Enrollment & Navigation Services

The federal Health Insurance Marketplace (Healthcare.gov) offers qualified health plans from private insurers with potential Premium Tax Credits and Cost-Sharing Reductions based on household income. Our CMS-certified counselors guide you through the entire process.

What We Help With

• Eligibility Determination: We verify your income, household size, citizenship or lawful presence status, and current coverage situation to determine Marketplace eligibility and estimated subsidy amounts before you begin the application.
• Plan Comparison & Selection: We analyze Bronze, Silver, Gold, and Catastrophic plan options across all available Arizona carriers, comparing monthly premiums, annual deductibles, out-of-pocket maximums, copayment structures, and provider networks to match your medical needs and budget.
• Premium Tax Credit Calculations: We calculate your Advanced Premium Tax Credit (APTC) based on projected household income relative to the Federal Poverty Level, ensuring you receive the maximum subsidy you qualify for without risking overpayment at tax time.
• Cost-Sharing Reductions (CSRs): For households between 100% and 250% FPL, we explain how enrolling in Silver-tier plans unlocks additional cost-sharing reductions that lower your deductible, copayments, and maximum out-of-pocket costs.
• Application Submission & Follow-Up: We complete and submit your Healthcare.gov application, upload required verification documents, respond to data-matching issues, and track your enrollment confirmation through the carrier.

The Arizona Health Care Cost Containment System (AHCCCS) provides comprehensive medical, dental, behavioral health, and long-term care coverage to eligible low-income Arizona residents. Unlike the Marketplace, AHCCCS enrollment is open year-round with no limited enrollment periods.

Eligibility Groups We Assist

• Adults (19–64): Single adults and couples with modified adjusted gross income at or below 138% of the Federal Poverty Level ($20,783 for an individual in 2026) qualify for full AHCCCS coverage, including primary care, specialist visits, hospitalization, prescriptions, and behavioral health services.
• Pregnant Individuals: Income eligibility extends to 156% FPL during pregnancy, covering all prenatal care, labor and delivery, and 12 months of postpartum coverage regardless of immigration status under the CHIP Unborn Child option.
• Individuals with Disabilities: Arizonans with qualifying disabilities may be eligible through the Supplemental Security Income (SSI) pathway, the Freedom to Work program (which allows higher income limits for working individuals with disabilities), or the Arizona Long-Term Care System (ALTCS) for institutional-level care needs.
• Seniors: Individuals aged 65 and older may qualify for AHCCCS as a supplement to Medicare, covering Medicare premiums, deductibles, and services not covered by Medicare such as dental, vision, and long-term care.

Our counselors navigate the Health-e-Arizona Plus (HEAplus) online portal, help gather required verification documents (proof of income, Arizona residency, citizenship or qualified immigration status), and track application status through determination.

KidsCare is Arizona’s Children’s Health Insurance Program (CHIP), providing affordable health coverage for children under 19 in families with income too high for AHCCCS but who may struggle to afford private insurance. Monthly family premiums range from $10 to $70 depending on income level.

• Income Thresholds: Families with income between 138% and 200% FPL qualify for KidsCare. For a family of four in 2026, this means household income between approximately $43,056 and $62,400 annually.
• Covered Services: KidsCare provides comprehensive pediatric coverage including well-child visits, immunizations, prescription medications, dental care, vision services, mental and behavioral health, emergency room visits, hospitalization, and specialty care referrals.
• No Enrollment Period: Like AHCCCS, KidsCare accepts applications year-round. There is no need to wait for an Open Enrollment window to apply for your children’s coverage.

Medicare’s multiple parts, supplemental options, and enrollment periods create genuine confusion for many Arizona seniors. Our counselors partner with the Arizona State Health Insurance Assistance Program (SHIP) to provide objective Medicare counseling that considers your specific health needs, prescription medications, provider preferences, and budget.

• Parts A & B (Original Medicare): We explain hospital insurance (Part A), medical insurance (Part B), associated premiums, deductibles, and coinsurance so you understand what Original Medicare covers and where gaps exist.
• Part C (Medicare Advantage): We compare Advantage plans from Arizona carriers including banner Health Plan, UnitedHealthcare, Humana, and Aetna, evaluating provider networks, prescription formularies, and supplemental benefits like dental, vision, hearing, and fitness programs.
• Part D (Prescription Drug Plans): We run your current medications through the Medicare Plan Finder to identify plans with the lowest total annual cost, including premiums, deductibles, copayments, and coverage gap (donut hole) expenses.
• Extra Help & Medicare Savings Programs: For low-income Medicare beneficiaries, we screen for the federal Extra Help/Low-Income Subsidy (LIS) program and Arizona Medicare Savings Programs (QMB, SLMB, QI) that can reduce or eliminate Part B premiums, deductibles, and prescription costs.

Losing employer-sponsored health insurance through job loss, reduction in hours, or other qualifying events triggers a 60-day COBRA election period. While COBRA allows you to continue your employer plan, premiums are typically the full cost (employee plus employer share) plus a 2% administrative fee, making it significantly more expensive than Marketplace alternatives in many cases.

Our counselors perform a side-by-side comparison of your COBRA continuation costs against Marketplace plans with applicable Premium Tax Credits. In many cases, a Marketplace Silver plan with cost-sharing reductions provides equal or better coverage at a fraction of the COBRA premium. We help you make an informed decision and enroll in the most cost-effective option within your election window.

Missed Open Enrollment? You may still qualify for a Special Enrollment Period (SEP) if you have experienced a qualifying life event within the past 60 days. Common qualifying events include:

• Loss of employer-sponsored or other qualifying health coverage
• Marriage, divorce, or legal separation
• Birth or adoption of a child
• Permanent move to a new coverage area (zip code change)
• Change in immigration status or gaining lawful presence
• Release from incarceration
• Loss of AHCCCS or KidsCare eligibility
• Household income dropping below 150% FPL (year-round SEP available)

Our counselors verify your qualifying event documentation, determine your SEP window, and complete your Marketplace application before the deadline expires. Early intervention is critical — SEP windows are strict and extensions are rarely granted.