If you’re new to the state, we think you’ve made a good move. We’re glad you’re here.
Now it’s time to talk about health insurance in Arizona.
AZ Health Insurance Brokers can help you with all your health insurance needs, but first it’s important to understand what’s out there. This guide to health insurance in Arizona explains what your options are for your particular situation.
For Individuals: ACA Options or Private Insurance Plans
Individual health insurance is for those who aren’t covered by a group plan through their employer or through some other way, such as the VA. In some cases, people aren’t happy with the plans offered through their employer, and they want to find their own policy.
There are two ways to purchase individual health insurance in Arizona: You can buy one through the Affordable Care Act (ACA) exchange (or marketplace), or you can purchase a private policy through a broker or agent.
Buying through the ACA exchange
The ACA (sometimes referred to as “Obamacare”) passed in 2010. Insurance purchased from the ACA exchange is considered “government” insurance, and you may also hear it referred to as “on-exchange.”
The ACA’s aim is to make health insurance available to everyone, and the law requires everyone to have health insurance or pay a tax penalty. All ACA plans cover preexisting conditions as well as a list of essential health benefits. Based on your household size and income, you may be eligible to receive a government subsidy that reduces your monthly premium for an ACA plan.
Important to note:
To get ACA coverage in Arizona for 2020, you had to buy your plan during the open enrollment period in 2019 (which was Nov. 1 to Dec. 15). The next open enrollment period for plans effective in 2021 will begin Nov. 1, 2020.
There is an exception; if you had any of the following “qualifying events” happen in your life, you receive a special enrollment period that lasts 60 days. According to the ACA site, these qualifying events are:
- Getting married
- Getting legally separated or divorced and losing health insurance as a result
- Having a baby, adopting a child or placing a child for adoption or foster care
- Moving
- Becoming a U.S. citizen
- Leaving incarceration
- Losing other health coverage
- Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
If you need health insurance in Arizona in 2020 but you haven’t had any of the above qualifying events happen in your life, consult with a broker or agent to see what you're eligible to sign up for.
Who should buy an individual health insurance plan through the ACA exchange?
The ACA marketplace is a good idea for those who:
- Qualify for a government subsidy. There are several factors that go into this determination, but the main one is that you have to earn between 100% and 400% of the federal poverty level.
- Are willing to accept a narrow in-network list of doctors.
According to Forbes, 72% of plans in the ACA marketplace have narrow networks, which limits choice for consumers. If this is OK with you, a plan purchased through the ACA may be a good fit.
Buying private insurance through a broker or agent
Private health insurance purchased through a broker or agent offers most of the essential health benefits as their ACA counterparts.
Who should buy a private individual health insurance plan through a broker or agent?
Go this route if you:
- Make too much money to qualify for a government subsidy. If you’re not able to take advantage of the government subsidy that accompanies the ACA, then you may want to consider a private plan.
- Your doctor doesn't accept any of the ACA plans. If you have a favorite doctor that you see often enough, it could make sense to go with a private plan that covers those visits.
- You want personal attention and guidance. Let’s face it — insurance policies are confusing, the laws change frequently, and professional insight and advice are very welcome things. A broker can provide you with guidance and insight as to which plan makes the most sense.
For Families: Government (ACA) Options or Private Insurance Plans
The same principles that guide buying insurance for an individual apply to buying insurance for a family. Read the above section if you haven’t already, and then note:
You also have two options
you can purchase a family plan through the ACA marketplace, or you can get a private family plan through a broker or agent.
Expert guidance is suggested
Working with an experienced professional becomes even more important when shopping for insurance for an entire family. You must consider the individual needs of every family member. It’s possible, for example, for each of your children to have different insurance plans based on their individual conditions. The same applies for a spouse. This becomes very difficult to maneuver when you’re shopping solo via the ACA exchange. An insurance professional can get a customized plan for your family.
Couples should compare individual vs. family plans
If you’re looking for health insurance for you and your spouse, get quotes for yourselves separately (individual plans) and together (family plan). Based on your age difference and health needs, you may save money by going one route or the other.
For Businesses: Group Health Insurance
The ACA has requirements for business owners when it comes to offering health insurance to employees. In 2020, if your company employs 50 or more full-time employees, you are required to provide a certain percentage of them with minimum essential coverage — or face penalties.
Employers with fewer than 50 full-time employees are not required to provide group health insurance coverage. However, these businesses may be eligible for a tax credit if they do offer coverage, which makes the purchase of group health insurance more affordable. If you’re a small business owner in Arizona, you can usually qualify for the tax credit if you meet the following conditions:
- You employ 25 or fewer full-time employees
- The average salary of your employees in 2019 was $54,200 or less
- Your business pays at least 50% of employee premiums
Even if your business isn’t required to offer health insurance to employees, it’s still a worthwhile thing to do. You’ll attract and retain top talent and be known as an employer of choice who cares about their employees.
It can be tough for business owners to keep up with the changing rules regarding health insurance. Working with an insurance professional ensures you understand what your responsibilities and options are.
Medicare Switch
Arizona is second on the list of states where senior citizens move to the most,
according to SmartAsset (Florida holds the number one spot). If you’re a senior who’s making Arizona home, you may wonder what you need to do regarding your Medicare.
The answer depends on the type of Medicare you have. If you’re enrolled in Original Medicare, Part A and Part B, you don’t need to do anything — your plan will transfer beautifully to Arizona. You simply need to find a new doctor who accepts Medicare.
If you have any other type of Medicare coverage, you will need to enroll in an Arizona plan. First, contact Social Security to update your mailing address. Then, notify your Medicare plan provider so you can enroll in a new plan (moving counts as a special circumstance in which you can switch plans).
You may wish to consult an insurance professional to help you with the process. We can help you understand Medicare coverage and the health care plans that supplement Medicare.
AZ Health Insurance Brokers Is Here for You
Please
reach out to us to discuss your health insurance needs. Before we recommend anything, we’ll get an idea of your current situation, so we can find the best solution for your circumstances. It’s always our goal to help you find the answers to your insurance questions and get the right insurance plan for your needs.
And if you need referrals for other services, let us know. We can give sound recommendations regarding financial advisors, home and auto insurance, real estate agents and more.
We’re here to help! Contact us today.
