Affordable Options for Health Insurance in Tucson

Updated: November 9, 2022
Health insurance in Tucson
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Residents of Tucson have access to affordable health insurance policies through the state marketplace, and Medicaid expansion in Tucson may make coverage available to low-income households. We compared all of the policies on the state exchange to identify those with the most affordable rates so that you may select the health insurance plan that is right for your family. Let’s learn about health insurance in Tucson in detail.

Tucson’s average monthly premium for health insurance is $503. Since the 2021 plan year, the cost has increased by 5%.

In 11 of Tucson’s 15 counties, Blue AdvanceHealth Silver – Neighborhood Network is the least expensive Silver health insurance plan available to residents.

Options for health insurance in Tucson, Tucson

In a fee-for-service (FFS) health plan, the doctor gets compensated only for the services they render to the patient. Patients are allowed to select the physician of their choice, and claims may be submitted by either the patient or the healthcare practitioner.

The majority of health care plans use managed care in some way. Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Point-Of-Service (POS) are examples of managed care policies.

HMO: With an HMO, your primary care doctor is the intermediary for all your medical services. Before seeing specialists or other medical professionals, you will require a recommendation. Typically, reduced paperwork and lower healthcare expenditures benefit all parties.

PPO: This strategy gives you more freedom. You are not required to have a primary care physician and may consult with any medical specialist of your choosing while keeping within the network will result in cheaper out-of-pocket expenses.

The benefits levels of POS plans can change based on whether you receive your treatment from a network of providers, and they include some of the best aspects of HMO and PPO plans. Similar to HMO plans, you can choose your primary care physician but will occasionally require a referral to a network specialist. Similar to PPO plans, non-network care is possible, but the out-of-pocket expenses are higher.

It’s important to get the proper Tucson medical insurance coverage. An HMO plan may be the best option if you prefer to have your care coordinated by your primary care physician. Consider a PPO plan if you frequently see specialists or would like greater flexibility in your medical care.

The Affordable Care Act and Tucson

As in the majority of other states, the number of Arizonans with health insurance coverage has increased because of the Affordable Care Act (ACA, sometimes known as Obamacare). Tucson had 1.1 million uninsured residents in 2013 when the Health Insurance Marketplace’s first open enrollment period started. By 2016, the figure had fallen to 681,000, representing a reduction in the state of Tucson’s uninsured population of 39.1%.

As of 2019, 11 percent of Tucson’s were uninsured, which is now somewhat higher than the 9 percent national average.

Through Medicaid expansion, the ACA has also benefited Tucson’s. Tucson got federal funding in 2014 to increase its Medicaid eligibility threshold for low-income residents to 138 percent of the federal poverty line. (FPL). With the expansion of Medicaid in Tucson, 432,100 additional people can now take advantage of low-cost or free medical coverage (AHCCCS).

The Tucson Health Insurance Marketplace enrollment

Open enrollment in the federally run Healthcare.gov Marketplace occurs annually in Tucson, beginning on November 1 and ending on January 15. The Affordable Care Act’s private individual and family health insurance enrollment period are currently open (ACA). You can also enroll in these programs if you’re a sole proprietor without any employees.

Since 2015, when Tucson’s Marketplace’s participation peaked at roughly 206,000, enrollment has decreased yearly. A little over 154,000 residents signed up for insurance through the Tucson Health Insurance Marketplace for the 2021 coverage year, a slight decrease from the 160,000 who did so the year before.

In addition to enrolling through Healthcare.gov’s public exchange, you can also purchase ACA-eligible coverage through the Private Marketplace. This includes dealing with a licensed insurance agent or purchasing health insurance directly from a private insurer. Also, check out Well Care health insurance reviews to find out how much coverage it provides.

Medicare and Tucson

Of those Medicare beneficiaries, 85% are eligible due to their age (65 or older). The remaining 15%, typically younger than 65, qualify due to a disability.

Medicare benefits are available to Tucson’s people in a variety of ways. Original Medicare, which includes Part A hospital and Part B health insurance, is the default choice. Some people are registered in Original Medicare without doing anything, and the federal government manages it.

Original Medicare provides coverage to over 783,000 residents.

