Known for turquoise, cacti, and the Grand Canyon, Arizona is a desert state filled with mountains, natural beauty and the attraction of some major cities. Phoenix is the sixth largest city in the U.S., comprising much of the Arizona population in the metro area, as well as nearby cities Scottsdale and Tempe.
For residents of Arizona, there are several great health insurance companies to choose from, such as Aetna, Blue Cross Blue Shield of Arizona, Cigna, Humana, Health Net and UnitedHealthcare. Due to the abundance of options, you are welcome to contact one of our Arizona agents at any time for extra assistance at 888 803 5917.
The overall level of health in the State of Arizona has increased over the past two years, though it still can use some further improvements. Based on the low population of smokers, which is 13% of adults over age 19 in 2011, it is the fourth lowest adult smoking population in the country. There is also a low rate of preventable hospitalization as well as a low rate of death caused by cancer and cardiovascular illness. Binge drinking is moderate in prevalence in Arizona, coming in at 14th in the nation.
Some of the less positive attributes of Arizona health are the amount of obese adults, and adults with diabetes. There are currently 1.2 million individuals living in Arizona who are considered obese, which has increased over the past ten years. The amount of adults with diabetes has doubled in the past ten years as well. Throughout the country, there is room for improvement in health status. This can be helped immensely by making lifestyle changes in diet and exercise, as well as making use of health insurance and public health programs if needed. Arizona residents have access to great health insurance companies for medical needs as well as the ability to take initiative and live healthy.
Health Insurance Plans
- Open Access Managed Choice plans in Arizona come in deductible options of $3,000 or $6,000 for individuals, and double for families. These plans give members freedom to choose their providers, whether in-network or out-of-network. Using in-network providers will give you preventive care for no cost to you, which includes immunizations for children and adults, routine physicals, mammograms, and other screenings. Once you have met the deductible, you can receive in-network care for either 20% or 40% depending on the service. Starting immediately, you can see a physician for non-preventive care for a copay for the first three visits.
- PPO plans are available in deductibles of $2,500, $3,000, and $5,000, and PPO Value plans are available in deductibles of $1,500, $5,000 and $10,000. The higher the deductible, the lower your monthly premium, and you have access to the Aetna PPO network for discounted rates on medical care of all sorts. Inpatient hospital stays, outpatient surgery, medical supplies, in-home care, and more are covered at a designated amount of coinsurance after deductible. The first three physician office visits are available for a copay, which varies depending on your plan ($35-50). Preventive care is available as soon as your plan begins with an in-network provider for no cost.
- PPO High Deductible plans from Aetna are compatible with health savings accounts (HSAs) and can therefore bring a greater level of control to your health care spending. Due to the high deductible, the premium is lower and the amount of services you receive is the most comprehensive of any plan offered. After you meet your deductible, which can be assisted by your HSA funds, you can receive virtually any type of medical care from inpatient work to doctor’s office visits in-network for no cost or 10% coinsurance. Deductible options are $3,500 and $5,500 for individuals, and preventive care is available immediately for no charge with network doctors.
Blue Cross Blue Shield of Arizona
- PPO plans from BCBS of Arizona come in a variety of types, including BlueOptimum Plus, BlueValue Plus, BlueEssential Plus, BlueBasic Plus. For physician’s office visits, you pay a $30 copay for non-preventive care for illness or injury, or $50 for a specialist no matter which plan you choose. From the day your plan starts, you can use in-network providers for preventive services like immunizations, well child care, routine physicals and more at no cost. Urgent care is also available for a $60 copay. These plans offer a solid set of benefits for all types of budgets, and once you meet your deductible, your hospital care is covered at 80% in-network (60% out-of-network) by the plan.
- HSA-qualified PPO plans are under the BluePortfolio Plus type for Arizona health plans. These plans are the most comprehensive and offer coverage on most medical services for no cost after deductible. They are also very efficient for those who like to have control over their medical spending, and wish to have a variety of health care options. After you have met the deductible, you can see an in-network primary care doctor for no cost, as well as receive discounts on prescription drugs, receive hospital services such as lab work, surgery and inpatient stays. Preventive care is covered at 100% immediately when your plan starts if you use a network provider.
- Open Access plans in Arizona are available in many deductible options, with coinsurance choices of 80/20% or 100%, depending on the deductible you choose. With an Open Access plan that has 100% coverage after deductible, you can receive a broad range of care for no cost, including surgery, inpatient room and board, physician services, lab work, ultrasound, cardiac and pulmonary rehabilitation and more. There are discounts in-network for both home-delivery and retail pharmacy options for prescription drugs of all categories.
