A Look Inside the Arizona Health Insurance Exchange
Beginning October 1, 2013, a new way to shop for individual and small group health plans was introduced: the health insurance marketplace. People in Arizona and nationwide are now able to purchase more affordable coverage that meets a higher set of standards than previously offered. Plans on the marketplace must include comprehensive benefits, accept all applicants, and be priced reasonably. Tax credits provided by the IRS are available to many residents to lower the cost of premiums and cost sharing — making health care and insurance more manageable.
The marketplace is the backdrop for established and lesser-known Arizona health insurers to sell their health reform-approved wares known as qualified health plans (QHPs). Each of these plans has to meet rigid criteria in order to be sold, including coverage for at least ten categories of services in each plan, and covering no less than 60 percent of medical expenses for the lowest cost plan.
Individuals without coverage through their employer are the target consumers for the marketplaces, though small business owners can also sign up and provide insurance to their workers. Both small group and individual plans can be reduced in cost with subsidies for those who qualify. Many Arizonans are eligible for subsidized coverage on the exchange and can save hundreds or even thousands of dollars each year on premiums by enrolling in a marketplace plan.
If you’ve been uninsured, without access to a government-funded or employer-sponsored source of coverage in the past, the exchange is designed for you. Individuals who don’t qualify for Medicaid (AHCCCS), Medicare, and other government health plans like TRICARE can apply. Also, if you’re job doesn’t offer coverage, or the plan they provide is sub-par according to the Affordable Care Act (meaning it covers less than 60 percent of your total medical costs), you’re welcome to enroll. Ideally, your income is just over the cutoff for AHCCCS, or 138 percent FPL, and no higher than 400 percent FPL. This way, you can receive reduced-cost coverage and possibly medical care.
Additionally, you must be between ages 18 and 64 to apply, an Arizona resident, and a U.S. citizen or legal immigrant. If you earn more than 400 percent of poverty, you can still apply for the exchange, but the cost may be equivalent to the already low-cost health plans on the traditional individual market in Arizona.
Tax credits, or subsidies, are available to discount coverage for low-to-moderate income individuals and families in Arizona purchasing plans on the exchange. If you have a lower income, you may be able to receive subsidies for both premiums and cost sharing, which includes copays, deductibles and coinsurance. Those with moderate to higher incomes may be eligible for a premium tax credit.
Premium Tax Credits Only: 138-400% FPL
Premium and Cost Sharing Tax Credits: 138-250% FPL
How subsidies are calculated is slightly complex, but it’s based on the cost of the second least expensive silver plan (70/30% coverage) in your zip code relative to how much you earn. If the cost of coverage is higher than a certain percentage of your income, your subsidy will cover up to the percentage alloted by law for your income group. The chart below indicates the six income groups and their corresponding premium shares as a percentage of income.
Plans sold on the exchange are offered by carriers like Aetna and Humana, and some smaller insurers, as well (see the full list below). While these companies continue their business outside the marketplace, their plans featured on the exchange all begin with the same structure of ACA-mandated benefits and coverage. Coinsurance ranges from 10 to 40 percent, and each plan covers ten categories of essential health benefits (EHBs) as required by the law.
To make the shopping process easier, there aren’t 50 different plan names like EssentialCore QHDHP and HealthyShare Plus — apparently those are too confusing and wouldn’t make exchange plans as easily identifiable. Exchange plans can vary in detail from carrier to carrier, but the names are at least streamlined into Bronze, Silver, Gold and Platinum across all companies. Bronze plans cover the least but also cost the least each month, unless you’re eligible for a catastrophic plan.
Catastrophic coverage includes free preventive care, four office visits covered in full, and emergency care covered at your deductible.
The graphic below shows the coverage levels and general facts about each. In some cases, however, platinum plans do not have the highest premium, but it will still be on the higher end based on the amount of coverage provided.
Average Premium Rates
According to data from HealthCare.gov, the chart below shows the average premiums charged for various age groups and family sizes. Premiums in Arizona, without the inclusion of tax credits, were averaged for a 27-year-old, 50-year-old, a four-person household with 30-year-old parents, a 30-year-old single parent with two children, a 40-year-old couple, and a child under age 21. Catastrophic plans are only available to young adults between up to age 30, therefore those figures have not been listed wherever they do not apply. As you can see, the prices without tax credits applied are very close to premiums off the exchange. For a sampling of traditional market rates throughout Arizona, visit our Cities/Regions section.
Several national insurers serving Arizona have decided to participate in the marketplace. The selection of carriers will vary based on your location, but each region will have a few to choose from. The following companies sell individual and family coverage on the exchange in Arizona.
- Blue Cross Blue Shield of Arizona
- Health Choice Insurance Co
- Health Net
- Meritus Health Partners
- Meritus Mutual Health Partners
- University of Arizona Health Plans – University Healthcare Marketplace
How to Apply
You can apply for coverage and determine your eligibility for tax credits online at HealthCare.gov, over the phone with a licensed agent at 888.803.5917, or request a paper application at 800-218-2596. The agents at East Coast Health Insurance are licensed to sell plans on and off the exchange to better serve the Arizona individual market. We’re happy to steer you toward the right plan in your area and find out if you qualify for tax credits to lower your costs. You can even purchase a marketplace plan directly from us, or if you’d rather buy a plan off the exchange, we provide products from the best carriers in the state.
Compare Arizona Marketplace Plans
Below is a cost comparison tool designed to give you an idea of what to expect on the exchange in your area. While this tool is for research purposes, our licensed agents can help you select and purchase a policy in Arizona at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.