Frequently asked questions about health insurance
coverage options in Arizona
Arizona uses the federally run marketplace (exchange), which means individuals and families enroll in health plans through HealthCare.gov. The exchange is used by people who need to buy their own health insurance, including people who are self-employed, people who work for a small business that doesn’t provide health benefits, and people who have retired prior to 65 and need to purchase their own health coverage until they become eligible for Medicare.
Arizona made headlines in the fall of 2016, due to the number of insurers leaving the exchange and the significant rate increases for 2017. But for 2018, Arizona had among the smallest rate increases in the country, with rates virtually unchanged from 2017.
Read our overview of the Arizona health insurance marketplace – including news updates and exchange history.
In Arizona, open enrollment for 2021 health insurance plans ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021.
The Biden administration created this enrollment opportunity to address the fact that millions of Americans remain uninsured amid the ongoing pandemic, including millions who would qualify for enough financial assistance in the marketplace that they could obtain some coverage with no monthly premium at all. And people can use the COVID-related enrollment period to access the newly enhanced premium subsidies created by the American Rescue Plan.
Plan selections made during this window will take effect the first of the month after the enrollment is completed. People who are uninsured can enroll in coverage, and people who already have a plan can switch to a different plan during this window. No qualifying event is necessary during the COVID-related enrollment window. But after August 15, a qualifying event will be necessary in order to enroll or make a plan change for 2021 coverage. Qualifying events are necessary both on-exchange and off-exchange if you’re applying for coverage outside of the open enrollment period.
The normal open enrollment period — and in 2021, the COVID-related enrollment period — is an opportunity for individuals and families to sign up for health coverage, or to change an existing policy. It’s also an opportunity for people with non-exchange plans to shop on the exchange to see if a better option might be available. The exchange is the only place where premium subsidies are available, and for 2021, the subsidies are larger and more widely available than normal, as a result of the American Rescue Plan.
During open enrollment for 2015 coverage, 205,666 people enrolled in private health plans through Arizona’s health insurance marketplace. Enrollment declined in each of the next several years, with only 153,020 people signed up for medical insurance through Arizona’s exchange during the open enrollment period for 2020 coverage — a 25 percent reduction in enrollment in four years.
Enrollment grew slightly in 2021, however, with 154,504 people purchasing plans during open enrollment. And it’s likely to increase a bit more during the COVID-related enrollment window that continues through August 15, 2021.
Arizona participates in the federally facilitated marketplace (HealthCare.gov) and has expanded its Medicaid program under the ACA.
According to U.S. Census data, 17.1 percent of Arizona residents were uninsured in 2013, and that had dropped to 10.1 percent by 2017, although it crept back up to 10.6 percent by 2018, and to 11.3 percent by 2019. Nationwide there was a gradual increase in the uninsured rate under the Trump Administration. While Arizona’s uninsured rate improved with Obamacare in effect, it’s still above the national average (9.2 percent in 2019).
As of 2020, there were more than 142,000 people covered by private health plans through the Arizona exchange. All of these people have coverage for the ACA’s essential health benefits, without any lifetime or annual caps on the benefits. And 81 percent of the exchange enrollees also have premium subsidies that make their monthly health insurance premiums much more affordable than they would otherwise be.
In the 2010 election, Arizona voters approved a state constitutional amendment barring any state rules or regulations that would force state residents to participate in a healthcare system. Federal law supersedes state law, so the ACA’s individual mandate still nominally applies in Arizona, although the penalty for non-compliance was repealed as of 2019.
Despite opposing the ACA in general, former Governor Jan Brewer was in favor of state-run health insurance exchange and said it was preferable to a one-size-fits-all model imposed by the federal government. To that end, Brewer established the Office of Health Insurance Exchange, and the state took numerous steps toward setting up a state-run exchange. However, with state legislators and a public majority remaining opposed. Brewer ultimately bowed to public sentiment and defaulted to the federally facilitated marketplace.
Doug Ducey, a Republican, took over the governor’s office in January 2015 and won re-election in 2018. During his campaign, he described himself as “100 percent opposed to Obamacare.” Within months of taking office, he signed House Bill 2643 into law, effectively banning the state from creating a state-run exchange. So Arizona, like most states, continues to use HealthCare.gov.
Brewer was one of several Republican Governors who supported Medicaid expansion despite opposing the ACA in general. Ultimately, Arizona did opt to expand Medicaid under the Affordable Care Act, and Medicaid enrollment in Arizona is 58 percent higher than it was in 2013.
Arizona’s Senate delegation includes Kyrsten Sinema and Mark Kelly, both Democrats who support the ACA. The state’s House of Representatives members include five Democrats and four Republicans as of 2021.