- Open Access Value plans have a variety of deductibles and 70/30 coverage after you meet the deductible. There is a copay for primary care physician visits as well as specialists as soon as you plan begins. Immediate benefits also include preventive care, such as immunizations, well-child care, screenings for cancer and more. Services available once you have met the deductible include inpatient hospitalization, surgery, allergy testing, lab and X-ray, diagnostic testing and more.
- Health Savings plans come in three deductible options: $1,500, $3,000 and $5,000 for individuals in-network. Each of these plans has an extensive level of coverage, covering 100% of major medical costs once you meet the deductible. Covered services include doctor’s office visits, specialist visits, lab work, short-term rehabilitative therapy, outpatient surgery, inpatient hospitalization and more. Emergency and urgent care are also included, as well as mental health care and pharmacy services. With your health savings account, you can save for retirement, or pay for qualified medical costs as you go.
- PPO plans come in three different types: Value, Advantage, and SelectChoice, with a variety of deductibles to choose between. These plans give you access to HealthNet’s preferred network of providers for discounted rates on medical services. You also have the freedom of seeing out-of-network providers of your choice, though your coinsurance will be slightly higher. Depending on which plan you choose, HealthNet will cover 70 or 80% of medical expenses after having satisfied the deductible amount. Some services are available as soon as your plan starts, such as primary care doctor visits, urgent care, and prescription drugs for a copay. Preventive care services are also available immediately for no cost when you are using in-network providers.
- HSA-compatible PPO plans are available in $3,000 and $5,000 deductibles for individuals, with the ability to open a health savings account (HSA). If you choose to open an HSA, you have more control over your spending in regards to health care, and receive tax advantages as well. As soon as your plan starts, you can receive preventive care for no cost when using network providers. These plans have the most comprehensive level of coverage, with 100% of your major medical bills covered after you meet your deductible. These services include outpatient care, lab work, specialist and non-specialist visits, inpatient hospital care, surgery, MRIs and other outpatient imaging, emergency care and more.
- HMO plans from HealthNet Arizona give you access to the HMO network, and make your care very structured through your primary care doctor. While you need referrals to see specialists other than your doctor and can only use providers in the HMO network, the network is one of the largest available in the state of Arizona. There is a $3,500 deductible, and once you have met that amount, you can receive more medical services for 30% coinsurance. Preventive care is no cost, including mammograms, screenings for prostate and colorectal cancer, vision and hearing exams and immunizations. Once your plan starts, you can visit your primary care doctor for a $30 copay, specialists for $60, and receive maternity care for a $30 copay each visit.
- Copay plans from HumanaOne in Arizona have the convenience of using set prices for certain medical costs, such as doctor’s office visits and prescription drugs. These plans are available in the following types: Enhanced Copay 80, Copay 80 and Copay 70. Enhanced Copay 80 plans have prescription discounts and a richer set of benefits, as well as the 80% coverage after deductible you get on most medical services. Immediately when your plan starts, preventive care is offered at no cost through in-network doctors, which includes immunizations, screenings, well child care, physicals and the like. These plans are similar to an employer-sponsored plan, which can be convenient for those who are used to using a copay method.
- 100% After Deductible plans are just as the name suggests, extremely convenient and cover 100% of your medical costs after deductible. These plans are available in Value, Enhanced HSA and HSA types, and come with a variety of benefits. Enhanced HSA and Value plans have prescription drug coverage, while HSA 100 does not, but both HSA plans allow you the opportunity to open a health savings account. Preventive care is available before you meet your deductible with each of these plans. There is a wide array of deductibles to choose from, between $1,500 to $7,500 in-network for individuals, and $3,000 to $22,500 for families.
- Copay plans from UnitedHealthOne are convenient and simple for individuals who want to pay a predictable rate for health care services. These plans are similar to group plans from an employer, but you have the freedom to choose in-network or out-of-network care because it is a PPO. As soon as your plan starts, you have the ability to receive preventive care such as cancer screenings, immunizations, well-child care and other exams for no cost. Prescription drugs are available for discounted prices, such as $15 for generics, and $30-40 for brand names through Copay 100 and 80 plans. Once you have met the deductible, you can receive more services through in or out-of-network providers, such as inpatient hospital stays, surgery, outpatient services and more. UnitedHealthOne has one of the largest provider networks throughout the state and the country, so you can always choose a good provider.
