Frequently Asked Questions (FAQs) About Health Insurance

Here’s a peek at some of the questions people often ask when shopping for a health plan. Click on the ones that interest you for helpful answers:

What are my healthcare needs?
Can I get help paying for an Affordable Care Act (ACA) plan?
How can I find out if I qualify for financial help?
How much does the plan cost for the care I need?
Are my doctors in the plan’s network?
What are my options for care with an ACA plan from Blue?


What are my healthcare needs?

To figure out what benefits you need from a health plan, start with your overall health. Consider the following questions:
 

How often do you visit a doctor?

• Do you only go for routine services (like yearly checkups or wellness visits) or an occasional illness?

• Or, do you have a condition that needs the care of a specialist?

Who do you need to cover?

• Do you need a plan for just you?

• Or, do you need to cover other people in your family?

Separate plans may save you money if your health needs are different.

Do you take any prescription drugs regularly?

Costs for prescriptions can be different from one plan to the next. If you take certain medications regularly, you’ll want to check the drug list (sometimes called a formulary) for each plan to:

1) Make sure your drugs are covered, and

2) Find out how much they will cost.

With most plans, drugs are assigned to pricing tiers. What you pay for a certain drug will depend on which tier it belongs to.

Do you expect to have any major healthcare needs?

• Are you pregnant or planning to get pregnant?

• Do you expect to have surgery?

• Are there other healthcare needs you need to discuss with your doctor? 

If you expect to have surgery or maternity care, you’ll want to pick a plan with a deductible and out-of-pocket maximum that fit your budget.



Can I get help paying for an Affordable Care Act (ACA) plan?  

The rules have changed. The American Rescue Plan Act has expanded subsidies. 9 out of 10 Arizonans are now eligible for more financial help from the federal government that can lower your overall cost of health insurance. You may qualify for a Premium Tax Credit which helps you pay for all or part of your monthly bill or a Cost-Share Reduction which helps pay your share of the costs for medical care, such as copays, deductibles and coinsurance.


How can I find out if I qualify for financial help?

You can apply for subsidies here as part of our online price quoting and application tool. Or, we can help you see if you’re likely to qualify. It depends on your income and the number of family members in your household. Call us at 1-855-329-2583.

QUALIFYING INCOME LEVELS
Subsidies are based on the household income earned during the year you will be covered.

FPL Chart

Source: U.S. Department of Health and Human Services Federal Poverty Level (FPL) Guidelines.

How much does the plan cost for the care I need?

Once you have an idea of your healthcare needs, it’s time to think about your budget. You’ll want to look at the different out-of-pocket costs you will have with each health plan.




Are my doctors in the plan’s network?

Before you pick a plan, you’ll want to check to see if your doctors are included in the plan’s network. A plan network is a set of doctors who agree to offer care to members of that plan. These doctors are what you call in-network providers.

When checking a plan’s network, keep these questions in mind:

• Are your doctors in the plan’s network?

• If your primary care provider or specialist is not in the plan’s network, would you be willing to see a different doctor?

• Would you consider using online doctor visits for illnesses and injuries that aren’t serious?

If you need help finding out which doctors are in a particular plan network, you can use the Find a Doctor tool. Or you can call us at 1-855-329-2583.



What are my options for care with an ACA plan from Blue?

Primary Care Provider (PCP) - When you need routine, non-emergency care or help managing an acute or chronic condition, or help with a referral to a specialist.

BlueCare Anywhere - See a doctor online and get care 24/7 on your smartphone, tablet, or computer.

Retail Clinic - Convenient locations for when you need care for minor medical needs like colds, flus, rashes, etc.

Urgent Care - For when you are sick and your regular doctor isn’t available, and your condition is not life- or limb-threatening.

Emergency Room (ER) - For serious medical conditions like broken bones, chest pains, severe burns, and other conditions that could be life- or limb-threatening.