Arizona is a beautiful place to live – but living without health insurance can be a nightmare no matter where you call home. In order to alleviate the anxieties and financial burdens associated with not having health insurance coverage, you need to sit down and go over your options. Obviously, a major medical health insurance policy through your employer or the ACA is some of the best coverage you can get. But is it the most affordable? And is it the best option for you, personally? Let’s take a moment to explore the answers to those questions as they pertain to Arizona residents.
Major Medical Insurance in Arizona
Obamacare, AKA the Patient Protection and Affordable Care Act, has been law since March 23rd, 2010. But the law has changed several times since the president originally signed it into being. As of right now in 2019, you can still register on HealthCare.gov and fill out an application in order to see if you can afford to purchase a major medical ACA health insurance plan. But certain parts of the original legislation, such as the individual mandate, are no more.
For the vast majority of Americans, Open Enrollment for an ACA plan happens every year between November 1st and December 15th. But there are special enrollment periods which you may qualify for based on extenuating life circumstances. Since Arizona does not have its own local state health insurance exchange, the easiest and most affordable way to get comprehensive coverage is to go through the federal Health Insurance Marketplace.
There are two very specific things about ACA plans which set them apart from other types of insurance available for purchase. Number one, the policies are what is known as “guaranteed issue”. Guaranteed issue means that it is illegal for any insurance company to deny you coverage or charge you more for coverage based on pre-existing conditions. With a guaranteed issue policy, your health insurance provider can only alter the overall cost of your premium based on the following variables:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Things like sex/gender or pre-existing health ailments cannot legally effect how much you are charged for your monthly premium. Furthermore, these major medical plans are required by law to guarantee that you receive all of the ten following Essential Health and Wellness Benefits:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
The reason so many people flock to the exchange each year to shop for a policy isn’t just because they can get a fully comprehensive, guaranteed issue policy; it’s because – most of the time – they can get such a policy at an affordable monthly premium thanks to a federal subsidy. But not all Arizona residents will qualify for a federal subsidy. If your household income is between 138% and 400% of the federal poverty level, you will likely qualify for a federal subsidy. But if you make less than that, you will probably have to apply for Medicaid instead through the HealthPlusArizona.gov website. That link also contains helpful contact information if you’d rather apply in person or over the phone. The chart below can help you figure out your likelihood of qualifying for a subsidy:
|Household Size||Annual Income (138% of FPL)|
Arizona is one of many states which made the decision to accept the federal government’s recommendation that they expand Medicaid (or, as it’s known in Arizona, the Arizona Health Care Cost Containment System) coverage to qualifying citizens who are making less than 138% of the federal poverty level threshold. As of right now, there is a pending work requirement to qualify for the Medicaid expansion which has not yet been implemented by the government. Some authorities expect this work requirement to be implemented in the fall of 2020; others aren’t so sure if it will ever be implemented at all. The work requirement would mandate that Medicaid beneficiaries participate in 80 hours per month of either employed work or qualifying volunteer opportunities. If not, they could temporarily lose their coverage until these requirements are met. But as of this writing, these work requirements have not yet been implemented, and it is uncertain if they ever will be.
Short Term Health Insurance in Arizona
If you don’t qualify for a federal subsidy or the Medicaid expansion, or if you do qualify for a subsidy but still can’t find an affordable major medical health insurance plan, then you may want to consider short-term health insurance instead. These plans operate in a similar manner to that of major medical, but they have some distinct differences which you should know about before you make such an important decision.
There are many benefits to a short-term health insurance plan over a major medical plan, especially given that many of these plans can cost up to 33% less than an unsubsidized health insurance plan through the ACA. In Arizona, you can get a short term plan that lasts for a full 12 months, with the option to renew for a total of 36 months before you must undergo medical underwriting again. The policies offered by short-term health insurance companies are highly customizable depending on your location and the company you purchase from. You can combine them with other forms of coverage such as vision, dental, or hospital indemnity insurance. You can apply directly through the company who is offering you the plan; there’s no need to go through HealthCare.gov or the Health Insurance Marketplace first. Best of all, unlike some of the other non-ACA options out there, you have more consumer protections with short-term health insurance plans. This means that if there is a dispute over a claim you file, you will likely be able to take the insurance company to court in order to get your medical costs covered in a way you deserve.