- High Deductible plans are available in three types, including Plan 80, Saver 80 and Plan 100, which means you can either have your plan cover 80 or 100% of your health care costs after deductible. Plan 100 is the most comprehensive coverage option, with more services available for no cost after you meet your deductible in exchange for higher premiums. Plan 100 and Plan 80 cover physician and specialist visits and prescriptions drugs, while the Saver plan does not, due to its low premiums. High deductible plans all cover preventive care at 100% before deductible.
- Health Savings Account plans in Arizona come with 100% in-network coverage on most major medical services after having met your deductible, and the ability to pair your plan with an HSA. Funds from the HSA can be used to pay for qualified health care costs, including your deductible, coinsurance, and other cost-sharing. Premiums are lower due to the high deductible, and preventive care is available for no charge from the start date of your plan. Most medical services are covered, as these are very comprehensive plans, including inpatient and outpatient hospital care, emergency room visits, home health care and more.
Public Health Options
Arizona offers its residents a variety of services and programs that are state-funded and can help those with medical or financial needs. These programs are designed to give people who are uninsured, cannot afford health insurance, have a right to health insurance, or have medical conditions get access to the same services as those with insurance. Primarily, Medicaid, called AHCCCS in Arizona, provides medical assistance to families and children with a low income, as well as pregnant women, elderly and disabled individuals. There are also programs to help prevent disease, help plan a family safely and confidentially, and also prescription drug assistance programs. For a full list of programs, visit the Arizona Department of Health Services. The following is a list of highlighted programs run by the state that you may be eligible for if you live in Arizona and meet the criteria.
- AHCCCS: Medicaid/health care coverage for families and children of Arizona who have a low income, as well as disabled, aged, and other groups of medically needy individuals.
- KidsCare: health care services provided to a select amount of children under 18 in Arizona who meet certain income and eligibility criteria, such as not being eligible for Medicaid.
- AIDS Drug Assistance Program (ADAP): assistance with getting residents of Arizona who have HIV/AIDS the medication they need if they cannot afford it.
- Reproductive Health/Family Planning Program: free and confidential education and testing to help prevent disease and provide contraceptives to anyone of any income level in Arizona who needs such services.
Health Insurance Laws
In the state of Arizona, health insurance companies have some regulations that work in their favor, including the laws for pre-existing conditions. Whereas most states use the objective or prudent person standard to define what a pre-existing condition is, Arizona insurers have no definition and have the right to determine it for themselves. Once they have decided an individual has a pre-existing condition, they can refuse to sell them a plan altogether. The health insurance company can also agree to sell them a plan, but raise the premiums, and issue an exclusion period of up to any amount of time they choose. This means the insurer will not pay for any care related to the pre-existing condition as long as the policy-holder remains in the exclusion period. They are also allowed to attach an elimination rider to the plan, which permanently makes it the policy-holder’s responsibility to pay for treatment of the pre-existing condition, though other medical services will be covered by the plan.
Despite the lack of concern for the individual in regards to having a pre-existing condition, there is an alternative to being rejected or charged too much. The Pre-Existing Condition Insurance Plan (PCIP) guarantees coverage to anyone who has been decided as having a pre-existing condition or deemed a high-risk individual. These plans provide medical coverage for affordable rates, and in Arizona, PCIPs are operated by the U.S. Department of Health and Human Services. These plans will expire in 2014, when the new legislation becomes effective for adults with pre-existing conditions.
As of 2014, the Affordable Care Act will make it illegal for insurance companies to deny coverage to any adult based on their health status. The law makes it possible for everyone to receive health care, either through the private health insurance market (companies like Aetna, Blue Cross and United) or state health exchanges. Regardless of having a pre-existing condition, everyone will be able to receive care and not receive an increased premium for being a potentially expensive client for a health insurance company. The use of elimination riders and exclusion periods will also be out of the question, as the law attempts to ease everyone into a private health plan or state run exchange health plan that fits their needs. The bottom line: get everyone insured no matter what.
Another important regulation is the guaranteed renewability provision of the HIPAA law. HIPAA has enabled many needy individuals to receive health care such as Medicaid, as well as protected the rights of privacy when medical information is transferred. There is also a law within the act that state that if an insurer takes on a client, they must offer to renew their plan when their term is over. This is true unless the insured individual has violated their plan in any way, such as not meeting premium payments or committing fraud on an application. Guaranteed renewal also makes sure that the policy-holder can keep their plan, despite contracting an illness or having a change in health status after they have applied for insurance. The insurance company does not have the right to cancel or revoke benefits due to health status.