moving, getting married, adopting a child or if your household income falls below a certain amount. You typically have 60 days before or 60 days following the event to enroll in an Ambetter plan during a special enrollment period.
Do I need a referral to see a specialist with Ambetter health plans?
No, you don’t need a referral to see a specialist on an Ambetter health insurance plan in Arizona.
Can you use an HSA with Ambetter?
Yes, Ambetter members get access to a health savings account (HSA) through Fidelity. An HSA allows Ambetter members to contribute savings tax-free and use those HSA funds toward covered healthcare costs.
Do income limits affect HSA eligibility with Ambetter?
No, there are no income limits for setting up an HSA in conjunction with an Ambetter healthcare plan. The HSA holder’s spouse and dependents can also use HSA funds for approved medical expenses.
Can I use Ambetter Arizona health insurance out of state?
Yes, as long as you visit a doctor who’s contracted with Ambetter in another state, your Ambetter health coverage will offer state-to-state reciprocity.
Who is Ambetter health insurance good for in Arizona?
Ambetter can be a good health insurance plan for individuals and families who are looking for ACA marketplace coverage in Arizona. Ambetter offers state-to-state reciprocity, so it can be a good choice for snowbirds who only live in Arizona part of the year. Ambetter can also be a good health insurance plan for individuals and families whose preferred providers are covered by the Banner Health and HonorHealth systems.
What health management programs does Ambetter offer?
Ambetter offers Arizona plan holders health management programs for anxiety, child and adult asthma, adult-only coronary artery disease, depression, diabetes, hypertension/high blood pressure, high cholesterol, lower back pain, substance use and tobacco cessation.
What discounts are offered through the Ambetter Perks program?
The Ambetter Perks program offers discounts for expenses in categories including food and dining, travel, technology, movie tickets, tours, attractions, auto insurance, mental wellness, gym memberships, online fitness, meal services, eyecare services, office, education, home goods and more. To access discounts, use the members-only Ambetter Perks code from your online member account in the Ambetter perks website.
What’s the difference between the metal tiers on Ambetter ACA plans?
With bronze plans, you’ll pay less in monthly premiums, but higher amounts when you need care. With gold plans, you’ll pay more in monthly premiums, but less when you need care. Silver plans land in the middle, with slightly higher monthly premiums compared to bronze plans, but lower out-of-pocket costs compared to bronze plans when you need care.
What is the Ambetter Start Smart for Your Baby® program?
The Start Smart for Your Baby® program from Ambetter has support for during pregnancy and after delivery, for things like prenatal care, depression and anxiety in pregnancy, preparing for labor and delivery, baby health screenings, breastfeeding and more.
What pharmacy benefits does Ambetter offer?
Ambetter offers medication delivery through Express Scripts® Pharmacy, as well as specialty pharmacy assistance through AcariaHealth and medication discounts through Sempre Health.
