Arizona Health Insurance Consumer Guide

To buy Marketplace health coverage in Arizona:³

• You must live in Arizona.
• You must be lawfully present in the U.S.
• You can’t be incarcerated.
• You can’t be enrolled in Medicare.

To qualify for financial assistance (which depends on your household income) through the Arizona Health Insurance Marketplace:

• You can’t be eligible for affordable coverage offered by an employer. You can use this tool to see if the employer-sponsored coverage available to you is considered affordable.
• You can’t be eligible for AHCCCS (Medicaid) or KidsCare (CHIP)
• You can’t be eligible for premium-free Medicare Part A.⁴
• If married, file a joint tax return.⁵
• Not be able to be claimed by someone else as a tax dependent.⁵

Arizona’s open enrollment period to sign up for ACA Marketplace individual and family health plans is between November 1 and January 15. The enrollment window applies whether you enroll through the exchange or directly with an insurer.

If you want your coverage to begin on January 1, 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). To qualify for a SEP, you’ll generally need a qualifying life event.

But there are instances where you don’t need a specific qualifying life event to apply outside of open enrollment. For example:

• If you’re eligible for premium tax credits and your income is not more than 150% of the poverty level, you can enroll anytime.
• If you’re part of the American Indian/Alaska Native population, you can enroll whenever necessary.

If you lose AHCCCS or KidsCare (Medicaid/CHIP) coverage between March 31, 2023 and November 30, 2024, you can enroll through the extended SEP.⁶

Here are the main ways to enroll in a Marketplace health plan in Arizona:

• Directly through HealthCare.gov
• By phone at (800) 318-2596 (TTY: 1-855-889-4325). Talk to an agent 24 hours a day, seven days a week, except for holidays.
• With the help of a local agent/broker, Navigator, or certified application counselor.
• Via an approved enhanced direct enrollment entity (EDE).⁷ (Make sure you request an on-exchange enrollment if that’s your preference, as EDEs can also generally enroll you in off-exchange coverage if you prefer that.)

In Arizona, individuals and families can generally find affordable health insurance coverage by shopping on HealthCare.gov, which is Arizona’s health insurance Marketplace. The Marketplace offers two different types of income-based subsidies:

• Premium subsidies: Depending on your household income, you could be eligible for subsidies known as Advance Premium Tax Credits (APTC) that help lower your monthly premiums. About 90% of Marketplace enrollees in Arizona qualified for premium subsidies in 2024, saving on average $453 monthly. With subsidies, enrollees paid an average of $115 per month for health coverage.⁸ (Note that these numbers are based on effectuated enrollment; the metrics and data in the chart below are different and are based on all applications submitted during the open enrollment period for 2024 coverage.)
• Cost-Sharing Reductions: If your income is no more than 250% of the federal poverty level⁹ and you select a Silver-level plan, you can receive cost-sharing reductions (CSR) in addition to APTC. CSRs help reduce your out-of-pocket costs, making medical care more affordable when you need it.¹⁰

Source: CMS.gov¹¹

Medicaid: If you’re eligible for Medicaid, you can enroll through the Arizona Health Care Cost Containment System (azahcccs.gov) or Health-e-Arizona (healthearizonaplus.gov).

Short-Term Health Insurance: Consider short-term health insurance if you need a more budget-friendly option and are either ineligible for Marketplace subsidies or Medicaid, or missed the enrollment window for a Marketplace plan (in that case, you’ll want to make sure you go back to the Marketplace to enroll during the next open enrollment window, which begins November 1 each year).

Eight private insurance companies will offer coverage through Arizona’s health insurance Marketplace for 2025, with varying coverage areas.¹ There were also eight insurers in the Arizona Marketplace in 2024,² but Medica is leaving the Arizona market at the end of 2024, and Antidote Health Plan is new for 2025.

In 2024, only one carrier offered coverage statewide; the rest had varying coverage areas. In some areas of the state, plans were only available from one insurer.¹²

In Arizona’s individual/family insurance market, the following average rate changes have been approved for 2025, applicable to full-price plans (meaning before subsidies are applied):

Source: Arizona Department of Insurance and Financial Institutions¹

When looking at overall average rate changes, it’s important to understand:

• Published rates are for full-price plans. Most Arizona Health Insurance Marketplace enrollees receive premium subsidies,⁸ so their net rate change also depends on how much their subsidy changes.
• Averages don’t account for premiums increasing with age. People pay more each year as they get older.
• A weighted average lumps all plans together. But rate changes vary by insurer (as noted above) and plan.

For perspective, here’s a summary of how average pre-subsidy premiums have changed over time in Arizona’s individual/family health insurance market:

• 2015: Average decrease of 3%¹³
• 2016: Average increase of 12.3%¹⁴
• 2017: Average increase of 57%¹⁵
• 2018: Nearly flat rate for the two on-exchange insurers¹⁶
• 2019: Average decrease of 6.3%¹⁷
• 2020: Average decrease of 0.2%¹⁸
• 2021: Average increase of 0.4%¹⁹
• 2022: Average increase of 0.5%²⁰ (three new insurers joined the exchange)
• 2023: Average increase of 4.3%²¹
• 2024: Average increase of 0.3%²²

During the open enrollment period for 2024 coverage, 348,055 people signed up for private health plans through Arizona’s exchange.²³

This was by far a record high (see chart below). The increase in enrollment was driven in large part by the enhanced premium subsidies available as a result of the American Rescue Plan and Inflation Reduction Act.²⁴ But the 2024 enrollment spike was also driven by the “unwinding” of the pandemic-era Medicaid continuous coverage rule. According to CMS, more than 134,000 people had transitioned from Arizona Medicaid to a Marketplace plan by April 2024, during the unwinding process.²⁵ 

Source: 2014,²⁶ 2015,²⁷ 2016,²⁸ 2017,²⁹ 2018,³⁰ 2019,³¹ 2020,³² 2021,³³ 2022,³⁴ 2023,³⁵ 2024³⁶

HealthCare.gov
The official federal website where you can sign up for health insurance plans through the ACA Marketplace. 

Arizona Department of Insurance
Regulates and licenses health plans, agents, and brokers. Provides consumer information about insurance.

Arizona Health Matters
A resource that provides information about health concerns in Arizona. 

Arizona Association of Community Health Centers/Arizona Alliance for Community Health Centers
Community health centers that are also Arizona’s federally-funded Navigator. Help with exchange enrollments.

Arizona Health Care Cost Containment System
Administers Medicaid in Arizona. Provides coverage to low-income residents.

Medicare Rights Center
National service with a website and call center to assist Medicare beneficiaries and their caregivers. 

Arizona State Health Insurance Assistance Program
Local counseling, advice, and assistance with Medicare issues.