Understanding Options for Affordable Health Insurance in Arizona

By: Tom Grote, Banner|Aetna CEO

It’s that time of year! The Affordable Care Act (ACA) health insurance Marketplace is open, and Arizonans can sign up for 2024 coverage until Jan. 15.

The Health Insurance Marketplace, sometimes referred to as the "exchange," is a national service designed to help people shop for and enroll in health coverage. You can use the Marketplace to purchase affordable health insurance in Arizona and other states across the United States.

Plans on the Marketplace provide access to quality health care for many people and their families who would otherwise face sky-high insurance costs or for those who can’t obtain coverage through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or from other sources.

You may qualify for the Marketplace’s affordable health insurance in Arizona if you:

• Are a consultant, freelancer or gig worker
• Are unemployed
• Work as a part-time employee and do not have access to coverage through your employer
• Own a business without employees
• Are retired but don’t yet qualify for Medicare

Even if you are eligible for employer health coverage, you could save money with a Marketplace plan. Consider these factors when weighing your options.

What’s covered by Marketplace plans

No matter what ACA plan you choose, your coverage will have 10 essential health benefits including prescription drug coverage, pregnancy and newborn care, pediatric services (including dental and vision), mental health, as well as lab tests, ER and hospital services. Plus, plans also fully cover important preventive and wellness services, so you won’t have any out-of-pocket costs for these benefits.

Understanding plan metal levels

Selecting the coverage that’s right for you starts with understanding Platinum, Gold, Silver and Bronze “metal” options. Metal levels are based on how you and your plan split the costs of your health care. They have nothing to do with the quality of care or your access to essential benefits. Cost sharing includes fees like deductibles, coinsurance and copays. Premium costs refer to the bills you pay every month for health coverage and are also an important factor when comparing plan options. Generally, plans with higher metal levels have higher premiums but lower out-of-pocket expenses. Plans with lower metal levels come with lower premiums but higher out-of-pocket costs.

How premium subsidies work

In 2023, 91% of people who enrolled in a Marketplace plan received premium subsidies, or discounts, that covered the bulk of their monthly plan costs. These subsidies lower the monthly cost of insurance coverage and can be applied to all four metal levels: Bronze, Silver, Gold and Platinum. They are calculated based on household size and income level, so households with lower incomes will get larger credits to help cover the cost of insurance.

Many people don’t realize they qualify for a subsidy, so it’s important to check if you’re eligible. It’s quick and easy to do, using this helpful calculator, and can dramatically reduce costs for individuals and families, putting affordable health insurance in Arizona within reach.

Premium discount income limits

Premium subsidies are available to people who buy Marketplace coverage and have an income between 100% and 400% of the federal poverty level.

If your income is above 400% of the federal poverty level, eligibility is based on the cost of the benchmark plan relative to your income. If the cost of the benchmark plan is more than 8.5% of your income (or a lower percentage, for people with lower incomes), subsidies are usually available.

Get more help with out-of-pocket costs

Some people also qualify for extra savings known as cost-sharing reductions which lower out-of-pocket costs for medical care. This is only available for individuals and families who select a Silver plan.

More factors to consider

The metal plan level isn’t the only thing to think about when selecting affordable health insurance in Arizona. In many counties, you have options from several health insurance companies that may have different value-added programs and services, in addition to the 10 essential health benefits.

This year, Banner|Aetna’s ACA plans include enhanced features like open access to in-network providers with no referrals required. To provide even more value, members also get a yearly allowance of $100* for CVS-brand health and wellness items and 20% off* CVS Health brand products in stores. Plus, no cost visits at CVS MinuteClinic** locations and no cost virtual primary care are part of every Banner|Aetna plan.

You may also have different preferences depending on each plan’s network, which includes all the doctors, hospitals and other providers contracted to provide care. Banner|Aetna's ACA insurance plans are designed to give consumers easier access to care at a lower cost in Cochise, Coconino, Gila, Maricopa, Pinal, Pima and Yuma counties. And in Maricopa, Pima and Yuma counties, Banner|Aetna Silver plans are offered at zero premium for fully subsidized members.

Shop and enroll for coverage

Many people compare and enroll in ACA plans through the Health Insurance Marketplace, which is managed by the federal government. Convenient enrollment in Banner|Aetna health insurance can be completed directly through BannerAetna.com, on HealthCare.gov, or with the help of an authorized health insurance broker. These options are also available to applicants and their families who are receiving federal assistance that lowers premium costs.

Get affordable health insurance in Arizona for 2024

There are a variety of factors to consider when you’re deciding if an ACA plan is right for you, or which plan best meets your needs for affordable health insurance in Arizona. To learn more, visit this helpful overview for individuals and families, and remember that open enrollment ends Jan. 15 for 2024 coverage. With so many affordable and innovative plan offerings from Banner|Aetna and other insurers, it’s the perfect time to enroll.

*FOR $100 ALLOWANCE: $25 allowance each quarter to use on select CVS Health brand products. Unused allowance does not carry over to the next Quarter $25 allowance each quarter to use on select CVS Health® brand products. Unused allowance does not carry over to the next quarter.

*FOR 20% OFF CVS HEALTH BRAND PRODUCTS: Excludes sale and promo items, alcohol, prescriptions and co-pays, pseudoephedrine/ephedrine products, pre-paid gift cards, and items reimbursed by any health plan. Not combinable with other offers. 20% discount is not valid on other CVS brands such as CVS Pharmacy, Beauty 360®, CVS, Gold Emblem® or Gold Emblem abound®. CVS reserves the right to apply the 20% discounts to qualifying items in any order within the transaction. For in-store use only. 20 percent savings is restricted to items purchased for the member, spouse or dependents. Excludes prescriptions, lottery tickets, postage stamps, gift cards, money orders, pre-paid cards, photofinishing, CVS.com purchases and are not valid on other items reimbursed by a governmental program.

***FOR MINUTECLINIC CARE AND SCHEDULING: For a complete list of participating walk-in clinics, log in to BannerAetna.com and use our provider search tool. Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered nonpreventive MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states. Access to walk-in clinics varies by geography. Walk-in appointments are based on availability and not guaranteed. Online scheduling is recommended. Age and service restrictions may apply.

98point6® is a registered trademark of 98point6 Inc. Access to 98point6® is not included in all plans. 98point6 is available to members age 1-17 when an adult parent or guardian is also enrolled in the plan. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving services at no cost-share. However, such services are covered at negotiated contract rates.

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