Health Insurance | Consumer Information

Info on health coverage, understanding your rights, and navigating the health care appeals process in Arizona.

Enrollment & Shopping Assistance

You may enroll in a major medical health insurance plan online, by phone, or with the help of a certified assister or broker.

Financial Assistance & AHCCCS

Many uninsured individuals could be eligible for Medicaid (AHCCCS) or may qualify for free or reduced-cost health insurance through the Marketplace via advanced premium tax credits.

Visit Health-e-Arizona Plus (opens in a new tab) to see if you qualify for no-cost health benefits.

Guides and Tools for Shopping

Review the following resources to help you make an informed decision when shopping for health insurance during Open Enrollment:

Affordable Care Act (ACA) Overview

The Affordable Care Act is the comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or "Obamacare").

The law has three primary goals:

  1. Make affordable health insurance available to more people. The law provides consumers with subsidies ("premium tax credits") that lower costs for households with incomes between 100% and 400% of the federal poverty level.
  2. Expand the Medicaid program. The ACA expanded Medicaid to cover all adults with income below 138% of the federal poverty level. (Note that not all states have expanded their Medicaid programs; Arizona has.)
  3. Support innovative medical care delivery methods. The law focuses on methods designed to lower the costs of health care generally.
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Mental Health Parity

Crisis Support

If you are in crisis, please call the 988 National Suicide and Crisis Lifeline (opens in a new tab).

The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that generally prevents health insurers and group health plans that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical and surgical benefits.

What Does Parity Mean for You?

Under the law, health plans must ensure that financial requirements and treatment limitations for mental health and substance use services are comparable to those applied to physical health services. This includes copayments, coinsurance, deductibles, prior authorization requirements, and limits on the number of visits.

Learn More About Mental Health Parity

View our complete guide on your parity rights, how to file an appeal or complaint, and access related forms, FAQs, and resources.

Visit the Mental Health Parity Hub
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Surprise Medical Bills

Surprise (balance) billing typically happens when a person needs emergency care and is not able to choose an in-network provider without risking their health or life, or when a person seeks non-emergency care at an in-network hospital or facility, and some types of medical providers (including anesthesiologists, radiologists, pathologists, and labs) are not contracted with your health insurer.

In addition to your expected out-of-pocket costs, you may also get a bill for the difference between what your insurer has paid the provider and the amount the provider or facility billed for their services.

Which Program Applies to My Bill?

Your surprise bill may be eligible for either the Arizona or the Federal program depending on your policy start date:

Arizona Surprise Medical Bills

If you receive a balance bill for health care services under a policy plan year that began prior to January 1, 2022, you may be eligible for the Arizona Surprise Out-Of-Network Billing Dispute Resolution Program.

View Arizona Program

Federal Surprise Medical Bills

Congress enacted the No Surprises Act to limit surprise medical billing for out-of-network healthcare. It applies to policies that are new or renewed as of January 1, 2022.

View Federal Program
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Understanding Health Care Appeals

Arizona law requires health insurers, HMOs, dental plans, prepaid dental plans, and vision plans to provide their insured members with a way to appeal denied claims or denied services.

Filing a Complaint with DIFI

If you file a complaint with the Department of Insurance and Financial Institutions related to an Adverse Determination that is subject to the appeals process, the Department must first require you to pursue the appeals process with your insurer. The Department will not otherwise address your complaint during the appeals process, unless your complaint is about an issue other than an Adverse Determination.

What Is an Adverse Determination?

An adverse determination means that a requested service, a claim for a service, or a denial, reduction, or termination of service (in whole or in part) is deemed:

  • Not medically necessary or appropriate (including the health care setting, level of care, or effectiveness of a treatment or service).
  • Experimental or investigational.
  • Not a covered service.

"Denied Claim" vs. "Denied Service"

  • Denied Claim: When you have already received care and submitted a claim, but the insurer has refused to pay the claim.
  • Denied Service: When the plan refuses to authorize a service that is covered by the plan (such as a referral to a specialist), or the plan refuses to pre-authorize any treatment or procedure that you or your doctor believe is medically necessary and covered by your policy.

The Appeals Process Levels

When your health insurer denies a claim or service, it must advise you of your right to appeal the denial. The appeals process will normally not occur unless you or your treating provider specifically request that your insurer reconsider its decision.

For urgently needed services not yet provided:

  1. Expedited Medical Review
  2. Expedited Appeal
  3. Expedited External Independent Review

For standard services or denied claims:

  1. Initial Appeal
  2. Voluntary Internal Appeal (some plans may not offer this level)
  3. External Independent Review
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Appeals Forms & Guides

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Resources for Seniors

General Help for Seniors

Long-Term Care Resources

Healthcare Resources for Seniors

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Military Service Members & Their Families

The following resources can help active duty service members, veterans, and their families make informed insurance decisions and access health benefits.

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Information for Employers

Mini-COBRA Coverage Continuation

Employers with 19 or fewer employees are required to offer continuation of health coverage (often referred to as "Mini-COBRA"). You may use the sample notice below to fulfill this requirement and notify your employees of their options.

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Arizona State Government Employees

Notice

The Arizona Department of Insurance and Financial Institutions regulates Arizona's insurance industry, but we do not administer benefits for Arizona State Government employees. Please use the resources below if you are looking for assistance with your state benefits.

Current State Employees

Retired State Employees

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Additional Consumer Resources

The following tools and guides provide more details on specific health insurance topics to help protect yourself and your family.

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Health Insurance | Consumer Information | Arizona DIFI