Health Insurance in Arizona

Having a suitable health insurance has always been a priority in an individual’s mind. Purchasing health coverage is quite expensive which requires a thorough review of all potential risks and its impact on your financial health. In the U.S. nearly 47 million people are uninsured, among whom a majority of families are exposed to the threat of lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.

In 2008, Arizona stood on the 33rd position on the Healthiest States List as issued by the America’s Health Rankings. The state of Arizona, with more than a 6 million population, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide economical health coverage to the uninsurable citizens of Arizona who meet specific eligibility requirements of age and income.

The Arizona Department of Insurance manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, owing to the skyrocketing health care costs, approximately 19.6% of the state population is still uninsured. The access to medical care remains restricted as a result of less number of physicians, lack of proper government funding and high geographical disparity. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 32.5% of uninsured residents come above the 200% FPL category.

On the whole, Arizona’s Health System does have a room for improvement and with the proper funding from the government; health care would soon be available to a larger percentage of the Arizona population. Shopping for health insurance has never been so simple. You need the help of a licensed health insurance agent/broker to the avail the suitable health insurance options and their benefits.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Arizona. These regulations apply to all insurance companies offering individual or family health insurance in Arizona:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
No Limit
Look Back Period
No Limit
Look Back Standard
No Definition
Mandatory Benefits
Cancer screening for women, breast cancer screening, reconstructive surgery after mastectomy, OB/GYNs as Primary Care Providers, depression parity, eating disorder parity
Market Rate Restrictions
None
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Arizona. These regulations apply to all insurance companies offering small group health insurance in Arizona:

Small Group Size
2-50 employees
Employee Qualifications
Must work for at least 6 months out of the year, and work 20 hours per week for coverage
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
60%
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Arizona. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
No
Eligible Group Sizes
NA
Extension of Benefits Period – Standard
NA
Extension of Benefits Period – Disabled
NA
Maximum Premium Increase
NA
State Legislation Reference
NA
Additional Notes
NA
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Arizona to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Arizona does not offer health insurance coverage through high risk pool for individuals who are medically-uninsurable.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Arizona provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
KidsCare
Website
https://www.azahcccs.gov/Members/GetCovered/Categories/KidsCare.html
Phone Number
602-417-5437, 877-764-5437
Apply Online
Yes
Age Limits
18
Insurance Carrier
Varies Based on County of Residence
Length of Coverage
12 months
Residency Requirements
Arizona resident, U.S. Citizen or qualified
non-citizen (5regardless of parent status)
Other Eligibility Requirements
Must be ineligible for no-cost Medicaid or employer-based coverage
No health insurance for the last three months at time of application

Pre-Existing Condition Exclusions
No
Cost
$10 to $25 a month for one child or $15-$35 a month for two or more children
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Arizona:

Governing Agency
Arizona Health Care Cost Containment System
Website
https://www.azahcccs.gov
Phone Number
602-417-4000
Residency Requirements
Arizona residents
Federal Poverty Line Income Limits
Income up to 100% FPL
Additional Resources

Arizona Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Arizona’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Arizona: At-A-Glance
Provides all-inclusive health data of Arizona. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.