Health Insurance Marketplace in Arizona
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Arizona will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Arizona 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
Get local help Arizona Association of Community Health Centers The Arizona Association of Community Health Centers has served as Arizona’s Primary Care Association since 1985 and continuously strives to fulfill its mission of promoting the development and delivery of affordable and accessible healthcare. The Arizona Association of Community Health Centers Navigators will coordinate outreach opportunities throughout Arizona. Arizona Board of Regents, University of Arizona The Center for Rural Health at the University of Arizona aims to reduce the numbers of Asian American and Pacific Islander uninsured in Pima County, and implement a comprehensive outreach strategy. They intend to use the Southern Arizona Asian & Islander Health Coalition to reach out to these populations and inform them of new coverage options. Greater Phoenix Urban League, Inc. The Greater Phoenix Urban League aims to equip the disadvantaged with tools to achieve economic and social equality, including through improving their health and well-being.Greater Phoenix Urban League’s Navigators will provide a comprehensive, statewide, public awareness campaign aimed at identifying and assisting uninsured individuals across Arizona to access and navigate the Health Exchange Marketplace. Campesinos Sin Fronteras, Inc. Campesinos Sin Fronteras is a Hispanic serving agency, providing services to farm workers and low-income Hispanics, while serving the general population as well. The Campesinos Navigator program will provide enrollment assistance to uninsured individuals in Yuma County, Arizona.
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Accountable Care Organizations in Arizona
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- National Council Of Young Men’s Christian Associations Of The United States Of America (YMCA Of The USA) AZ – Health Care Innovation Award
- University Of North Texas Health Science Center AZ – Health Care Innovation Award
- Mountain Vista Medical Center Mesa, AZ – BPCI Initiative: Model 2
- Banner Boswell Medical Center Sun City, AZ – BPCI Initiative: Model 2
- Banner Del E. Webb Medical Center Sun City West, AZ – BPCI Initiative: Model 2
- Banner Desert Medical Center Mesa, AZ – BPCI Initiative: Model 2
- Banner Estrella Medical Center Phoenix, AZ – BPCI Initiative: Model 2
- Banner Heart Hospital Mesa, AZ – BPCI Initiative: Model 2
- Banner Thunderbird Medical Center Glendale, AZ – BPCI Initiative: Model 2
- St. Luke’s Medical Center Phoenix, AZ – BPCI Initiative: Model 2
- Banner Thunderbird Medical Center Glendale, AZ – BPCI Initiative: Model 2
- West Valley Hospital Goodyear, AZ – BCPI Initiative: Model 4
- Phoenix Baptist Hospital/Arizona Heart Hospital Phoenix, AZ – BCPI Initiative: Model 4
- Scottsdale Healthcare Osborn Medical Center Scottsdale , AZ – BCPI Initiative: Model 4
- Paradise Valley Hospital Phoenix, AZ – BCPI Initiative: Model 4
- Scottsdale Healthcare Shea Medical Center Scottsdale, AZ9003 Shea Blvd – BCPI Initiative: Model 4
- Arrowhead Hospital Glendale, AZ – BCPI Initiative: Model 4
- St. Joseph’s Hospital & Medical Center (SJHMC), member of Dignity Health Phoenix, AZ – BCPI Initiative: Model 4
- Carondelet Chronic Care Navigation Program AZ – Community-based Care Transition Program
- Sun Health Sun City, AZ – Community-based Care Transition Program
- Maricopa County, Arizona: The Area Agency on Aging, Region One AZ – Community-based Care Transition Program
- El Rio Santa Cruz/Tucson – Robert Gomez Clinic Tucson, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- North Country HealthCare – Flagstaff Flagstaff, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- North Country HealthCare – Kingman Kingman, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- North Country HealthCare – Lake Havasu City Lake Havasu City, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Sun Life Family Health Center – Casa Grande Casa Grande, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Sun Life Family Health Center – Coolidge Coolidge, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Sun Life Family Health Center – Maricopa Maricopa, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Sun Life Family Health Center – San Manuel San Manuel, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Sunset Community Health Center San Luis San Luis, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Sunset Community Health Center Somerton Somerton, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Sunset Community Health Center Wellton Wellton, AZ – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Scottsdale Healthcare Medical Center Scottsdale, AZ – Graduate Nurse Education Demonstration
- Banner Health Network Mesa, AZ – Pioneer ACO
- 7th Avenue Family Health Center Phoenix, AZ – Strong Start for Mothers and Newborns Initiative
- Birth & Women’s Health Center Tucson, AZ – Strong Start for Mothers and Newborns Initiative
- Maricopa Integrated Health System’s Comprehensive Healthcare Center Phoenix, AZ – Strong Start for Mothers and Newborns Initiative
- Maryvale Family Health Center Phoenix, AZ – Strong Start for Mothers and Newborns Initiative
- South Central Family Health Center Phoenix, AZ – Strong Start for Mothers and Newborns Initiative
Establishing the Exchange in Arizona
What has been done, not been done, or left up to the federal government to do.
