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Arizona Health Insurance

Arizona Medical Insurance Overview

People living in the state of Arizona have the ability to get health insurance coverage through their place of employment, with the aid of state-funded programs or through an individual policy. Despite all of the available choices, residents of Arizona still have a greater percentage of uninsured people than the whole United States. With the addition of health care reform in the state, health coverage statistics are more likely to shift in both directions for the years ahead.

Until the year 2020, health care services provided under the Patient Protection and Affordable Care Act will go into effect. This new law is geared toward the establishment of a marketplace that is dedicated to making it easier for people who need insurance coverage to obtain it. By the year 2020, reports show that 30 million additional residents of the U.S. will be able to obtain affordable insurance coverage. By way of these laws, it is hoped that the residents of the state of Arizona will seek health insurance coverage.

Arizona’s Health Care Issues

Overall, Arizona’s population has seen climbing rates in the area of the health of those living in the state. The United Health Foundation has revealed that Arizona has ranked at 25th place with regard to how well the residents take care of themselves compared to the rest of the country. Residents in this state don’t suffer from high rates of cancer sufferers or problems concerning obesity when compared to the other states in the country, but they do not have a good amount of access to doctors and there are a greater number of kids in the state who are living below the Federal Poverty Level.

Understanding Arizona’s Uninsured Population

The Henry J. Kaiser Family Foundation estimated that Arizona’s residents living without health insurance was at a figure of 18 percent in 2011. The state has seen many expensive health coverage plans, causing residents to struggle with their medical needs. Those who are without employment in the state reached a number that was higher than the entire country as a whole, causing corresponding numbers with those covered under employer-sponsored health plans. Arizona has had many problems providing its residents with adequate health insurance because of health care related budget cuts. In addition, those who suffer from mental illness in the state risk being turned down for insurance under programs like Medicaid.

Provided below are some statistics regarding health insurance trends in Arizona:

  • The number of uninsured children under 19 is at ten percent in Arizona. This figure is five percent higher than the entire country’s uninsured percentage of children.
  • 33 percent of the children residing in Arizona are covered under the Medicaid program.
  • Roughly 29 percent of companies with less than fifty workers offer employer-sponsored health insurance plans to their employees.
  • 16 percent of adults earning between 251 and 399 percent of the Federal Poverty level don’t have insurance coverage.

Group Health Plans

Residents in the state of Arizona have the ability to join their employer’s sponsored health plan regardless of any pre-existing medical conditions. Those entities operating in the state that have of up to fifty workers can offer these types of benefits to their pool of employees, but smaller corporations might be unable to afford the cost of offering these plans and the workers can’t always afford to pay for the premiums. The Health Reform Bill encourages workplaces to offer insurance coverage to workers by giving a 35 percent tax credit for the entire cost of the premiums to those entities operating with less than 25 workers. The Department of Insurance regulates HMOs, individual insurance plans and group plans.

Signing Up

People in Arizona looking to get covered for health insurance should look to see if their employer offers a group health plan. This type of coverage is cheaper than individual coverage and the possibility of enrollment into an employer’s plan typically disqualifies those applying for coverage from a state-funded plan.

There are a few things listed below to keep in mind when considering going through an employer for health insurance coverage:

  • Employers usually offer two plan options, one that is inexpensive with less coverage and one that is costlier with more coverage. Consider these options with regard to what you may need for medical care in the future.
  • Ask the person in charge of the health benefits if there is a specific enrollment period. Sometimes, companies have time frames of which you can enroll for coverage and you won’t be able to do so until that time occurs.
  • Dependent children are required to remain on a parent’s health insurance plan until the age of 26, according to the terms of the Affordable Care Act.

Pre-Existing Condition Exclusion Periods

Despite not being allowed to be turned down for a group plan through your employer because of a pre-existing condition, you may have to wait out an exclusion period in order to receive insurance. In determining whether or not you have a pre-existing condition, insurance companies can look into your medical records for the past six months. If one is found, you may be forced to wait a year until your new coverage goes into effect.

