Just as navigating the streets of an unfamiliar city is easier with GPS, having a reliable guide to buying health insurance in Arizona can make the process much easier. Without your own guide, finding your way through confusing insurance industry jargon and small print can seem as confusing as street signs in another language.
This guide to buying health insurance in Arizona aims to provide you with all the necessary information to make an informed decision.
Understanding the Health Insurance Landscape
Whether through state-sponsored programs, the federal marketplace, a private insurer, or an employer, securing the right coverage is essential to protecting yourself and your family against unexpected medical expenses. The difference between these options is the first stop in our guide to buying health insurance.
Arizona Medicaid Program
Arizonans who qualify may be able to receive health insurance benefits as part of the state’s Medicaid program – known as the Arizona Health Care Cost Containment System, or AHCCCS. The qualifications include household size and income levels.
But for many who came to rely on these essential benefits, the prospect of losing Medicaid due to the nationwide Medicaid Rewind is an imminent threat. These hundreds of thousands of individuals need other options as soon as possible.
Health Insurance Via Obamacare
If you and your family no longer qualify for AHCCCS, the next best option to explore is most likely a health insurance policy purchased through Obamacare, also known as the Affordable Care Act (ACA). All ACA plans cover preexisting conditions and a list of essential health benefits. Depending on your projected income for the following year, you may qualify for cost assistance in the form of a tax subsidy, which reduces the monthly rate of your plan.
However, there are limitations on ACA plans, one of which is limited time to apply. During the Open Enrollment Period, typically from mid-November to the end of January, anyone can apply for health insurance through the exchange. Outside of the Open Enrollment Period, Arizonans can apply for coverage only if their circumstances qualify them for a Special Enrollment Period.
Does this sound confusing? Then you might like our article Why Should You Use a Broker For Obamacare Plans?
Private Health Insurance Plans
The next option for Arizonans who do not qualify for AHCCCS and are ineligible for premium tax credits through the health insurance exchange is obtaining coverage through a private health insurance plan. Private insurers who do not have to meet every requirement of the ACA are often more flexible and are customizable to a family’s specific needs.
Employer-Sponsored Health Insurance
Of course, some lucky Arizonans are among those who receive access to affordable health insurance through their employer. However, with the rising costs of group health insurance, many employers are looking for ways to cut costs – resulting in higher contribution requirements from their employees or providing benefits to only employees and not their dependents.
If you’re unsatisfied with the plans offered by your employer or if your employer doesn’t offer health insurance, exploring alternative options for individual health insurance may be beneficial.
Comparing Health Insurance Plans
Now that you know the different avenues available for obtaining health insurance, the next step in our guide to buying health insurance is to define the common types of plans you may choose from. Each type impacts your out-of-pocket costs and flexibility to choose your healthcare providers.
HMO: Health Maintenance Organization
HMO plans typically have lower out-of-pocket costs. However, they require you to stay within a specific network of providers (except in emergencies). You also generally need referrals from a primary care physician before seeing a specialist.
PPO: Preferred Provider Organization
PPO plans offer more provider options and do not require referrals. However, they usually come with higher out-of-pocket costs. You can go out-of-network, but care will be more expensive.
EPO: Exclusive Provider Organization
EPO plans are similar to HMOs, requiring you to obtain care within a specific network for coverage, except in emergencies. However, they typically do not require referrals from a primary care physician.
POS: Point of Service Plan
POS plans offer more provider options and require a primary doctor to coordinate your care. You can go out-of-network, but care will be more expensive, and you’ll need a referral.
Guide to Buying Health Insurance: Other Factors to Consider
The next item in our guide to buying health insurance is looking at the big picture. While premium costs can be the most significant contributing factor to which health insurance plan you choose for your family, be sure to consider the following additional factors as well:
Current and Future Medical Needs
When choosing health insurance considering your family’s current and future medical needs is essential. Look at the amount and type of treatment you’ve received in the past and anticipate your future healthcare needs, such as upcoming procedures or surgeries, recurring prescriptions, regular visits to specialists, and the likelihood of emergency care.
If you have a chronic condition, a higher-cost plan with lower out-of-pocket costs may be beneficial. On the other hand, if you’re in good health and rarely see a doctor, a plan with higher out-of-pocket costs but lower monthly premiums might be the better choice.
Comparing Out-of-Pocket Costs
Out-of-pocket costs include expenses like copays, deductibles, and coinsurance. Consider both the monthly premium and these costs when choosing a plan. Generally, plans with higher premiums have lower out-of-pocket costs and vice versa.
Checking Provider Networks
Your health insurance network refers to the healthcare providers and facilities contracted by your health plan to provide care. Costs are typically lower when you use in-network providers. If you have preferred doctors, make sure they’re in the provider directories for the plan you’re considering. If a more extensive network is essential, look for a plan offering a broad range of in-network providers.
Evaluating the Scope of Services
Before making a final decision, review the summary of benefits for each plan to see what services are covered. Some plans may offer better coverage for specific treatments or services, so it’s essential to check the scope of services each plan provides thoroughly.
Considering Alternative Solutions
If conventional health insurance seems unaffordable or out of reach for other reasons, alternative solutions such as short-term health insurance exist. These plans can provide coverage for up to 12 months at a lower cost while you figure out your long-term healthcare strategy.
Getting Professional Advice – When You Need A Personal Guide to Buying Health Insurance
Navigating a maze of health insurance options with a compass is a great starting point, but how much easier would this journey be with an experienced guide by your side, helping you choose the best path for your family and budget?
This is precisely what we promise to do at Arizona Health Insurance Experts. Our extensive database of health insurance brokers and agents can connect you with a local expert who will guide you through buying health insurance. They will take the time to get to know you and your family and recommend plans that suit your needs and budget. All at no cost to you.
Ready to connect with your personal health insurance guide? Start here.
