One of the most common complaints about the ACA marketplace is that it limited health insurance choice — pushing most plans toward HMO-style networks and eliminating the flexible PPO options that many Americans preferred. However, ACA health insurance alternatives do exist for people who want more flexibility than the marketplace offers. Here’s what’s available in Arizona in 2026.
How the ACA Limited Health Insurance Choice
Before the ACA, many individuals had access to a range of private PPO plans with broad networks and no referral requirements. After 2014, most of those plans disappeared from the individual market — replaced by ACA-compliant HMO and EPO plans with narrower networks and strict in-network requirements.
The result: millions of Americans found themselves in plans that didn’t include their doctors, required referrals to see specialists, or excluded major hospitals like Mayo Clinic.
ACA Health Insurance Alternatives in Arizona
Several ACA health insurance alternatives have emerged to serve people who want more flexibility — especially those who don’t qualify for large ACA subsidies:
Off-exchange PPO plans — Available from select carriers outside the ACA marketplace. Broader networks, no referral requirements, no subsidy eligibility. Ideal for healthy individuals earning above subsidy thresholds.
Short-term medical plans — Provide PPO-style access at lower premiums. Not ACA-compliant but useful for healthy individuals between coverage periods.
Health sharing ministries — A non-insurance alternative for cost-sharing among members. Not a substitute for comprehensive coverage but used by some as a lower-cost option.
Level-funded group plans — Self-employed individuals and small business owners may qualify for group-style coverage with broader options than the individual marketplace.
Does Mayo Clinic Accept ACA Marketplace Plans?
This is one of the most important questions Arizona residents ask. Most ACA marketplace plans in Arizona do not include Mayo Clinic Arizona in their networks. Select off-exchange PPO plans do. If keeping Mayo Clinic access is a priority, this is a key reason to explore ACA health insurance alternatives.
Free Help Comparing Your Options in Arizona
I’m Andy Orlikoff, an independent health insurance broker in Surprise, AZ. I compare ACA health insurance alternatives alongside marketplace plans — showing you exactly what each option covers, what it costs, and which doctors are included. My help is free.
Medicare Advantage plans — also called Medicare Part C — are heavily marketed to Arizona seniors every fall. The ads make them sound like a no-brainer — low premiums, extra benefits, simple coverage. However, after more than 20 years helping Arizona residents navigate Medicare, I’ve seen the disadvantages of Medicare Advantage plans up close. Here are 9 things the ads don’t tell you.
1. Disadvantages of Medicare Advantage: Narrow Provider Networks
One of the biggest disadvantages of Medicare Advantage is the restricted network. Most plans only cover care from in-network providers. If your doctor isn’t in the plan’s network, you pay out-of-pocket — or find a new doctor.
Original Medicare lets you see any doctor in the U.S. who accepts Medicare. That’s the vast majority of physicians. Medicare Advantage plans can’t say the same.
2. Prior Authorization Requirements
Before Medicare Advantage pays for many procedures, the insurance company must approve them first. This process — called prior authorization — can delay care by days or weeks. In some cases, approval is denied entirely.
According to Medicare.gov, Original Medicare does not require prior authorization for most services. Your doctor decides what care you need, and Medicare covers it.
3. Higher Out-of-Pocket Costs When You’re Sick
Medicare Advantage plans often advertise low or zero premiums. However, when you actually use the plan, costs can add up quickly. Copays for specialist visits, hospital stays, and procedures can push your annual out-of-pocket costs to $8,000–$10,000 or more.
With a Medicare Supplement (Medigap) Plan G, your only cost is the Part B deductible — $283 in 2026. After that, you pay nothing for covered services the rest of the year.
4. Plans Change Every Year
Medicare Advantage plans can change their benefits, networks, copays, and drug formularies every January 1st. A plan that worked well for you in 2025 may look very different in 2026. Your doctors may drop out of the network. Your medications may no longer be covered at the same cost.
Medigap plans are standardized and stable. Plan G benefits are set by the federal government and don’t change from year to year.
5. The One-Way Door Problem
This is the most serious of all disadvantages of Medicare Advantage that most people don’t discover until it’s too late. If you enroll in Medicare Advantage and later want to switch to a Medigap supplement plan, you may need to pass medical underwriting.
Insurance companies can deny you Medigap coverage — or charge significantly higher premiums — based on your health history. Once you’re locked into Medicare Advantage with serious health conditions, switching may no longer be possible.
6. Limited or No Coverage Outside Your Service Area
Most Medicare Advantage plans only cover non-emergency care within their local service area. If you travel frequently, spend time in another state seasonally, or want access to specialists in other cities, Medicare Advantage can leave you uncovered.
Original Medicare — and any Medigap plan — covers you at any Medicare-accepting provider nationwide. No zip code restrictions.
7. Mayo Clinic and Major Hospitals Often Not Included
Mayo Clinic Arizona does not accept most Medicare Advantage plans. Neither do many other major specialty hospitals. If you’re diagnosed with a serious condition and want access to the best specialists in the country, Medicare Advantage may not get you there.
Original Medicare is accepted at Mayo Clinic and most major medical centers across the U.S.
