Blue Cross Blue Shield (BCBS) ACA Marketplace Explained
Whether you’re gearing up for Affordable Care Act (ACA) federal marketplace health insurance open enrollment, or you qualify for a special enrollment period on the ACA Marketplace, it’s helpful to know what your options are if you’re considering those plans. Open enrollment begins November 1 and lasts through January 15, but you can also get ACA Marketplace insurance when you go through a qualifying life change, like moving or having a child. One top insurer to consider for individual and family insurance in Arizona is Blue Cross Blue Shield (BCBS).
BCBS presents some unique advantages among insurers in Arizona. With considerable coverage throughout the state and solid partnerships with top AZ healthcare providers, it’s worth evaluating this network if you need an ACA plan. If you qualify for a special enrollment period, such as divorce or losing health insurance coverage from work, you may be able to enroll in a BCBS ACA plan at any time of year.
When you’re ready to
sign up for insurance,
contact AZ Health Insurance Brokers for a free consultation. We can help you find the best plan for your unique healthcare needs. When you want to sign up for
ACA coverage, use our free link that also connects you with a personalized health insurance broker in case you need any help during the process.
Key Takeaways
- As the only health insurance carrier in Arizona that offers plans in all 15 counties and the only carrier offering a statewide preferred provider organization (PPO) plan, BCBS offers the most comprehensive health insurance coverage in the state for individuals and families.
- BCBS is contracted with Abrazo Health, Barrow Neurological Institute, Dignity Health and Phoenix Children’s Hospital. These provider partnerships illustrate the strength of BCBS in the Arizona market.
- The BCBS statewide PPO network is also contracted with all major hospital networks in AZ, except for Mayo Clinic Care Network. This gives individuals and families more choice in who they see as their preferred provider, but BCBS PPO plans are also more expensive compared to other plan pricing.
What Do ACA Marketplace BCBS Plans Cover?
BCBS is a prominent name in the Arizona health insurance market, as it’s the only carrier in the state that offers plans in all 15 counties. The carrier has several notable contracts with Arizona healthcare providers, including Abrazo Health, Barrow Neurological Institute, Dignity Health and Phoenix Children’s Hospital.
BCBS plans through the ACA Marketplace cover essential healthcare services, including:
- Free preventive care with $0 primary care provider (PCP) visits, including screenings, flu shots, wellness checks and immunizations, with no copays
- Doctor visits
- Prescription drugs, including $0-$3 costs for generic drugs, including prescriptions for diabetes, heart conditions and mental health
- $0 nurse on-call, where plan holders can talk with a registered nurse in English or Spanish at any time
- 24/7 online doctor visits, with English- and Spanish-speaking doctors available
- Mental and behavioral healthcare, including psychiatry and counseling services
- Outpatient care
- Emergency care
- Hospital stays
- Urgent care
- Maternity and newborn care
- Dental insurance and vision care for children
Plan holders can also get discounts on health services and equipment, including vision services and wearable fitness devices. You could also earn up to $100 in rewards for taking preventive care measures, such as attending regular health exams and screenings.
With comprehensive health insurance coverage and a variety of perks for plan holders, it’s no wonder BCBS is a top insurer in Arizona.
Types of BCBS ACA Plans
BCBS offers two types of ACA Marketplace plans: health maintenance organization (HMO) plans and PPO plans. HMO plans are lower-cost but limit plan holders to in-network providers for coverage. With an ACA StandardHealth HMO with Health Choice Plan through BCBS, members are designated a PCP, who can be changed up to six times a year. Plan holders must receive a PCP referral in order to see a non-emergency, non-urgent specialist. Seeing a doctor who isn’t covered could require full charges.
With BCBS PPO plans through the ACA Marketplace, plan holders can see whichever provider or specialist they want, without a referral. Costs will be higher for out-of-network providers and will be lower for in-network providers. Out-of-state services aren’t covered, unless they’ve received prior authorization.
BCBS offers six categories of ACA plans. Each one will have various pricing and benefits. They are:
- AdvanceHealth HMO: This is a lower-cost plan that includes a low monthly premium, low-cost care and online doctor visits. It’s most recommended for healthy people who want low monthly healthcare costs.
| BCBS AdvanceHealth HMO Gold, Silver, & Bronze |
|---|
| Deductible | OOP Max | Coinsurnace | PCP Co Pay | Spec Co Pay | |
|---|---|---|---|---|---|
| Gold | $4,375 | $4,375 | 100%/0% | Ded | Ded First |
| Silver | $6,600 | $6,600 | 100%/0% | Ded | Ded First |
| Bronze | $9,000 | $9,000 | 100%/0% | Ded | Ded First |
- EverydayHealth HMO: For individuals and families with more frequent healthcare needs, this HMO plan offers a variety of deductibles for predictable monthly costs.
| BCBS EverydayHealth HMO Gold & Silver |
|---|
| Deductible | OOP Max | Coinsurnace | PCP Co Pay | Spec Co Pay | |
|---|---|---|---|---|---|
| Gold | $1,300 | $7,250 | 70%/30% | $15 | $50 |
| Silver | $5,000 | $8,200 | 60%/40% | $20 | $75 |
- Portfolio HSA HMO & PPO: These HMO and PPO plans are eligible to be paired with a health savings account (HSA).
