Arkansas Health Insurance Consumer Guide

To be eligible for health coverage through the Arkansas Marketplace, you must meet certain criteria. Typically, you can apply if you:²

• Reside in Arkansas
• Are either a U.S. citizen, U.S. national, or lawfully present in the U.S.
• Are not incarcerated
• Are not enrolled in Medicare

So most Arkansas residents are eligible to enroll in a Marketplace plan. However, a more important question for most people is whether they’re eligible for financial assistance (premium subsidies and cost-sharing reductions) in the Marketplace.

Eligibility for financial assistance depends on your income. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable employer-sponsored health insurance. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A ³
• File a joint tax return with your spouse, if you’re married.⁴ (with very limited exceptions)⁵
• Not be able to be claimed by someone else as a tax dependent.⁴

The open enrollment period to buy individual and family health coverage in Arkansas runs from November 1 to January 15. Here are some key dates:⁶

• November 1: Open enrollment starts! This is when you can first sign up for or change plans for the 2024. If you enroll by December 15, your coverage will start on January 1.
• December 15: Last day to enroll or change plans to start on January 1. After this date, any changes or new plans won’t start until February 1.
• January 15: Open enrollment ends. After this, you only change or enroll in coverage through a special enrollment period (SEP).

An SEP allows you to make plan changes outside open enrollment if you’ve had a qualifying life event, like getting married, having a baby, or losing other health coverage.⁷

But some people can sign up without a qualifying life event. For example:

• Native Americans can enroll in Marketplace plans year-round.
• People eligible for subsidies with income under 150% of the poverty level can enroll anytime.
• People who lose Medicaid/CHIP between March 31, 2023 and November 30, 2024 are eligible for a temporary extended SEP.⁸

If you’re eligible for an ACA Marketplace plan, you can enroll:

• Online through HealthCare.gov
• By phone at (800) 318-2596
• With the help of a local insurance agent/broker, Navigator, or certified application counselor
• Via an approved enhanced direct enrollment entity.⁹

You can find affordable health plans in Arkansas on the ACA Marketplace (HealthCare.gov).

As of early 2024, 93% of Arkansas Marketplace enrollees were receiving advance premium tax credits (APTC, or premium subsidies). The average subsidy amount was about $477/month, leaving the average enrolling paying only about $119/month for their coverage; that average includes the 7% who paid full price.¹⁰

(The numbers above are based on effectuated enrollment. The graphic below uses data from all applications submitted during open enrollment, and also shows some different metrics.)

Source: CMS.gov¹¹

If your income isn’t more than 250% of the federal poverty level, you may also qualify for cost-sharing reductions (CSR) to lower your deductibles and out-of-pocket costs.¹²

You may enroll in Medicaid coverage if eligible. Arkansas expanded Medicaid under the ACA, and the state purchases Marketplace health plans for people who are eligible for expanded Medicaid.

Short-term plans can be a lower-cost coverage option for people not eligible for Medicaid, Medicare, or subsidized Marketplace coverage. But it’s important to understand the drawbacks of short-term coverage before purchasing it, as these plans are not regulated by the ACA.

The Arkansas exchange/Marketplace offers individual and family health plans from six insurers, although some are subsidiaries or licensees of a single parent entity.

Octave (USAble HMO, Inc.) was new to the Arkansas Marketplace for 2024, and will continue to offer plans in 2025.¹³

The Arkansas Insurance Department announced the following approved average rate changes for 2025,¹⁴ which amount to a weighted average increase of 6.2%, before subsidies are applied.¹⁵

Source: Arkansas Insurance Department¹⁴

The average rate changes are for full-price premiums. But most people in Arkansas receive subsidies to lower their costs, so their rate change may be different.¹⁶

For perspective, here’s an overview of how unsubsidized average premiums have changed in Arkansas over the years:

• 2015: Average decrease of 2%.¹⁷
• 2016: Average increase of 4.4%.¹⁸
• 2017: Average increase of 9.1%.¹⁹
• 2018: Average increase of 17.5%.²⁰
• 2019: Average increase of 4.1%.²¹
• 2020: Average increase of 2.3%.²²
• 2021: Average increase of 3.4%.²³
• 2022: Average increase of 4.4%.²⁴
• 2023: Average increase of 5.9%.²⁵
• 2024: Average increase of 4.1%.²⁶

During the open enrollment period for 2024 coverage, a record-breaking 156,607 people enrolled in private plans through the Arkansas Marketplace.²⁷ (See chart below with historical enrollment data.)

That came on the heels of a previous record high the year before, when just over 100,000 Arkansans signed up for private health plans through the ACA Marketplace.¹⁶

The enrollment growth in recent years was driven in large part by the American Rescue Plan’s subsidy enhancements, which have been extended through 2025 by the Inflation Reduction Act. These subsidy enhancements make coverage more affordable than it was before 2021.

The enrollment spike in 2024 was also partially due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in the spring of 2023, and Arkansas had completed the unwinding process by October 2023, with more than 427,000 people disenrolled from Medicaid.²⁸

HealthCare.gov is offering an extended special enrollment period, through November 2024, for people disenrolled from Medicaid during the unwinding period.⁸ But by April 2024, nearly 65,000 people had transitioned from Arkansas Medicaid to a private plan offered in the Arkansas Marketplace,²⁹ helping to drive 2024 enrollment higher than it had been in recent years.

Source: 2014,³⁰ 2015,³¹ 2016,³² 2017,³³ 2018,³⁴ 2019,³⁵ 2020,³⁶ 2021,³⁷ 2022,³⁸ 2023,³⁹ 2024⁴⁰

HealthCare.gov
This is the ACA Marketplace where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596.

Arkansas Center for Health Improvement
Nonprofit focused on improving healthcare access and public health in Arkansas.

Arkansas Insurance Department Consumer Services Division
Regulates insurance companies and assists consumers. Can help with health insurance questions, complaints, and more.

ARKids First
Arkansas’ Children’s Health Insurance Program. Provides low-cost health coverage for children in families who earn too much for Medicaid but can’t afford other insurance.

Arkansas Senior Health Insurance Information Program
Provides local Medicare counseling and assistance. Can help answer questions, resolve issues, and enroll in Medicare plans.