Many people with Original Medicare additionally purchase additional plans that commercial insurance firms offer. In 2018, about 455,000 Tucsonns enrolled in Medicare Part D, generally known as a Prescription Drug Plan. There is also Medicare Supplement (commonly known as Medigap), which assists in covering all or a portion of the out-of-pocket medical expenses associated with Original Medicare.

Private health insurance through Medicare Advantage, which also includes Part A and Part B, is an alternative to Original Medicare. In addition to Original Medicare, Medicare Advantage also provides supplemental benefits, including regular dental and eye treatment and prescription medication coverage. Approximately 570,000 Tucson residents are presently enrolled in Medicare Advantage.

Costs of Health Insurance in Tucson

The state has approved premium price hikes for 2021 that vary from 1.82% to 9.33% for Blue Cross and Blue Shield of Tucson, Bright Health Company of Arizona, Cigna Healthcare of Arizona, Health Net of Arizona, and Oscar Health Plan.

When compared to the previous year, it was projected that residents of Tucson will not experience any price hikes for individual or family plans in the year 2020.

In Tucson, the average monthly premium for a silver Marketplace plan in 2021 was $436, a decrease from $442 in 2020. Your costs can be significantly lower if you are eligible for government subsidies.

An Obamacare silver plan would cost $85 after subsidies (or $353 before subsidies) for a 30-year-old in Mesa, Tucson, who makes $30,000 annually.

Obamacare Grants

With Obamacare subsidies from the federal government, low-income individuals may obtain reasonably priced private health insurance in Tucson. This includes premium tax credits that cut your monthly premium for any metal plan. You might be eligible for cost-sharing reductions for silver plans to lower your out-of-pocket costs.

Prior to 2021, if you signed up for a Marketplace plan and your income fell within the range of 100 and 400% of the federal poverty line, you were eligible for premium tax credits. The federal government increased subsidies in 2021; therefore, there is no upper-income limit for eligibility. Instead, you must only spend 8.5% of your household income on health insurance. Subsidies will be used to make up the difference. You can see the income restrictions for larger households in our Obamacare subsidy chart.

46% of Tucson Marketplace enrollees for 2021 obtained cost-sharing reductions, compared to 81 percent who received subsidies.

The average subsidy was $466, which brought down monthly costs to an average of $130.

Medicaid program

One in five Tucsonns between the ages of 19 and 64 receive Medicaid assistance. About 40% of American children are enrolled in Medicaid, which covers their medical expenses. Tucson’s Medicaid program, the Tucson Health Care Cost Containment System, was dubbed by a trio of researchers. Depending on your income, you might be eligible for free or low-cost coverage through AHCCCS.

Who is eligible for AHCCCS health insurance in Tucson is listed below:

  • Adults without children
  • Children
  • Children’s caregivers
  • Pregnant females
  • People with developmental or physical disabilities
  • Women seeking breast and cervical cancer screenings
  • Adults over 65
  • People in need of nursing home care
  • Some Medicare beneficiaries

Children’s Health Insurance Program for Tucson (CHIP)

Your household’s uninsured children (18 and under) who are not eligible for Medicaid may be able to get affordable health insurance through Tucson’s KidsCare program.

Eligibility is based on household size and income. For instance, if you have a household of four, your income cannot exceed $53,004. If accepted, you’ll pay up to $50 per month for a single child or up to $70 per month, no matter how many children you have.

Locating the greatest health insurance coverage in Tucson

You can qualify for health insurance coverage through Tucson’s expanded Medicaid program if your household income is less than 138% of the federal poverty threshold. For individuals who don’t meet the requirements, the best affordable health insurance plan offered through the Tucson marketplace will be determined by your county of residence, household income, and anticipated medical costs. There are several health plans available depending on the county. For instance, an Apache resident might have different coverage possibilities than a Pima resident.

You can select between many metal tier health plans, each of which has advantages and disadvantages within a specific Tucson county.

Gold plans are ideal if your anticipated medical expenses are considerable.

In spite of the fact that Gold health insurance plans have the highest premiums (in Tucson, on average, they are 20% more expensive than Silver plans), your variable costs will be significantly lower if you go with one of these policies. The cost-sharing components of gold health plans, like as deductibles, copays, and coinsurance, are among the lowest available, making them an excellent choice for individuals who anticipate incurring significant medical expenses in the near future.

