Health insurance is an important piece of any well-rounded financial plan.
But, the health insurance landscape can be complex and confusing, with variations from one state to the next. So, it’s critical to understand your state's specific options and considerations to make an informed decision about your health coverage.
In this article, we’ll cover the specific options that Arizona residents need to understand, diving into both private and public health insurance options.
High-Level Overview: The Difference Between Public and Private Health Insurance
Before diving into the specifics in Arizona, it’s important to have a high-level understanding of the two main types of health insurance: Public and Private.
Private health insurance is coverage purchased from a private company. It offers choice and flexibility but can be costly and complex. Public health insurance, provided by the government, is more affordable for those who qualify but may have limited choices and flexibility. Examples of public insurance include Medicare and Medicaid. Private plans are typically offered through an employer or purchased through the health insurance marketplace.
The decision between private and public insurance depends on what’s available to you, your individual needs, preferences, and financial circumstances.
Understanding Private Health Insurance in Arizona
“62% of Arizona’s healthcare consumers are covered by private insurance providers, and the largest private provider in the state is Blue Cross Blue Shield”, according to data from the Common Sense Institute of Arizona.
For most people, private insurance is offered through their employer, but individuals can also purchase private insurance independently.
Your employer may offer a few different plan options. When choosing a private health insurance plan, it's crucial to consider factors such as your health care needs, budget, preferred doctors and hospitals, and prescriptions. Assessing the coverage level, network restrictions, out-of-pocket costs, and benefits can help you identify a plan that aligns with your specific needs and circumstances.
The Health Insurance Marketplace
Alternatively, if you either don’t have private coverage through your employer or simply want to choose a different plan, you can purchase your own directly through the federal health insurance marketplace.
The health insurance marketplace, often referred to as ACA or Obamacare, allows individuals and families to purchase private insurance and, in some instances, qualify for subsidies to help with the cost in the form of an “advanced premium tax credit.” The amount of your credit depends on your income and household size, and it’s important to note that if your employer offers an “affordable” plan, you will not be eligible for any tax credits if you choose to purchase your own plan through the marketplace.
You can only purchase coverage through the marketplace during the open enrollment period each year from November 1st to January 15th. That said, there are certain qualifying events that can make you eligible for a special enrollment period outside of open enrollment.
For 2023 in Arizona, there are eight insurers offering plans on the health insurance marketplace, and roughly 235,000 people enrolled through the Arizona marketplace, according to HealthInsurance.org.
In summary, there are a variety of private health insurance options available for individuals and families in Arizona. Taking the time to do your research can go a long way in helping you make an informed decision and choosing the right plan for you and your family.
Understanding Public Health Insurance in Arizona
Next, there are two public health insurance programs to consider in Arizona: Medicare and the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency.
Medicare in Arizona
Medicare is a federal health insurance program for people aged 65 as well as certain people with disabilities.
“As of late 2022, there were 1,434,539 residents with Medicare in Arizona, amounting to nearly 20% of the state’s population”, according to data from HealthInsurance.org.
1. Part A (Hospital Insurance)
2. Part B (Medical Insurance)
3. Part C (Medicare Advantage Plans)
4. Part D (Prescription Drug Coverage)
Retirees in Arizona have access to a variety of Medicare plan options, with Medicare Advantage plans, Medigap plans, and Medicare Part D available through private insurers, as well as Original Medicare available through the federal government. It's important to be aware of the different options and compare plans when choosing what works best for you.
Medicare open enrollment is every year from October 15th to December 7th. To get started with Medicare, visit Medicare.gov.
Medicaid in Arizona
Medicaid, known as the Arizona Health Care Cost Containment System (AHCCCS) in Arizona, is a joint federal and state program that provides health coverage to people with low income, including some low-income adults, children, pregnant women, elderly adults, and people with disabilities.
According to HealthInsurance.org, the AHCCCS is available to:
- Children birth to 1 year with family income up to 152% of the federal poverty level (FPL)
- Children 1 to 5 years with family income up to 146% of FPL
- Children 6 to 18 with family income up to 138% of FPL
- Children not eligible for Medicaid but with family income up to 205% of FPL are eligible for KidsCare (CHIP)
- Pregnant women with family income up to 161% of FPL (coverage continues for 12 months postpartum)
- Adults under age 65 with family income up to 138% of FPL (Medicaid expansion population)
- Elderly and disabled individuals who meet both income and asset limits
You can use Arizona’s benefit quick screener to check your eligibility.
To enroll in AHCCCS, applicants can apply online through Health-e-Arizona Plus or fill out a paper application and mail it to the AHCCCS office. Applications are accepted all year round.
Benefits under AHCCCS are comprehensive and include hospital services, doctor visits, immunizations, maternity care, and behavioral health services, among others. Children's services include regular check-ups, dental care, and vision care.
The Bottom Line
Understanding your health insurance options in Arizona is a critical step toward financial security.
From Medicaid programs like AHCCCS to private insurance, each option has unique benefits and eligibility requirements tailored to different income levels and health needs. By thoroughly examining these choices, Arizona residents can navigate the complexity of health insurance and make informed decisions that best align with their individual circumstances and preferences.
If you feel overwhelmed by the process, don't be afraid to ask for help. A trusted financial planner can offer invaluable advice, helping you navigate the complex and confusing landscape of health insurance. So, start your journey towards secure health coverage today with the help of one of our trusted financial advisors.