Frequently Asked Questions

The Open Enrollment Period for 2027 ACA Marketplace plans runs from November 1, 2026 through January 15, 2027. If you enroll by December 15, 2026, your coverage begins on January 1, 2027. If you enroll between December 16, 2026 and January 15, 2027, coverage begins on February 1, 2027. If you miss Open Enrollment entirely, you cannot enroll in a Marketplace plan unless you qualify for a Special Enrollment Period due to a qualifying life event (job loss, marriage, birth of a child, loss of other coverage, or relocation to a new area). Important exception: AHCCCS and KidsCare applications are accepted year-round with no enrollment period restrictions. If your income qualifies you for AHCCCS rather than the Marketplace, you can apply at any time.

AHCCCS (Arizona Medicaid) eligibility for adults ages 19 through 64 is set at 138% of the Federal Poverty Level (FPL). For 2026, the income limits are approximately: $20,783 for a single individual, $28,208 for a household of two, $35,632 for a household of three, and $43,056 for a household of four. These thresholds are based on Modified Adjusted Gross Income (MAGI). Certain populations have different income limits: pregnant individuals qualify at up to 156% FPL, and children under 19 can qualify for KidsCare at up to 200% FPL. Individuals with disabilities may qualify through alternative pathways with different income and asset criteria. Our counselors can assess your specific situation and determine which program best fits your circumstances.

Your premium after subsidies depends on your household income as a percentage of FPL, age, household size, and the plans available in your zip code. As a general guide: households at or below 150% FPL typically pay $0 to $25 per month for a Silver plan with generous cost-sharing reductions. Households at 150% to 200% FPL typically pay $50 to $150 per month. Households at 200% to 300% FPL typically pay $150 to $350 per month. Under the Inflation Reduction Act extension, even households above 400% FPL may receive subsidies that cap their premium contribution at 8.5% of household income. Our eligibility checker tool can provide a quick estimate, and our counselors can calculate your exact subsidy and compare specific plan options during a free appointment.

Coverage options depend on immigration status. DACA recipients with valid Employment Authorization Documents are eligible for ACA Marketplace plans with Premium Tax Credits and Cost-Sharing Reductions, following a 2024 federal rule change. Undocumented individuals are not eligible for Marketplace plans, AHCCCS, or KidsCare. However, Arizona’s Emergency Medicaid program covers emergency medical treatment regardless of immigration status. Pregnant individuals, regardless of immigration status, may qualify for prenatal coverage through the CHIP Unborn Child option, which provides care for the unborn child. Additionally, children born in the United States are U.S. citizens and eligible for AHCCCS or KidsCare regardless of their parents’ immigration status. Community health centers in Arizona also provide primary care services on a sliding fee scale based on ability to pay, regardless of insurance or immigration status. Our counselors can discuss your specific situation in a confidential, non-judgmental setting.

Members of federally recognized tribes and individuals eligible for Indian Health Service (IHS) have unique coverage options. IHS provides healthcare services at IHS facilities, tribal 638 facilities, and urban Indian health programs, but these services are limited to available funding and facilities. Tribal members can enroll in AHCCCS, Marketplace plans, or both to access a broader network of providers and services. Importantly, American Indians and Alaska Natives under 300% FPL can enroll in Marketplace plans during any month of the year (a permanent Special Enrollment Period), and those enrolled in Marketplace plans have no cost-sharing (no deductibles, copays, or coinsurance) regardless of the metal tier they select. Our tribal health liaison, Robert Kinlicheenie, specializes in coordinating IHS benefits with other coverage programs.

The metal tiers represent different balances of monthly premiums versus out-of-pocket costs when you use healthcare services. Bronze plans have the lowest monthly premiums but the highest deductibles (typically $7,000 to $8,000 for an individual). You pay less each month but more when you see a doctor or need prescriptions. Silver plans have moderate premiums and deductibles (typically $4,000 to $5,500). Crucially, Silver plans are the only tier eligible for Cost-Sharing Reductions (CSRs), which lower your deductible and copays if your income is below 250% FPL. A Silver plan with CSRs can have an effective deductible as low as $250, making it far more cost-effective than Bronze for many families. Gold plans have the highest premiums but the lowest deductibles (typically $1,000 to $2,000) and copays. They are best for individuals or families who expect frequent medical visits, ongoing prescriptions, or planned procedures.

Yes. Losing employer-sponsored health coverage is a qualifying life event that triggers a 60-day Special Enrollment Period for ACA Marketplace plans. You can enroll in a Marketplace plan within 60 days of the date your employer coverage ends (not the date you lost your job, but the date your health insurance actually terminates). Additionally, if your income has dropped due to job loss, you may now qualify for AHCCCS, which accepts applications year-round. Many newly unemployed individuals are surprised to learn that their reduced income qualifies them for Medicaid with zero premiums. Your former employer may also offer COBRA continuation coverage, but in most cases, a subsidized Marketplace plan will be significantly less expensive. Our counselors perform a side-by-side COBRA vs. Marketplace comparison at every job-loss appointment.

All of our enrollment assistance services are completely free of charge. We never charge consultation fees, application fees, plan selection fees, or follow-up fees. Arizona Healthcare Coverage is funded through federal CMS (Centers for Medicare & Medicaid Services) Navigator grants, the Vitalyst Health Foundation, Arizona Blue Cross Blue Shield Community Partnership Fund, Maricopa County Community Health Improvement grants, and individual charitable contributions. We do not sell insurance products, and we do not receive commissions or referral fees from insurance carriers. Our counselors are required to provide unbiased guidance that is always in the client’s best interest, regardless of which insurer or plan is recommended.

To ensure an efficient appointment, please bring the following for each household member who needs coverage: a government-issued photo ID, Social Security number (or card), proof of Arizona residency (utility bill, lease, or bank statement within 60 days), your most recent federal tax return, your last four pay stubs (or self-employment income documentation), any immigration documents if applicable, and information about your current health coverage (insurance card, employer plan summary). If you are applying due to a qualifying life event, bring documentation of that event (termination letter, marriage certificate, birth certificate, proof of address change). Our enrollment guide has a complete checklist.

Provider network varies by plan. When comparing Marketplace plans, our counselors check whether your current primary care physician, specialists, and preferred pharmacies are included in each plan’s provider network before recommending a plan. Arizona Marketplace carriers include Blue Cross Blue Shield of Arizona, Ambetter from Arizona Complete Health, Oscar Health, and Cigna, each with different provider networks. For AHCCCS, you will be assigned to a managed care health plan (such as Banner University Family Care, Arizona Complete Health, Mercy Care, or UnitedHealthcare Community Plan), and most plans include a broad network of community providers. If maintaining your current doctor is a priority, tell your counselor at the beginning of your appointment so we can prioritize plans that include your provider.