How to choose a health plan in Arizona

5 min read · MyAZHealthInsurance editorial team

Shopping for health insurance gets easier when you know which parts of a plan actually change what you pay and who you can see. Here is what to compare.

1. Network type: HMO, PPO or EPO

• HMO plans usually have lower premiums. You pick a primary care doctor, use in-network providers, and often need referrals to see specialists.
• PPO plans let you see specialists without referrals and may cover some out-of-network care, usually for a higher premium.
• EPO plans sit in between: no referrals in most cases, but little or no out-of-network coverage except emergencies.

If you have doctors you want to keep, check that they are in the plan's network before anything else.

2. Metal level: bronze, silver, gold

ACA plans are grouped by how costs are shared. Bronze plans have the lowest premiums and the highest costs when you get care. Gold plans cost more each month but less when you use them. Silver plans fall in the middle, and depending on income, some people qualify for extra savings on silver plans.

3. The numbers that matter

• Premium: what you pay each month.
• Deductible: what you pay for covered care before the plan starts sharing costs.
• Copays and coinsurance: your share for visits, prescriptions and procedures.
• Out-of-pocket maximum: the most you would pay in a year for covered, in-network care.

4. Prescriptions

Each plan has a drug list, called a formulary. If you take regular medications, check which tier they fall in, since that sets your cost.

Putting it together

If you rarely see a doctor, a lower premium may make sense. If you expect regular care, a plan with lower deductibles can cost less over the year. A licensed agent can line plans up side by side using your doctors and prescriptions.

This article is general information, not legal, tax or medical advice. Plan availability, benefits, eligibility and prices vary by location and situation. A licensed agent can review your specific options.