Tips on Choosing an Arizona Health Plan

Blue Cross BLue Shield of Arizona

Provider Networks Both companies have extensive doctor and hospital lists doctors and hospitals up and down the state.  Typically the lists overlap with doctors/hospitals participating with other carriers.  Occasionally there will be a doctor who participates with one company but not the other so it's best to check on your doctor.  Online Doctor Listing
Financial Strength  This really is the main reason to go with the "Blues".   Smaller or less efficient carriers are having difficulties with some filing for Bankruptcy.  If you are with a smaller carrier that is offering significantly reduced costs, they almost definitely raise rates, lower benefits, and/or leave the market entirely.  If you have developed health conditions, the other carriers will not pick you up at that time.                                     back to top

Difference between HMO and PPO

Most people already have a strong preference between these two models but in case you a need a quick summary, here it is.
With a PPO, you have more flexibility to choose your doctors; you are not locked into a region or a primary care doctor.  You can self-refer yourself out to specialists.  The trade off is that you will help share the costs when you get sick or hurt in the form of a deductible or co-insurance.
With an HMO, you choose a Primary Care Physician who has more control over referral and/or decisions regarding your care.  You must remain within your medical group and within a geographic region.  The trade off with this more structured approach is that there will be less out of pocket when sick or hurt.  For example, for inpatient hospital, you may be looking at nothing out of pocket.
TIP  HMO's have become more expensive so compare the annual premium difference with PPO options to make sure you are not paying too much.
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How are pre-existing conditions handled

Getting Approved  When applying for coverage, the carrier will make their decision to approve/decline coverage and/or increase rates based on pre-existing conditions.  You can find more information on qualifying for health insurance.  They are mainly looking for current or ongoing situations.  They will also heavily weigh anything that is open-ended such as a doctor's request for a check up in the future which has not happened yet.  Medication now weigh heavily because of the associated cost.  You can run your situation by us first to see what the probable outcome might be.  The carriers cannot exclude a certain condition from coverage in order to approve a person's coverage.
Once Approved  If you have not had coverage in the prior 63 days before your effective date, there is a 6 month waiting period for pre-existing conditions.  This means they will not pay out for claims relating to pre-existing conditions until you have been on the plan for 6 months.  If you have not lapsed coverage more than 62 days up to your new effective date, the carrier will take into account your prior coverage against a 6 month waiting period.   back to top

Is my doctor on the list

You can check for your doctor or hospital below.  Make sure you specify HMO or PPO.  Sometimes, doctors are listed under medical group or a billing doctor so if you do not see your doctor on the list, call their office and ask if they EXAMPLE..."participate in the Blue Cross Blue Shield PPO network".

Online Doctor Listing                                               back to top

Can you breakdown the PPO's plans

This is a simple breakdown and you should read through the benefit summary for more detail but it helps to simplify the plans.

PPO plans breakdown into three main categories:  Office consultation, Prescriptions, and...pretty much everything else (hospital, labs/x-rays, emergency, surgery, etc..)  
Most plans offer some type of immediate coverage for the office consultation and generic drugs.  NOTE  Blue Cross' Basic 1000 PPO does not cover either and Shield's Preferred Savings makes these benefits subject to the deductible.  Keep in mind that there is usually a separate deductible (from $250 up to $750 depending on plan) for Brand Name drugs.  The "everything else" is typically subject to the main deductible ($500-$5000 depending on plan).  Once you meet your deductible, you pay a percentage until you reach your max-out-of-pocket.    back to top

What does the deductible mean

A deductible is an amount that you will pay first before the plan kicks in.  Keep in mind that you will still get the discounted rate (usually 30-60% off) on covered benefits, in-network even before you meet your deductible.  After the deductible is met, you typically go into a % of the discounted rate.  Some benefits such as maternity and brand name descriptions will have their own, separate deductible.    back to top

What does max-out-of-pocket mean

This basically lets you know how the plan will treat large bills...so called catastrophic or major medical coverage.  Your max-out-of-pocket let's you how much you will pay up to for covered benefits, in-network in a calendar year.  Usually, the max is per person up to two people maximum.  The Blue Shield Preferred Savings plans have a family deductible for 2 or more people on one plan.   back to top

Can the rates change

The rates can change by class (the entire state of Arizona or county) or when you move up to a new age band (typically at 5 year increments such as age 35-39).  The stronger the carrier, the less severe and less often the rate increases.  Once approved, they cannot change rates based on your medical health or claims.  back to top

Can a child have a plan alone

Yes.  With either carrier, you have a single child or multiple siblings on one plan if they are under the age of 18.   back to top