Arizona Medicaid coverage is called AHCCCS, for Arizona Health Care Cost Containment System.
Former Gov. Brewer followed a different course than most Republican governors and pushed hard for Medicaid expansion in Arizona. A bill authorizing expansion was passed with some Republican support and signed into law by Brewer in 2013.
However, the expansion has been repeatedly challenged. The Arizona legislature in February 2015 passed SB1092, which requires the state to seek an annual waiver from CMS to allow additional eligibility restrictions for Arizona’s Medicaid program – Arizona Health Care Cost Containment System (AHCCCS, which is pronounced “access”). Gov. Ducey signed the bill into law in March 2015.
In September 2016, the Obama Administration CMS approved Arizona’s waiver proposal, but eliminated the most conservative aspects of it. The new waiver runs through September 2021. The waiver rules require modest health savings account contributions from enrollees in Medicaid plans with income above the poverty level, and enrollment in an optional (rather than mandatory) job search program.
Under the Obama Administration, CMS did not allow Arizona to implement a work requirement, limit AHCCCS coverage for able-bodied adults to five years, or to charge premiums for enrollees in Arizona Medicaid plans with income below the poverty level. The state also cannot lock people out of AHCCCS for six months if they miss a health savings account contribution, or charge fees for missed health care appointments. In short, CMS denied various state bids to increase costs for enrollees.
However, the Trump Administration was much more open to the sort of proposals that Arizona made in previous years, and a new Arizona Medicaid waiver received partial CMS approval in early 2019. The new waiver allows the state to impose a Medicaid work requirement (which the state has indefinitely postponed), but CMS did not approve the state’s proposal to limit total Medicaid coverage for able-bodied enrollees to five years. And in February 2021, the Biden administration notified Arizona that the work requirement approval was being reconsidered.
Arizona saw a 45 percent increase in monthly Medicaid/CHIP enrollment from 2013 to November 2016. But enrollment plateaued by 2016 (as was the case in most states), and net enrollment was up 43 percent as of late 2019. But by September of 2020, the total number of people covered by Medicaid/CHIP in Arizona was 58 percent higher than it had been in 2013. The coronavirus pandemic has been driving Medicaid enrollment higher throughout the nation, including in Arizona, and highlighting the importance of a health care safety net for situations where people suddenly lose their jobs, incomes, and employer-sponsored health benefits.
Learn more about Arizona’s Medicaid expansion.
Arizona changed its rules for short-term health insurance in Arizona in 2019, allowing plans to follow federal rules instead of the stricter rules the state had previously imposed. So short-term plans in Arizona can have initial terms of up to 364 days, and total duration, including renewals, of up to three years.
Short-term medical plans are not considered minimum essential coverage, and the insurers’ business model tends to be quite different from that of ACA-compliant health insurers. Short-term plans do not have to provide coverage for the essential health benefits, do not have to cover pre-existing conditions, and are medically underwritten.
Get more information about short-term health insurance in Arizona.
As of late 2020, more than 1.375 million Arizonans were enrolled in Medicare coverage. Most are eligible due to age (at least 65), but 13 percent of the people with Medicare coverage in Arizona are under age 65 and eligible for Medicare because of a disability.
You can read more about Medicare in Arizona, including details about optional Medicare Advantage and Medicare Part D prescription plans, as well as the state’s rules for Medigap (Medicare Supplement) plans.
- Arizona Department of Insurance — Regulates and licenses health insurance companies, agents, and brokers; provides information to consumers about a wide range of insurance issue.
- Arizona Health Matters
- Arizona Association of Community Health Centers (AACHC)/Arizona Alliance for Community Health Centers — Community health centers that also serve as
- Arizona’s federally-funded Navigator organization, helping individuals and families enroll in health coverage through the exchange.
- Arizona Health Care Cost Containment System — Medicaid in Arizona. Provides health coverage to various low-income populations.
Medicare Rights Center — A nationwide service (website and call center) that provides information and assistance to medicare beneficiaries and their caregivers.
- Arizona State Health Insurance Assistance Program — A local service that can provide a variety of counseling, advice, and assistance with Medicare issues.
Here’s what’s happened recently in terms of state-level health care reform legislation in Arizona:
- Gov. Ducey signed HB2643 into law in April 2015. The legislation effectively bans the state from creating a state-run exchange.
- Also in 2015, SB1092 was signed into law, requiring the state to continue to ask CMS to approve eligibility changes for Medicaid, including a work requirement and a five-year lifetime coverage limit. The Obama Administration rejected most of the major changes that the state wanted to make, but a new waiver proposal, submitted in late 2017, gained partial approval from the Trump administration.