The following information regarding exclusion periods for group plans is listed below for your consideration:

  • Companies providing insurance cannot enforce any exclusion period on a minor child as of September 23, 2010.
  • Under the list of pre-existing conditions, pregnancy is not listed.
  • Without receiving a diagnosis, a person’s genetic predispositions cannot be considered a pre-existing condition for the purposes of issuing health insurance coverage.

Affiliation or Waiting Periods

The maximum about of time you should have to wait following enrollment is sixty days. Those enrolling late might be forced to wait ninety days before their insurance coverage period begins. The insurance company or HMO providing insurance coverage determines the rules with regard to waiting periods.

Individual Health Plans

To those who are able to afford paying a monthly premium, there are individual health insurance plans readily available. The amounts charged can vary and prove to be quite expensive. For instance, a young and healthy non-smoker living in Arizona may be asked to pay a $70 monthly premium with a high deductible amount. Health insurance companies offering these plans are subject to underwriting and coverage can be declined under individual plans because of a pre-existing medical condition.

For people looking to get coverage under an individual insurance plan, there is the disadvantage in that the insurance provider can look back into your medical history as far back as they want and impose any exclusion period they feel is necessary. Elimination riders can exclude various medical conditions or procedures and are legal in Arizona. An estimated amount of 4 percent of the population of Arizona receives coverage under individual health insurance plans. Arizona’s population is privileged to have a renewal policy that guarantees coverage as long as participants pay their monthly insurance premiums. For more information on group and individual plans in the state of Arizona, consult the Department of Insurance’s website. Health insurance policies in Arizona must cover screenings for breast cancer, care for diabetes sufferers, contraceptives and medical care for women who are pregnant.

Continuation Coverage

If you live in Arizona and don’t have health insurance because of a change in employment status or loss of coverage can seek temporary insurance through COBRA (Consolidated Omnibus Budget Reconciliation Act). COBRA can go into effect to provide the uninsured party with health insurance for a year and a half following the day that coverage was lost. To be eligible, it depends greatly on the size of the company of which the individual worked.

Arizona Health Benefit Exchange

Along with many other states in the U.S., Arizona voted to have a benefits marketplace that was completely run by the federal government. Despite accepting the $1 million grant offered for planning the creation of a health benefits exchange, the governor strongly opposed the Affordable Care Act proposed by President Barack Obama in 2010. The governor felt that the federal benefits exchange would mean that Arizona could exercise little control over the marketplace and that the marketplace itself would be subject to vast amounts of federal regulations. With regard to regulations for the benefits exchange, the governor also felt that there wasn’t enough information provided.

Because the state voted to default to an exchange managed on a federal level, the exchange was required to be active by the year 2014. These marketplaces were intended to give resources to uninsured people so that they could find coverage that is reasonably priced and provided a good deal of coverage. For more information, look up the data provided by the Henry J. Kaiser Family Foundation.

Arizona State Insurance Programs

There are a variety of state-funded health insurance programs available to residents in need of insurance in the state of Arizona. Some programs include the Pre-Existing Condition Insurance Plan (PCIP), Arizona Health Care Cost Containment System (AHCCS), SOBRA Child, KidsCare, KidsCare II, the Well Woman HealthCheck Program, Indian Health Services, Baby Arizona and Medicare. Other resources in the state include the VA Medical Benefits Package, the Health Coverage Tax Credit, the Partnership for Prescription Assistance, the WIC Program, Federal Emergency Services (FES), and the National Association of Mental Illness Helpline (NAMI).

For more information on the programs available to Arizona state residents, consult this matrix.

Pre-Existing Condition Insurance Plan (PCIP)

If you have had a problem getting insurance coverage because of a pre-existing medical condition, you should apply for PCIP. If you’ve been uninsured for a period of six months when you apply and have proof of a denial for health coverage, you are guaranteed to receive coverage under this program.


