Alyssa Lane
Arizona offers a range of health insurance options for individuals and families, including Affordable Care Act (ACA) Marketplace plans, also known as Obamacare. The state uses the federally-run Marketplace, with residents enrolling through HealthCare.gov. Arizona's health insurance Marketplace offers plans from multiple private insurance companies, with varying coverage areas and income-based subsidies. While Arizona does not have an exact equivalent to the Oregon Health Plan (OHP), a program that provides healthcare coverage for low-income residents in Oregon, it does have Medicaid expansion and eligibility, as well as Medicare and supplemental insurance options.
| Characteristics | Values |
|---|---|
| Name of Insurance | Oregon Health Plan (OHP) |
| State | Arizona |
| Type of Program | Medicaid |
| Who is it for? | Low-income residents |
| What does it cover? | Doctor visits, prescriptions, hospital stays, dental care, mental health services, addiction treatment, glasses, hearing aids, medical equipment, home healthcare, transportation to healthcare appointments |
| How to Apply | Online, by phone, or by mail |
| Contact Number | 1-800-699-9075 or TTY 711 |
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What You'll Learn
Arizona's health insurance marketplace
There are a few ways to enroll in a Marketplace plan in Arizona. One can enroll by phone, with the help of a local agent, broker, navigator, or certified application counselor, or via an approved enhanced direct enrollment entity (EDE). It is important to note that EDEs can generally enroll individuals in off-exchange coverage, so it is recommended to request on-exchange enrollment if that is your preference.
Arizona's open enrollment period for ACA Marketplace individual and family health plans is between November 1 and January 15. If coverage is desired to start on January 1, enrollment must be completed by December 15. Enrollment between December 16 and January 15 will result in coverage starting on February 1.
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ACA marketplace premiums
Arizona uses the federally-run Affordable Care Act (ACA) Marketplace, so residents enroll through HealthCare.gov. The ACA Marketplace offers two different types of income-based subsidies: premium subsidies and cost-sharing reductions (CSRs).
Premium subsidies are based on your household income, and about 90% of ACA enrollees in Arizona receive some level of financial assistance. If your income falls within 138% to 200% of the Federal Poverty Level (FPL), you may qualify for a CSR. CSRs provide additional savings on Silver-tier plans by lowering your copays, deductibles, and out-of-pocket maximums.
Arizona's open enrollment period to sign up for ACA Marketplace individual and family health plans is between November 1 and January 15. If you want your coverage to begin on January 1, you must enroll by December 15. If you sign up between December 16 and January 15, your coverage will start on February 1.
If the open enrollment deadline passes, you may still be able to sign up for or make changes to an ACA Marketplace health plan through a Special Enrollment Period (SEP). You may qualify if you experience a Qualifying Life Event (QLE) such as losing other coverage, getting married, or having a baby. You typically have 60 days from the event to enroll in a new plan.
The Arizona Department of Insurance and Financial Institutions regulate and license health plans, agents, and brokers. They provide consumer information about insurance, and you can find more information on their website.
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Medicare and Medicaid plans
Arizona residents can enrol in health insurance plans through HealthCare.gov, the state's health insurance marketplace. Here, individuals and families can find affordable health insurance coverage, with eight private insurance companies offering plans with varying coverage areas for 2025. Arizona's open enrolment period for ACA Marketplace individual and family health plans is between November 1 and January 15.
Arizona also offers Medicare plans, including Medicare Advantage and Medigap coverage. Medicare is a federal program that provides health insurance to people over 65 and those with certain disabilities. It is important to note that one cannot be enrolled in Medicare and receive financial assistance through the Arizona Health Insurance Marketplace.
Medicaid, on the other hand, is a joint federal and state program that helps cover medical costs for certain low-income people, families and children, pregnant women, the elderly, and people with disabilities. In Arizona, Medicaid is known as AHCCCS, and individuals can enrol through the extended SEP if they lost coverage between March 31, 2023, and November 30, 2024.
The Oregon Health Plan (OHP) is another state-specific program similar to Medicaid. OHP is a program that pays for low-income Oregonians' healthcare, with coverage for doctor visits, prescriptions, hospital stays, dental care, mental health services, and more.
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Health insurance costs
Arizona's health insurance marketplace is federally run, with residents enrolling through HealthCare.gov. The state has a range of health insurance options for individuals and families, including Affordable Care Act (ACA) plans, also known as Obamacare. Arizona also offers Medicare, Medicare Advantage, Medigap, and short-term health plans.
The cost of health insurance in Arizona can also be influenced by age, tobacco use, and the metal level of the plan. Metal levels, which include categories like Bronze, Silver, and Gold, indicate the actuarial value of the plan, or the percentage of medical expenses that the insurer will cover. Generally, plans with higher metal levels have higher premiums but lower out-of-pocket costs, while plans with lower metal levels have lower premiums but higher out-of-pocket costs.
Additionally, Arizona offers financial assistance through its Medicaid program, known as the Arizona Health Care Cost Containment System (AHCCCS). Individuals who meet certain income and eligibility requirements can enroll in AHCCCS, which provides comprehensive health coverage at low or no cost. For those who do not qualify for AHCCCS, Arizona has a separate Children's Health Insurance Program called KidsCare, which offers affordable coverage for children in families with incomes too high for Medicaid but too low to afford private insurance.
To find the most affordable health insurance option, Arizonans can compare plans and rates from different providers. The state's health insurance marketplace allows individuals and families to shop for plans that fit their budgets. It is recommended to consider factors such as premiums, deductibles, copayments, and coverage limits when evaluating the cost of health insurance in Arizona.
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Dental insurance
Arizona uses the federally-run Marketplace, with residents enrolling through HealthCare.gov. This is also the case for dental insurance, with Arizona using the federally facilitated health insurance Marketplace, HealthCare.gov, for the sale of certified individual/family dental plans, as well as small group dental plans.
Not all insurers that offer medical plans through the Arizona exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children. There are eleven insurers offering stand-alone individual/family dental coverage through the health insurance marketplace in Arizona for 2025. These plans can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event.
Stand-alone pediatric dental plans available through the Marketplace/exchange in Arizona comply with the ACA's pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care will not exceed $400 per child in 2024 ($800 for all children on a family's plan), and there is no cap on medically necessary pediatric dental benefits.
There are also various dental discount plans available in every state. Dental discount plans are not insurance, but they can offer discounted rates at participating dentists. Adults enrolled in Medicaid in Arizona are eligible to receive up to $2,000 in total dental services, divided between diagnostic/preventive and emergency dental care. Eligible children (up to age 21) are also able to access emergency or medically necessary dental services.
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Frequently asked questions
OHP stands for Oregon Health Plan. It is a program that pays for low-income Oregonians' healthcare. The State of Oregon and the US Government's Medicaid program fund it.
Arizona does not have an Oregon Health Plan (OHP) program. However, Arizona does have Medicaid, which is funded by the US Government, and Arizona Health Care Cost Containment System (AHCCCS), which is Arizona's version of Medicaid.
To qualify for financial assistance through the Arizona Health Insurance Marketplace, you must meet the following criteria:
- You cannot be eligible for affordable coverage offered by an employer.
- You cannot be eligible for AHCCCS (Arizona's Medicaid) or KidsCare (CHIP).
- You cannot be eligible for premium-free Medicare Part A.
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