For instance, if you use prescription medications on a regular basis, you will most likely find that the out-of-pocket payments associated with Gold plans are the lowest.

Bright Health Gold 1000 Direct is the least expensive Gold plan in Tucson.

Silver plans: Ideal for those with average medical expenses or little income

If you live in a low-income household, one of these policies is probably the best affordable health insurance plan because silver plans are eligible for cost-sharing reductions. A suitable compromise between Gold and Bronze plans, Silver insurance combines affordable monthly premiums with out-of-pocket costs in the event that you do require medical attention.

Bright Health Silver 4000 Direct is the least expensive Silver plan in Tucson.

The Bronze and Catastrophic policies are best for healthy individuals with modest anticipated medical bills.

Only individuals under 30 or those who satisfy certain criteria are eligible for catastrophic insurance. However, we would only advise these policies for those who are relatively young and in good health. Similarly to this, if your predicted medical expenses are low and you can afford the high out-of-pocket charges in the event that you require medical attention, a Bronze plan will probably be the best affordable health insurance option for you.

Although Bronze and Catastrophic health insurance plans offer the lowest monthly premiums, you might have to pay a hefty bill before your coverage begins because of their high deductibles, copays, and coinsurance.

The Ambetter Essential Care 1 plan offered by Health Net of Tucson, Inc. is the bronze coverage option with the lowest monthly premium in Tucson. The Bright Health Catastrophic 8700 Direct plan is the catastrophic option that comes with the most affordable monthly premium.

Tucson’s best affordable health insurance providers

Six different health insurance companies are represented on the Tucson health market for the year 2022. These are:

  • Bright Health Company of Tucson
  • Blue Cross & Blue Shield of Tucson
  • Oscar Health Plan
  • Cigna HealthCare
  • Health Net of Tucson
  • UnitedHealthcare of Tucson

Blue Cross & Blue Shield of Tucson offer the most cost-effective Silver plans in 11 counties across the state. Some health insurers may not be available in your area, so it may not be easy to shop around and get the best health insurance policy. Only one insurance company, Blue Cross Blue Shield of Arizona, is available statewide.

FAQs

What Tucson health insurance is the best?

Your budget and usage will determine which health insurance in Tucson is best for you. Catastrophic policies with lower monthly premiums but larger deductibles and copays are Tucson’s lowest tier of plans. These plans misuit for people without a high prescription drug usage rate or frequent medical needs. Gold plans are more affordable for people who have continuing medical costs since they have higher premiums but lower out-of-pocket payments.

How much does health insurance cost in Tucson?

The current average monthly cost of an Affordable Care Act health insurance policy in Tucson for an individual who is 40 years old and has coverage under any plan tier is $503. Those who are qualified may be able to lower the overall cost of their insurance coverage by applying for cost-sharing subsidies or premium tax credits, whichever is applicable. These methods of decreasing costs vary according on the number of people in a family and their income.

How can I receive Tucson’s free health insurance?

The Medicaid program in Tucson may be able to provide you with low-cost or even completely free medical coverage. The Medicaid programs cover a variety of services, such as going to the doctor, getting immunized, filling prescriptions, and meeting any other essential medical criteria. Please visit this page for further information on how to apply for and qualify for Medicaid in Tucson.

How much does Tucson health insurance cost each month?

Tucson’s average monthly premium for health insurance is $503. Since the 2021 plan year, the cost has increased by 5%.

In Tucson, how do I obtain health insurance?

Visit the Health-e-Tucson PLUS online application page to submit an online application. Visit the Tucson Health Care Cost Containment System (AHCCCS) page for further details on how to apply. An application form will be available for direct download from the website.

Is health care affordable in Tucson?

Medicaid and KidsCare are two government-funded healthcare initiatives managed by AHCCCS in Tucson that help low-income residents obtain health insurance. Your income, the number of people living in your home, their ages, and whether you are a caregiver for someone with a handicap will all affect your eligibility.

Summary

The CMS website served as the source for the data on Tucson health insurance rates used in this analysis. Using data from the CMS Public Use Files, we determined the average premium for varying factors such as metal level, county, and family size (PUF). In our research, we used the plans and providers for which the CMS Crosswalk file contained county-level data; those who were left out of this dataset might not be visible.

Visit our website NewHealthInsurance.com to learn more.

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