These two programs are designed for families and adults with low incomes and eligibility is determined by meeting certain income requirements.
AHCCCS is Arizona’s version of Medicaid, and it covers a wide range of treatment and health care services including preventive health care, hospital services and visits, lab and x-rays, dialysis, surgery, podiatry, pregnancy services, immunizations, prescription drugs, and more.

SOBRA Child provides coverage options for both pregnant women and children. With both AHCCCS and SOBRA Child, applicants have the possibility of being given retroactive coverage for treatments occurring within three months of application to the programs.

KidsCare and KidsCare II

These programs are designed to cover children from families of a moderate-income level. While both programs provide similar coverage, they each feature slightly different monthly contributions and income requirements. Applicants can only be guaranteed coverage through KidsCare and KidsCareII if they are ineligible for Medicaid and an employer-sponsored group health insurance plan.

Well Woman HealthCheck Program

This program is managed by the Arizona Department of Health Services, and it provides health services such as breast exams, pelvic exams, and pap smear tests to women with incomes of 250% of the federal poverty level (FPL) or below.

Baby Arizona

The Baby Arizona health care program provides prenatal care services to pregnant women who are in the process of applying to AHCCCS. Applicants approved for benefits through Baby Arizona should have an income at or below 150% of FPL.

Indian Health Services (IHS)

Health benefits may be acquired for those who are either Indian or a woman who is pregnant with the child of an Indian, through the Indian Health Services. Coverage can include prenatal and post delivery care, birth control, minor surgical and orthopedic procedures, and nursing.


Those older than 65 or those suffering from a disability or end-stage renal disease can enjoy varying levels of coverage through Medicare or through the Medicare Prescription Drug Program. Pre-existing health conditions are covered through Medicare, and certain services and plans require no minimal monthly contribution.

Health Coverage Tax Credit (HCTC)

The HCTC can cover up to 72.5% of qualifying health insurance premiums for those who meet certain requirements. Applicants who receive the credit must be receiving Trade Adjustment Assistance benefits and payments from the Pension Benefit Guaranty Corporation. The spouse or dependents or an individual meeting these requirements may also be eligible for the credit.

VA Medical Benefits Package

Veterans can enjoy health coverage through the VA Medical Benefits Package. Any individual who served in any branch of the armed forces for more than 24 consecutive months or who served out their entire active duty commitment is eligible for the VA Medical Benefits Package, as long as they were not dishonorably discharged from the services.

Partnership for Prescription Assistance

Those who do not have prescription drug coverage could take advantage of acquiring free or low-cost prescription drugs through the Partnership for Prescription Assistance. The Partnership for Prescription Assistance can connect you to a variety of different prescription drug coverage options, including 475 programs run by both public and private institutions that help individuals get the medications they need.

Women-Infant-Children Program (WIC)

The USDA Food and Nutrition Service run the WIC program, and this program endeavors to improve the health of lower-income women, infants, and children. The program provides nutritional assistance to children up to the age of five years, and also offers some immunization benefits.

Federal Emergency Services (FES)

Part of Arizona’s Medicaid Agency (AHCCCS), Federal Emergency Services (FES), covers medical emergencies that result from health conditions. FES provides medical attention in the case of events that pose serious, immediate risk to the health of an individual.

National Association of Mental Illness Helpline (NAMI)

NAMI is a mental health organization that provides resources intended to improve the lives of the millions of Americans who suffer from a mental illness each year. Volunteers run the NAMI helpline, which provides information to callers regarding mental health services and treatments.

Health Insurance Portability and Accountability Act (HIPAA)

Those in the market for health insurance should be aware of the significance of the Health Insurance Portability and Accountability Act (HIPAA) and the effect it has on health insurance providers. HIPAA brought many restrictions down on health insurance providers; especially in terms of their ability to deny coverage to an individual seeking to join a group health plan due to a pre-existing health condition. HIPAA puts limits on the exclusion period a group health insurance provider can impose, and it also poses limitations on an insurance company’s ability to look back into the medical history of a new enrollee. Although HIPAA was a step forward in securing health insurance for many individuals, it does not require that employers offer a group health insurance plan to their employees.