| BCBS Portfolio HSA PPO Gold & Portfolio HSA HMO Bronze |
|---|
| Deductible | OOP Max | Coinsurnace | PCP Co Pay | Spec Co Pay | |
|---|---|---|---|---|---|
| PPO Gold | $2,500 | $4,500 | 80%/20% | Ded First | Ded First |
| HMO Bronze | $7,050 | $7,050 | 100%/0% | Ded First | Ded First |
- StandardHealth HMO & PPO: These plans are recommended for those who see doctors frequently or who take prescription drugs for something like a chronic condition.
| BCBS StandardHealth HMO Gold, Silver, & Bronze |
|---|
| Deductible | OOP Max | Coinsurnace | PCP Co Pay | Spec Co Pay | |
|---|---|---|---|---|---|
| Gold | $1,500 | $7,800 | 75%/25% | $30 | $60 |
| Silver | $5,000 | $8,000 | 60%/40% | $40 | $80 |
| Bronze | $7,500 | $9,200 | 50%/50% | $50 | $100 |
| BCBS StandardHealth PPO Gold & Silver |
|---|
| Deductible | OOP Max | Coinsurnace | PCP Co Pay | Spec Co Pay | |
|---|---|---|---|---|---|
| Gold | $1,500 | $7,800 | 75%/25% | $30 | $60 |
| Silver | $5,000 | $8,000 | 60%/40% | $40 | $80 |
- ACA StandardHealth HMO with Health Choice: This new plan from BCBS includes the same benefits as the StandardHealth plan, but with access to the BCBS ACA Health Choice network. This plan has been a popular option in terms of value and price.
| Deductible | OOP Max | Coinsurnace | PCP Co Pay | Spec Co Pay | |
|---|---|---|---|---|---|
| Silver | $5,000 | $8,000 | 60%/40% | $40 | $80 |
- PPO PremierHealth: This is a more expensive plan that offers more freedom and choice in healthcare providers. Out-of-network care in Arizona is covered in this plan.
| PremierHealth Statewide PPO |
|---|
| Deductible | OOP Max | Coinsurnace | PCP Co Pay | Spec Co Pay | |
|---|---|---|---|---|---|
| Gold | $1,250 | $9,100 | 80%/20% | $5 | $25 |
| Silver | $3,400 | $9,100 | 80%/20% | $15 | $75 |
When you’re signing up for a BCBS ACA Marketplace plan, you’ll see different Metal Levels: Bronze, Silver and Gold.
- With Bronze plans, BCBS pays 60% of costs, and the plan holder pays 40% of expenses.
- With Silver plans, BCBS pays 70% of costs, and the plan holder pays 30% of expenses.
- With Gold plans, BCBS pays 80% of costs, and the plan holder pays 20% of expenses.
Some plans in Arizona will be limited to certain Metal Levels. Here's the breakdown of the plans and networks by county in Arizona.
| Network | Plans |
|---|---|
| Statewide PPO | • PPO PremierHealth (Gold, Silver) |
| • Portfolio HSA PPO (Gold) | |
| • StandardHealth PPO (Gold, Silver) |
| MaricopaFocus (Maricopa County only) | • EverydayHealth HMO (Gold, Silver) |
| • AdvanceHealth HMO (Gold, Silver, Bronze) | |
| • Portfolio HSA HMO (Bronze) | |
| • StandardHealth HMO (Gold, Silver, Bronze) |
| PimaFocus (Pima County only) | • EverydayHealth HMO (Gold, Silver) |
| • AdvanceHealth HMO (Gold, Silver, Bronze) | |
| • Portfolio HSA HMO (Bronze) | |
| • StandardHealth HMO (Gold, Silver, Bronze) |
| Neighborhood (all other counties) | • EverydayHealth HMO (Gold, Silver) |
| • AdvanceHealth HMO (Gold, Silver, Bronze) | |
| • Portfolio HSA HMO (Bronze) | |
| • StandardHealth HMO (Gold, Silver, Broze) |
| ACA Health Choice (Maricopa, Pima, Pinal, Coconino, Gila, Mohave, and Santa Cruz counties) | • ACA StandardHealth HMO with Health Choice (Silver) |
If you need help deciding on a plan with the benefits you need, that fits your budget, AZ Health Insurance Brokers can guide you through the process. Use our
form, and one of our team members will provide expert guidance.
Do You Qualify for Financial Help for a BCBS ACA Plan?