On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default to a federally-facilitated health insurance exchange. Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to “organize the health insurance marketplace for easier evaluation by individuals and small businesses to acquire affordable health insurance.” While legislation establishing a state-run health insurance exchange failed in 2011, the Governor’s Office and legal counsel had researched non-legislative options for establishing an exchange. The Arizona Health Insurance Exchange Steering Committee was established to coordinate exchange planning activities across state agencies and met regularly. Members included Directors and senior staff from the Office of Health Insurance Exchange, the Department of Insurance, the Arizona Health Care Cost Containment System, the Department of Economic Security, the Department of Health Services, and the Director of Health Care Innovation Infrastructure Management. Stakeholder feedback was gathered through five work groups including, a health plans work group led by the Department of Insurance and focused on plan management requirements; a health brokers and agents group, concentrating on broker licensing and compensation; a tribal work group, which was developing outreach and education plans; an information technology infrastructure work group led by the Arizona Health Care Cost Containment System; and a legislative work group. On April 24, 2010, Arizona enacted a law prohibiting plans in a state exchange from offering abortion coverage except in cases of life endangerment or severe health impairment of the pregnant woman. Contracting with Plans: Prior to defaulting to a federal exchange, the Department of Insurance took the lead in researching and developing the plan management functions for the exchange, including certification of qualified health plans, quality rating systems, risk adjustment and transitional reinsurance. Their work was informed by the health plans work group meetings. Arizona expressed support for adopting a market facilitator approach, whereby the exchange would contract with all qualified health plans meeting certain criteria. In February 2012, the state released a Request for Proposals soliciting subcontractor assistance with exchange management functions including, plan management, plan selection, data management and reporting, consumer support services, and financial management. Information Technology (IT): Arizona had planned to design and build the individual and small business exchange components, upgrade its Medicaid eligibility systems, and integrate everything into one seamless system. Arizona submitted an Advanced Planning Document which was accepted by CMS, indicating the state intends to make major Medicaid eligibility systems upgrades. In 2011, the state released a Request for Information to identify viable available or proposed solutions for aligning its Medicaid and Children’s Health Insurance Program (CHIP) enrollment and eligibility systems with an exchange as well as estimated pricing. Arizona also participated in the “Enroll UX 2014” project, which is a public-private partnership creating design standards for exchanges that all states can use. Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. The Department of Insurance examined the state’s EHB options and solicited subcontractors to complete an analysis on options for the final benchmark plan. The state selected the State Employee Benefit- United Healthcare EPO with pediatric and vision coverage supplemented by the FEDVIP plans as the benchmark package.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA. As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum. However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that. Arizona is participating in Medicaid expansion.
Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP in Arizona: Compass Cooperative Health Network
In September 2010, the Arizona Governor’s Office of Economic Recovery received a federal Exchange Planning grant of $1 million. In November 2011, the Governor’s Office was awarded a $29.8 million Level One Establishment grant to further secure IT infrastructure and assist in finalizing plan management functions for the exchange.
The federal government will assume full responsibility for running a health insurance exchange in Arizona beginning in 2014. For more information on Arizona’s health insurance exchange planning, visit: http://www.azgovernor.gov/hix/
1. Governor Jan Brewer letter to CCIIO. November 28, 2012.http://azgovernor.gov/dms/upload/PR_112812_CohenLetter.pdf 2. Office of Health Insurance Exchange: http://www.azgovernor.gov/hix/index.asp (Accessed February 16, 2012) 3. House Bill 2783. Arizona Health Insurance Exchange. Introduced February 8, 2012.http://www.azleg.gov/legtext/50leg/2r/bills/hb2783p.pdf 4. Arizona Exchange Planning Grant Final Report. January 5, 2012.http://www.azgovernor.gov/hix/documents/QuickLinks/ExchangePlanningGrantReportFinal.pdf 5. Arizona Exchange Planning Grant 4th Quarterly Report. October 15, 2011.http://www.azgovernor.gov/hix/documents/QuickLinks/ExchangePlanningGrantReportQ4.pdf 6. Senate Bill 1305. April 24, 2010. http://www.azleg.gov/legtext/49leg/2r/bills/sb1305h.pdf 7. Health Insurance Exchange and ACA Update. August 23, 2012. Arizona Health Care Cost Containment System. http://www.azdhs.gov/diro/documents/forums/2012/health-insurance-exchange-affordable-care-act.pdf 8. Arizona’s Options related to risk adjustment, transitional reinsurance and risk corridors (ACA requirements). Arizona Department of Insurance. April 12, 2012. Mercer.http://www.azgovernor.gov/hix/documents/Grants/AZOptionsRiskAdjTransReinsuranceRiskCorr.pdf 9. State of Arizona Health Insurance Exchange. Notice of Request for Proposal. February 2, 2012.http://www.azahcccs.gov/commercial/Downloads/Solicitations/YH12_0023/AZ_HIX_RFPSoliticationNoYH12-0023.pdf 10. Request For Information Health Insurance Exchange Commercial Component/Interface. Issued 8/15/2011. http://www.azahcccs.gov/commercial/Downloads/Solicitations/Open/RFIs/YH12-0013/YH12-0013.pdf 11. Enroll America, UX 2014. http://www.ux2014.org/ 12. Essential Health Benefits. Arizona Department of Insurance. June 1, 2012. Mercer.http://www.azgovernor.gov/hix/documents/Grants/EHBReport.pdf 13. State of Arizona. Letter to CCIIO from Jan Brewer. September 28, 2012.http://www.statereforum.org/sites/default/files/az_letter_to_hhs_9-28-12.pdf 14. Level One Establishment grant application. State of Arizona Governor’s Office. September 30, 2011.http://www.azgovernor.gov/hix/documents/Grants/L1EstGrantApp_SubmittedNOTApproved.pdf
Also of interest
Provided by the Henry J. Kaiser Family Foundation