There are ten states that did not expand Medicaid when the ACA was passed into law on March 23rd, 2010. In the forty states that did expand Medicaid an applicant’s income must be at or below 138% of the Federal Poverty Line (FPL.)
ACA Federal subsidies have been expanded for those living in the ten states that did not expand Medicaid. Those with incomes between 100%-138% of the FPL now qualify for premium assistance with a private insurance plan offered on the Marketplace. Unfortunately, those in these ten states with income below 100% of the FPL and are disabled or pregnant likely do not qualify for Medicaid or any financial assistance in purchasing a private plan.
Most of the ACA plans available on the Marketplace are HMO plans, and do not extend coverage beyond the county in which the policy was purchased. Emergency care is covered outside the provider network. Purchasing an individual PPO plan on or off the Marketplace will cost a pretty penny. As an example, a married couple in their early 60’s will pay over $3200 a month!
The good news is that 95% of Arizona residents qualify for a federal subsidy on the federal Marketplace exchange. Individuals and families must purchase coverage through the Marketplace to qualify for a subsidy. Purchasing identical coverage (in most cases) directly from the insurer is possible, but the applicant will not receive premium assistance, if qualified.