According to BCBS, 9 out of 10 Arizonans are eligible for financial help to pay for their ACA health plan monthly premiums. The following table shows if you do or may
qualify for a subsidy or discount on BCBS health insurance through the ACA Marketplace.
| Persons in household | Income range that qualifies for $0 plans | Income range that qualifies for subsidy | Income range that may qualify for a subsidy |
|---|---|---|---|
| 1 | $20,783 to $22,590 | $22,591 to $60,240 | $60,241 and above |
| 2 | $28,207 to $30,660 | $30,661 to $81,760 | $81,761 and above |
| 3 | $35,632 to $38,730 | $38,731 to $103,280 | $103,281 and above |
| 4 | $43,056 to $46,800 | $46,801 to $124,800 | $124,801 and above |
| 5 | $50,480 to $54,870 | $54,871 to $146,320 | $146,321 and above |
| 6 | $57,905 to $62,940 | $62,941 to $167,840 | $167,841 and above |
Pros of BCBS ACA Marketplace Plans
When you’re comparing BCBS ACA Marketplace plans against other carriers, here are some advantages to consider.
- Extensive coverage: BCBS is the only carrier offering plans in all 15 counties, providing a wide network and access to care throughout the state.
- Strong provider network: BCBS has contracts with major hospital networks and healthcare providers in Arizona, including Abrazo Health, Barrow Neurological Institute, Dignity Health and Phoenix Children’s Hospital (select networks).
- Statewide PPO option: BCBS offers a statewide PPO plan, giving you more flexibility in choosing your healthcare providers.
- Excellent prescription drug coverage: BCBS ACA plans often provide good coverage for expensive medications listed in their formulary, potentially saving you significant costs on prescriptions.
If you prefer a PPO plan through the ACA Marketplace, BCBS is one of the best options with the widest reach in Arizona.
Cons of BCBS ACA Marketplace Plans
There are also a couple considerations for BCBS ACA Marketplace plans that may not make it your preferred choice. Consider these potential disadvantages.
- Cost: BCBS’s PPO options are the most expensive plans on the ACA Marketplace. Overall, BCBS plans can be more expensive compared to other carriers on the ACA Marketplace.
- HMO restrictions: HMO plans have limitations on provider choice and may require referrals for specialist visits.
There’s a wide variety of choice for BCBS plans in AZ, but there may be better options out there. Talk with an Arizona health insurance broker for assistance in selecting the best plan for your budget and needs.
How to Get Individual & Family Insurance Coverage Through the BCBS ACA Marketplace
If you want BCBS healthcare coverage as an individual or family in Arizona, you can find health plans using our free ACA Marketplace health insurance link, which also gives you access to a personalized customer representative who’s available to answer any questions you have. Open enrollment begins November 1, but special qualifying enrollment periods, such as moving or having a baby, may allow you to enroll at other times during the year. Use our link now to see what discounts you might qualify for.
If you have questions about health insurance in general, you can call 602.617.4107, email
quotes@azhealthinsurance.com, or
contact us online to talk with one of our team members. We can present you with all available health insurance options that meet your healthcare needs and budget.
BCBS ACA Marketplace FAQs
How can I enroll in BCBS ACA Marketplace insurance?
Use the AZ Health Insurance Brokers form to start the enrollment process for BCBS ACA Marketplace health insurance. It’s free to sign up through the form, and you’ll also get a customer service representative who’s available to help you, should you need it.
How can I see if I qualify for financial aid or free health insurance through the ACA Marketplace?
You can use the subsidy qualification table to see if your income potentially qualifies you for no-cost insurance through the ACA Marketplace, or for a discount or subsidy. You can also contact AZ Health Insurance Brokers, and a representative will check how your income levels impact potential discounts.
How can I make sure I’m choosing the right BCBS ACA Marketplace plan?
Use the free ACA Marketplace sign-up form from AZ Health Insurance Brokers. You’ll receive a free personalized customer service representative who can guide you through the process and ensure you consider all relevant options based on your healthcare needs and budget.
What’s included in BCBS ACA Marketplace health insurance plans?
BCBS ACA Marketplace health insurance plans include coverage for free preventive care, including primary care physician visits, screenings and immunizations. Coverage also includes prescription drugs, emergency care and other healthcare services.
When can I enroll in BCBS ACA Marketplace health insurance?
Open enrollment for BCBS ACA Marketplace health insurance is from November 1 to January 15. You may qualify for a special enrollment period if you experience a qualifying life event, such as having a baby or losing health insurance coverage through work. A special enrollment period would enable you to sign up for health insurance at any time of the year.
What are the pros of BCBS ACA health insurance?
Some of the advantages of BCBS ACA Marketplace plans include extensive coverage in all 15 Arizona counties, a strong provider network and contract partnerships with major Arizona hospital networks, a statewide PPO plan and solid coverage for expensive medications listed in the BCBS formulary.
What are the cons of BCBS ACA health insurance?
Some of the disadvantages of BCBS ACA Marketplace plans are that they tend to be more on the expensive side compared to other providers, and the HMO plans limit provider choice.
Can I use BCBS Arizona health insurance in another state?
Yes, as long as you get prior authorization, you can use BCBS Arizona health insurance at in-network providers across the country and for emergency services around the globe.
What providers are contracted with BCBS in Arizona?
BCBS AZ contracted providers include those with Abrazo Health, Dignity Health, Phoenix Children’s Hospital and Barrow Neurological Institute. The statewide BCBS AZ PPO network is contracted with all major hospital networks in Arizona, except for Mayo Clinic Care Network.
What is customer satisfaction for BCBS?
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