Frequently Asked Questions

By getting health coverage, you know that your health needs will be covered and that you do not have to worry about what would happen if you had an accident.

For most people, you (and your family) should get an individual health plan through HealthCare.gov if you cannot get public health coverage or affordable health coverage through an employer.

Speak to your employer’s Human Resources department (or your spouse’s or parent’s Human Resources department) to learn if you can get coverage through an employer. HealthCare.gov can help you figure out if you are eligible for public health coverage. If you have been determined disabled according to the Social Security Administration's rules, you may be able to get other types of AHCCCS. Talk to a Work Incentive Consultant to learn more about them.

• HealthCare.gov has a lot of great information introducing your options. You can also call HealthCare.gov at 1-800-318-2596 or 1-855-889-4325 (TTY).
• HealthCare.gov also lists organizations that offer local help for finding the right plan for you. You can use the Live Chat feature if you want to copy-and-paste a record of what was said.
• If you have a disability, talk to a Work Incentive Consultant to learn if you have additional options.

Yes. Plans cannot deny people coverage anymore. That means that when you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.

Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer much more comprehensive coverage than many health plans did in the past, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, just to name a few.

“Health insurance marketplace” is a national term used for the websites in each state that let individuals and small businesses sign up for health coverage. In Arizona, the website is called Health Insurance Marketplace, but a lot of people also call it HealthCare.gov instead, because that's its address on the web. It is operated by the federal government.

“Health exchanges” is a term that was used before HealthCare.gov was established.

There are new programs that make health coverage more affordable if you have low income. If health coverage is too expensive for you, the government may help you pay for it via tax credits. If you still cannot afford a private health coverage plan, you may be able to get a public health coverage plan like AHCCCS. Check HealthCare.gov to see if you can get one of these options.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

Depending on your situation, you may qualify to have the government help pay for your individual health plan via tax credits. Here's how it works:

1. When you sign up at HealthCare.gov, you give details about your family's situation. HealthCare.gov reviews that information instantly. If your family qualifies for government help to pay for individual coverage, HealthCare.gov tells you and lists insurance options for you.
2. Your insurance options list the full cost of the monthly premium, how much of that premium the government will pay each month, and how much you will pay each month. The way the government helps pay the premium is by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
3. In January or February, the government will send you a form listing how much your total health care tax credits were for the previous year. You will need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this will be sorted out when you file your taxes.

No, but depending on your income, you may get more help from the government if you get a silver level plan. Here’s how it works:

• The government may help pay for your premium through tax credits. That means you would pay less each month. You might get this help no matter what metal your plan is.
  
• If you make 250% of the Federal Poverty Guidelines (FPG) or less and get a silver plan, the government also pays to reduce your copayments, co-insurance, deductible, and out-of-pocket maximum. That means you pay less each time you need medical services. If you get this help, your silver plan might actually be as good or better than many platinum or gold plans. If you do not get a silver plan, the government does not help you with these expenses.

Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.

When HealthCare.gov looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

The bottom line: You may get help paying the premium, regardless of whether you get a platinum, gold, silver, or bronze plan, but if you make less than 250% of FPL, you will only get help with your copayments and other expenses if you get a silver plan.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Annual income limits for your family:
	$15,060
	$5,380
	$15,060
	$5,380
Income-based AHCCCS (138% FPG)
AHCCCS KidsCare (205% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

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HealthCare.gov is the best place for you to get individual health coverage. Through HealthCare.gov you can apply for individual coverage or for public health coverage, such as AHCCCS. HealthCare.gov will calculate your eligibility for all of these programs and, if you choose individual health coverage, will tell you how much your premium will cost you and how much the government will help with tax credits.

HealthCare.gov lets you compare health plans side-by-side and figure out which is best for you based on their costs and the benefits they offer.

Usually, when you sign up for a plan through HealthCare.gov, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2024, then you can’t leave that plan until 2025.

However, there are certain situations when you may be able to change plans mid-year:

• If your income changes and you gain or lose eligibility for government help paying for your coverage
• If you move
• In other life-changing circumstances, such as having a child or getting married

The first one is the key. If your income goes down and you can’t afford your plan anymore, you need to report your change in income to HealthCare.gov. You may qualify to get AHCCCS or to have the government increase how much it pays for your current insurance (meaning that you have to pay less).

Note: American Indians do not have these restrictions and can change up to once a month.

Most immigrants can get health coverage through HealthCare.gov. However, the rules are not identical to the rules for United States citizens. Here are the basic rules:

• Legal residents for 5 or more years or who meet specific noncitizen requirements have the exact same benefits as citizens. They can pay for individual plans through HealthCare.gov, qualify to get government help paying for their premiums and other fees (if their income is low enough), and get public coverage through AHCCCS and other programs.
• Some non-citizens who have legal immigration status in the United States do not qualify for full AHCCCS coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who are undocumented cannot get individual plans through HealthCare.gov, cannot get government help paying for their coverage, and cannot get public coverage through AHCCCS. They can purchase coverage through an insurance agent or directly from an insurer and they may qualify for other public programs or for emergency AHCCCS coverage. Visit your local DES/Family Assistance Administration office to learn what programs may exist for undocumented immigrants.

If your immigration status changes and you become eligible for a public program or if you become eligible to use HealthCare.gov, you can sign up immediately – you do not need to wait until open enrollment begins.

Yes, but it is probably a bad idea. If your employer offers coverage that is affordable, you and your family will not get any help paying for an individual plan, so it will be much more expensive than the employer-provided plan.

Note: Before 2023, the spouse or children of an employee would not qualify for subsidies on HealthCare.gov if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." This changed starting in 2023. Learn more about affordability rules for family members and how it affects eligibility for tax credits on HealthCare.gov.