All of Arizona’s 15 counties will have at least one health insurance company offering Affordable Care Act plans for 2021, and most counties are expected to have more than one.

Despite an impending presidential race that’s divided over health care and upcoming U.S. Supreme Court oral arguments about overturning the Affordable Care Act, all five health insurance companies that offered plans to Arizonans on the individual marketplace in 2020 will return to offer plans for 2021, company officials confirmed with The Arizona Republic this week.

The companies are Blue Cross Blue Shield of Arizona, Cigna, Oscar, Bright Health and Ambetter from Arizona Complete Health.

In addition to the five returning companies, officials with UnitedHealthcare confirmed Wednesday that they will be offering ACA insurance to Maricopa County residents in 2021, but didn’t reveal any other details.

That five companies are returning is a sign of stability in what was once a volatile Arizona market. It’s also the third consecutive year of more choice for Arizona residents.

In 2018, just one company offered ACA insurance in Maricopa County. For 2021, Maricopa County residents will be able to choose from plans offered by at least six companies.

The eighth annual open enrollment for plans sold on the individual marketplace created by the ACA, sometimes known as “Obamacare,” begins Nov. 1 and goes through Dec. 15. The plans are for coverage that begins Jan. 1, 2021.

The individual marketplace created by the Affordable Care Act sells private insurance with federal subsidies available to people with qualifying incomes. Most of the 153,020 Arizonans who purchased plans on the marketplace for 2020 qualified for a federal subsidy to help pay for it.

The ACA marketplace is often referred to as an exchange. While some states have their own health care exchanges, Arizona uses the federal exchange, which is known as healthcare.gov.

Exchange plans are for working-age Arizonans who do not have insurance through an employer, or through a government program like Medicaid.

Medicare is a government insurance program that primarily covers people over the age of 65. 

Open enrollment for Medicare this year is Oct. 15 through Dec. 7 and is a chance for people with Medicare to change their Medicare Advantage and prescription drug coverage for the following year. People enrolled in Medicare don’t need ACA coverage and vice versa.

Maricopa County residents will have the most choice

Phoenix-based Blue Cross Blue Shield of Arizona officials told The Republic that, as the company did in 2020, they will be offering 2021 health insurance plans for residents of all 15 Arizona counties on the individual marketplace.

Residents of nine Arizona counties will have a choice of at least two different companies. Tempe-based Ambetter from Arizona Complete Health will be offering plans for residents of Maricopa, Pima, Pinal, Graham, Gila, Greenlee, Santa Cruz, Cochise and Coconino counties, company spokeswoman Monica Coury confirmed Wednesday.

Minnesota-based Bright Health will once again offer plans in Pima and Maricopa counties, company officials confirmed Wednesday.

New York-based Oscar and Connecticut-based Cigna both confirmed that they will be offering plans in Maricopa County.

Even if there is just one company offering plans in a particular county, there are different levels of plans offered: catastrophic, bronze, silver and gold. Silver is the most popular level that consumers purchase.

Plan prices expected soon

Some consumers could see their out-of-pocket expenses go down in 2021 while for others it will go up, depending on their individual situation, said Jeff Stelnik, general manager of individual and government segments for Blue Cross Blue Shield of Arizona.

“Each year, the premium level resets based on the second lowest silver. We don’t know for sure the level of the second lowest silver, but very often the bronze plans are available at zero premium,” he said.

“But we won’t know that until all the plans come out in the next several weeks.”

Stelnik said based on consumer need, the plans this year are focusing on giving options to individuals, not just in terms of affordability but usability and stability as well, he said.

For example, Blue Cross Blue Shield plans already offer telemedicine for some health care, but in 2021 plans will specify that behavioral health is available by telemedicine, too.

“Our visits for behavioral health in this very interesting 2020 are up over 20% this year,” Stelnik said.

Stelnik advises looking at plans on healthcare.gov or on the Blue Cross Blue Shield of Arizona website to compare prices and find out what subsidies may be available.

People who earn 400% or less of the federal poverty level — about $86,880 or less for a family of three — may be eligible for federal subsidies to help pay for their coverage, depending on the plan they select.

People who don’t qualify for subsidies because their income is too high have long been adversely affected by high premiums and deductibles and that’s not expected to change for 2021 plans.

But consumers should check their eligibility, Stelnik said. Thousands of Arizonans are eligible for ACA plans with subsidies but aren’t buying them, he said.

Enrollment assistance is free

Anyone who wants to figure out whether they are eligible for a subsidized ACA plan, or who is interested in finding out more about them, should never have to pay to get assistance.

Cover Arizona has bilingual information about how to get help from an enrollment assister, either in person or on the phone. The website — https://coveraz.org/ — also has information about options. Cover Arizona’s enrollment help line is 800-377-3536.

Enrollment assisters will help individuals and families figure out whether they qualify for an ACA plan with a subsidy, or if they qualify for Medicaid, a government health insurance program for low-income people that in Arizona is called the Arizona Health Care Cost Containment System.

In some cases, families may earn too much to qualify for regular AHCCCS, but their children could be eligible for a government health insurance program called KidsCare, said Allen Gjersvig, director of outreach and enrollment for the Arizona Alliance for Community Health Centers.

“We have application assisters all over the state,” Gjersvig said. “You can complete an application over the phone either with healthcare.gov or the application assisters in Arizona. You don’t even have to meet face to face. And it can be done without a computer, without Wi-Fi.”

If people do want in-person appointments to get help enrolling, those will be available with strict hygiene measures in place, Gjersvig said.

He said people who have lost jobs or income during the pandemic could be eligible for AHCCCS or for a subsidized ACA plan.

“Anyone who has had a loss of employer coverage or loss of income may be eligible,” he said. “This year, they might be eligible for a generous financial aid package. The clear message is you don’t know what you are going to pay until you look.”

Every year, there are new plans and prices change every year, he said.

“It’s kind of mind-boggling to think how many people are eligible, but they don’t take the first step to see if they are eligible,” he said.

Insurance brokers also will provide free help enrolling, and consumers also may go directly to the insurance companies.

ACA and the U.S. Supreme Court

The U.S. Supreme Court in November is set to hear oral arguments in a case seeking to overturn the ACA and a ruling is expected next year. The case was filed by a group of Republican state attorneys general, including Arizona Attorney General Mark Brnovich.

Stelnik said he can’t predict the future, but he has no reason to believe coverage for people with 2021 plans would change midyear.

“From our point of view, whether it is the election or the Supreme Court that has changes, our focus will be on providing coverage,” he said. “We expect any changes to take time to implement, so for 2021 we expect that the ACA and the law of the land will be in place.”

Some experts say there’s a possibility for congressional action that could help preserve the ACA, but for now it’s unclear how the Supreme Court case, called Texas v. U.S., will play out.

For now, at least, the ACA is “still the law of the land,” Gjersvig said, and that means people get coverage for 2021.

He’s concerned that people might not know subsidized insurance and free enrollment help is still available.

“It’s going forward as usual. The ACA is still here. It will be just like last year,” he said. “Sometimes, people don’t distinguish between what could happen and what has already happened. That’s why we are trying to get the word out — just the facts.”

Reach health care reporter Stephanie Innes at [email protected] or at 602-444-8369. Follow her on Twitter @stephanieinnes.

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