How to Choose the Best ACA Healthcare Coverage in AZ

While we recommend to connect with a health insurance broker who can walk you through all your options and help you find the most affordable plan for your unique healthcare needs, you can also use these tips when you’re looking for health insurance coverage through the ACA.

First: What Is the Affordable Care Act?

The Affordable Care Act when into effect in 2010. It helps “make affordable health insurance available to more people”. Part of achieving that mission is to offer subsidies, also known as premium tax credits, to households with incomes up to 400% of the federal poverty level when they purchase ACA health insurance.

The ACA also expanded Medicaid program coverage to adults who have income below 138% of the federal poverty level. This helps more people obtain Medicaid coverage, which is federally funded healthcare coverage for people with unique needs.

Some people may choose ACA coverage even when they don’t fall into groups like those above. ACA healthcare plans may be a convenient option for people who don’t receive healthcare coverage through their employer, or if they’re self-employed, for example.

What ACA Healthcare Providers Are Available in Arizona?

ACA coverage and related providers depend on the county you live in. For example, here’s a sampling of insurers in Arizona’s two most-populated counties.

• For Maricopa County, providers include: Ambetter, Blue Cross Blue Shield, Banner Health Network, Aetna, Cigna, Imperial, Medica, Oscar and UnitedHealthcare.

• For Pima County, providers include: Banner Health Network, Aetna, Blue Cross Blue Shield and UnitedHealthcare.

All ACA healthcare plans provide coverage for essential healthcare needs, including ambulatory and emergency care, hospitalization, pediatric services, preventive and wellness services, laboratory services, rehabilitative services and more.

It’s important to know that if you’re considering getting an ACA plan, even if you stay with same insurer you’ve previously had, say, with an employer, not all doctors are in network with ACA healthcare plans. You can call your preferred doctor’s office to check if they’ll accept your health plan, or you can call the Marketplace Call Center at 1-800-318-2596 for help.

If you need health insurance, but your preferred doctors don’t provide coverage under the ACA, you still have options. You can get a private insurance plan for yourself or your family any time of year, including outside of ACA open enrollment.

How to Select an ACA Plan

During open enrollment, you can go to this website to browse health insurance plans available to you based on your ZIP code. Health insurance coverage through the ACA is available in bronze, expanded bronze, silver, and gold tiered categories.

• Bronze: A bronze plan typically requires paying around 40% of your healthcare costs, while the insurance company will typically pay around 60% of your healthcare costs. Bronze plans offer the lowest monthly premium but will cost the most when you need care. They’re a good choice if you are relatively healthy and you don’t anticipate major healthcare costs. If you want coverage for worst-case medical scenarios but want to keep your monthly costs the lowest possible, this is an ideal plan.

• Expanded Bronze: An expanded bronze plan generally mirrors a bronze plan, the main difference would be having co pays for PCP and for specialists. We generally like going this route so you at least have co pays to see a dr outside of just a wellness plan.

• Silver plan: A silver plan will typically require plan holders to pay about 30% of healthcare coverage, while the insurance company will cover around 70% of healthcare costs. Plan holders will have a higher monthly premium than a bronze plan, but the costs on healthcare deductibles will be lower. If you visit the doctor periodically, a silver plan could save you money. There may also be cost-sharing reductions available that could help you save on a silver plan, as well.

• Gold plan: A gold plan will have a higher monthly premium than bronze and silver plans, but you’ll have lower costs when you need care. On gold plans, the health insurer typically pays 80% of costs, while the insured pays 20%. Gold plans may be a good choice if you use a lot of care, since the deductible is typically lower that bronze and silver plans.

Put simply, if you anticipate having relatively fewer medical costs, a bronze or silver plan can lower your premium costs and provide you with the basic coverage you need. If you get frequent medical care, a gold plan may make more sense.

Have a Health Savings Account? You Can Still Get an ACA Plan

Now’s a good time to mention a health savings account, or HSA. An HSA works similarly to a flexible savings account. It’s used for healthcare costs. Employees whose employers offer an HSA can add money to their account and use those tax-free contributions to pay for healthcare costs.

If you know you’re going to need coverage for out-of-pocket expenses your health insurance won’t cover (naturopathic doctor, co pays, etc), or you need extra funds to pay for healthcare costs toward your deductible, you can use HSA pre-taxed funds for those expenses. This is a popular option if you know you’ll meet your deductible for a surgery or maternity, and they generally have a lower out of pocket maximum. You can have both an HSA and an ACA high deductible health plan, so having both could be a good option when you’re considering coverage.

ACA Open Enrollment Is Here: Research Plans Now

If you’re considering an ACA plan, don’t miss out on open enrollment. You can visit here to look up plans you qualify for in your area. You can also search doctor names to filter plans that are in network with your doctor(s).

Have questions about ACA plans? The AZ Health Insurance Brokers team is here to help. Give us a call at 602.617.4107, email us at quotes@azhealthinsurance.com or contact us by filling out the form online.