But there are also some disadvantages you should know about while you are considering a short-term health insurance plan. For starters, none of these plans are guaranteed issue. They can deny you coverage or charge you significantly higher rates based on pre-existing conditions, sex, and anything else that their medical underwriting determines would make you a risky investment. Your short-term health insurance company will likely impose both lifetime and annual benefit limits in order to limit their financial liability. There won’t be any caps for you on your out-of-pocket costs, either; and many of these plans come with deductibles in the thousands of dollars. Your deductible is the amount of money you pay out-of-pocket first before your benefits kick in and your insurance company starts paying out on your medical claims. Lastly, there are no essential coverage guarantees for a short-term health insurance policy. This means that many of the major medical benefits listed above (such as preventative care or mental health counseling services, for example) might not be available to you via a short-term health insurance plan – not even if you request to purchase extra coverage.
Christian Health Plans/Health Share Plans in Arizona
During the early days of Obamacare, people who couldn’t afford to purchase ACA insurance were desperate for a solution to the federal mandate. Christian health plans, also known as health sharing plans, grew to fill this need. People could sign up for these more affordable plans and fulfill the mandate without being forced into a prohibitively expensive unsubsidized major medical policy. But as of January 2019, the federal mandate was eliminated, meaning that you don’t have to purchase insurance if you don’t want to anymore. That being sad, it’s still worth looking into something like a Christian health plan in order to get more affordable care.
In a sense, these health plans work very similarly to the way short-term health insurance does. Here are some of the following attributes that both types of coverage have in common:
- No guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
But it’s the differences between these two plans that are the most important to focus on. To start with, participating in a Christian health plan is voluntary and there is no contract between you and the plan provider. This means that if you ever get into a dispute over a claim, you likely won’t have any legal recourse. Many of these organizations also impose “participation guidelines” which will require you to declare a specific faith, adopt certain biblical lifestyle changes, and also make more healthful lifestyle choices such as giving up cigarettes, other tobacco products, or even alcohol. It’s also important to understand that the terminology is different, mostly for legal reasons. You don’t pay a monthly premium for your plan; you contribute a “monthly share amount”. Likewise, you don’t pay co-pays, deductibles, or co-insurance; you contribute “personal responsibility amounts” or “unshared amounts” towards the general fund.
Fixed Indemnity Plans in Arizona
When you purchase a fixed indemnity plan, you’re effectively purchasing a medical insurance supplement – not a full-fledged, comprehensive major medical policy like you would get through the ACA. As a matter of fact, most fixed indemnity plans are designed to be sold alongside major medical policies. Fixed indemnity supplements help lower the cost of hospital treatment and doctor visits. They do this by making predetermined payments for a specific unit of time (per day, week, or month, usually), or they may pay out per visit or per event. But you will likely still have out-of-pocket costs even with a fixed indemnity plan.
Not unlike many of the other insurance options we have discussed so far, you can expect a fixed indemnity plan to come with annual and lifetime benefit caps. There is also no guaranteed issue coverage protection, meaning you will be subjected to medical underwriting and possibly charged more or denied coverage based on pre-existing conditions. But if you are worried about the cost of hospital treatment, especially if you have a major medical policy and don’t feel like it is comprehensive enough, then investing in a fixed indemnity plan could save you money in the long run.
Discount Cards in Arizona
Medical discount cards are not a replacement for major medical insurance. What they are is a way to help control your out-of-pocket costs, whether you use them to supplement the health insurance you already have or to take the edge off of exorbitant prices for uninsured care. It works the same way any discount membership club (think AAA or AARP) does: you agree to pay a monthly fee and receive a medical discount card in the mail. Then, whenever you need medical care (certain doctor visits, prescription medications, flu shots, etc), just present your medical discount card in order to redeem your discounts.
Of course, there are some limitations when it comes to medical discount cards. Some cards are only available through certain associations or institutions; they may not be available for retail sale to just anybody. Furthermore, it isn’t uncommon for unscrupulous companies out there to falsely advertise the level of discounts you can get, the providers you can get discounts from, or both in order to sell you a medical discount card subscription. It’s important to follow up with a medical discount card provider as well as the people they claim they are affiliated with to make sure that what they advertise is genuine. Lastly, keep in mind that these cards are not insurance policies, you are not filing any claims, nor are you getting reimbursed for your medical care; you simply pay a modest monthly membership fee in order to get a discounted price on certain medical goods and services at the register.