Your Arizona health insurance options before Medicare

If you are under 65 and need health insurance, you generally have five places to look: an employer plan, a Marketplace plan on HealthCare.gov, a plan bought directly from an insurance company, AHCCCS (Arizona's Medicaid program) if your income is low enough, or temporary cover such as short-term medical. Each one solves a different problem. The right answer depends on your income, your health, your doctors and how long you need the coverage, and a licensed agent can lay them side by side for you at no cost.

The five places coverage comes from

Most people only ever see one option at a time: whatever their job offers, or whatever an ad shows them. It helps to see the whole map first, because the choice you make in one place often closes a door somewhere else.

Marketplace plans and off-exchange plans

Arizona uses the federal Marketplace, HealthCare.gov. Every plan sold there follows the Affordable Care Act: no one can be turned down or charged more for a health condition, every plan covers the ten essential health benefits, and preventive care is covered without a copay when you use a network provider.

The same insurance companies often sell ACA plans directly, outside the Marketplace. Those plans follow the same consumer protections. The difference is money: premium tax credits are only available on plans bought through HealthCare.gov. If there is any chance your income qualifies, start on the Marketplace.

Open Enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027, according to HealthCare.gov. Enroll by December 15 for coverage that starts January 1. Outside that window you need a qualifying life event, such as losing other coverage, moving or having a baby.

Plan types: HMO, EPO, PPO and POS

Inside each metal level you will see letters. They describe how the network works, and they matter as much as the price.

• HMO: you use the plan network and usually need a primary care doctor and referrals. Out-of-network care is not covered except in an emergency.
• EPO: network only, like an HMO, but often without referrals.
• PPO: you pay less in network, and the plan still pays something if you go out of network, at a higher cost to you.
• POS: you pay less in network and need a referral from your primary care doctor to see a specialist.

Short-term medical: a bridge, not a home

Short-term medical plans are not ACA plans. They can start quickly and often cost less, which makes them useful for a healthy person between jobs or waiting for new coverage to begin.

The trade is real. Short-term plans use medical underwriting, so they can decline you or exclude pre-existing conditions. They usually leave out maternity, mental health care and routine preventive visits, and they have benefit maximums. Read the exclusions list before you buy, and remember that choosing short-term cover does not open a new enrollment window for an ACA plan later.

Where a Health Savings Account fits

A Health Savings Account (HSA) is not insurance. It is a tax-advantaged account you can open when you are covered by an HSA-qualified high-deductible health plan. Contributions are tax deductible, growth is tax free, and withdrawals for qualified medical expenses are tax free.

For 2026 the IRS limits are $4,400 for self-only coverage and $8,750 for family coverage, plus a $1,000 catch-up if you are 55 or older (IRS Rev. Proc. 2025-19). For 2027 the IRS has announced $4,500 and $9,000 (IRS Rev. Proc. 2026-24). Starting in 2026, federal law also treats Bronze and Catastrophic Marketplace plans as HSA compatible (IRS Notice 2026-5), which opens HSAs to many more individual buyers.

How to read a plan before you buy it

Every ACA plan has to give you a Summary of Benefits and Coverage, a standard form that lets you compare plans apples to apples. It shows the deductible, copays, coinsurance and out-of-pocket maximum, plus coverage examples that walk through what a plan would pay in common situations.

Look past the premium. A low premium with a high deductible can cost more in a year when you need care. The fair comparison is premium plus what you would expect to spend on care, checked against a bad year as well as a normal one.

• What will your household income be for the year of coverage? That decides your tax credit.
• Which doctors, hospitals and prescriptions do you need covered?
• Is this coverage for the long haul, or a bridge of a few months?
• Would a large deductible be a problem, or would you rather pay a higher premium for predictability?
• Could you use an HSA to save on taxes while you are healthy?

AHCCCS and KidsCare: Arizona programs to check first

Before you pay full price for anything, find out whether your household qualifies for AHCCCS, the Arizona Health Care Cost Containment System, which is Arizona's Medicaid program. Arizona expanded Medicaid, so many adults with income up to about 138% of the federal poverty level qualify. AHCCCS has no open enrollment period: you can apply any day of the year.

KidsCare is Arizona's Children's Health Insurance Program, also run by AHCCCS. It covers children in families who earn too much for AHCCCS but still find private coverage hard to afford. It is common for parents to be on a Marketplace plan while their children are on KidsCare, and that is perfectly fine.

You do not have to work out which program to apply for. One application on HealthCare.gov checks your household for Marketplace savings, and if anyone looks eligible for AHCCCS or KidsCare, it sends their information to the state. The AHCCCS online portal is another way in.

What a typical East Valley family weighs

Here is the kind of conversation we have every week in Chandler. A couple in their 40s, one self-employed and one working for a small business that only covers the employee. The employee spouse stays on the work plan. The self-employed spouse and the children look at the Marketplace, where the 2023 family glitch fix means the family's eligibility for a tax credit is judged on what family coverage at work would cost, not just the employee's share.

They compare a Silver plan, where cost-sharing reductions may apply if their income is low enough, against a Bronze plan paired with a Health Savings Account. They check that their pediatrician and the hospital they would use are in network, and they read the Summary of Benefits and Coverage for the two finalists. That is the work, and it is the same work whatever your situation.

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The bottom line

There is no single right plan, only the one that fits your income, your doctors and how long you need it. Start with our Individual and Family Health page, then call Viola at (480) 300-5776. She will lay the options side by side with your real numbers, explain what each one leaves out, and let you decide. We speak insurance, so you don't have to.