8. “Extra Benefits” Are Often Overstated
Medicare Advantage plans advertise dental, vision, hearing, gym memberships, and other extras. In practice, these benefits are often limited — small dollar amounts for dental, narrow networks for vision, or gym programs that require specific facilities.
Many people find these add-ons don’t offset the higher costs they face when they need real medical care.
9. Smaller Networks in Rural Arizona
If you live outside the Phoenix metro — in rural Arizona, smaller cities, or communities far from major medical centers — Medicare Advantage networks may offer very few in-network options. Driving long distances to see an in-network provider, or paying out-of-network rates, becomes a regular reality.
Original Medicare works everywhere there’s a Medicare-accepting doctor. In rural areas, that’s often the only practical choice.
What to Consider Instead of Medicare Advantage
Understanding the disadvantages of Medicare Advantage before you enroll can save you from a very difficult situation down the road.
I’m Andy Orlikoff, an independent Medicare broker based in Surprise, AZ. I don’t sell Medicare Advantage. After 20+ years watching what happens when people need their coverage most, I recommend Medicare Supplement Plan G to nearly every client who qualifies.
I’ll compare rates from multiple carriers, explain your options clearly, and help you enroll — at no cost to you. Your premium is the same whether you use a broker or go direct.
As an independent insurance broker helping Arizona retirees since 2004, I’m seeing a clear pattern this year: more people are asking whether they should stay with Medicare Advantage or switch to something better. After reviewing what’s happening with Advantage plans in 2026, I’m recommending Medicare Supplement Plan G to virtually every client who qualifies. Here’s why.
Why I’m Recommending Medicare Supplement Plan G in 2026
Medicare Advantage plans have been losing ground. In 2026, several major carriers cut benefits, raised copays, and reduced networks. According to Medicare.gov, you can switch plans during open enrollment if yours no longer works for you. A JAMA study found that 1 in 10 Medicare Advantage members was forced off their plan entirely. Meanwhile, Medicare Supplement Plan G hasn’t changed — and that stability is exactly what my clients need.
No Prior Authorization With Medicare Supplement Plan G
One of the biggest frustrations I hear from clients on Medicare Advantage is prior authorization. Before you can have a procedure, the insurance company has to approve it. That approval can take days or weeks — and it can be denied.
With Medicare Supplement Plan G, there is no prior authorization. If Medicare covers a service, Plan G pays. The decision stays between you and your doctor, not an insurance company’s claims department.
See Any Doctor in Arizona — and Across the Country
Medicare Advantage plans restrict you to a network. Step outside it and you pay out-of-pocket — or you’re not covered at all.
Medicare Supplement Plan G works with Original Medicare, which means you can see any doctor in the U.S. who accepts Medicare. In Arizona, that matters for a few specific reasons:
Mayo Clinic Scottsdale accepts Original Medicare — and therefore Plan G. Most Medicare Advantage plans are not accepted at Mayo Clinic.
Snowbird protection — many Arizona clients split time between states. Plan G covers you wherever Medicare is accepted. Your Advantage plan likely doesn’t.
No referrals required — you can see a specialist directly, without waiting for a primary care gatekeeper.
Predictable Costs All Year
Medicare Advantage plans advertise low or zero premiums. However, the real costs show up in copays, coinsurance, and out-of-pocket maximums that can reach $8,000–$10,000 per year if you get seriously ill.
With Medicare Supplement Plan G, your only out-of-pocket cost is the Part B deductible — $283 in 2026. After that, you pay nothing for covered services for the rest of the year. No surprise bills. No anxiety about what the mail brings after a hospital stay.
Plan G Rates in Arizona — What to Expect in 2026
Plan G premiums vary by age and carrier. However, as a general benchmark for Arizona:
Age 65: approximately $100–$150/month
Age 70: approximately $130–$190/month
Age 75: approximately $160–$230/month
Rates for the same plan vary significantly between carriers. As a result, comparing quotes from multiple companies before you enroll can save you $50–$100 per month — with identical benefits. That’s exactly what I do for every client.
The One-Way Door: Why Timing Matters
Here’s what most people don’t know: if you enroll in Medicare Advantage and later want to switch to Medicare Supplement Plan G, you may need to pass medical underwriting. That means insurance companies can deny you or charge more based on your health history.
When you first turn 65 and enroll in Medicare Part B, you have a 6-month open enrollment window where no company can deny you Plan G regardless of health. That window only happens once. After it closes, switching becomes much harder — and sometimes impossible.
If you’re turning 65 or newly enrolled in Medicare, get Plan G in place now, while the door is open.
Ready to Talk About Plan G for 2026?
I’m Andy Orlikoff, an independent Medicare broker based in Surprise, AZ. I don’t sell Medicare Advantage — and I’ll tell you exactly why when we talk. I work with multiple carriers and find the lowest rate for Medicare Supplement Plan G that fits your situation.
Serving Phoenix, Scottsdale, Peoria, Glendale, Surprise, Mesa, Chandler, Gilbert, Goodyear, Tucson, Sun City, and all of Arizona.
If you’re shopping for Arizona PPO health insurance in 2026, you’ve probably noticed two things: premiums are higher than ever, and nearly every ACA marketplace plan in Arizona is now an HMO. For many residents, that means limited doctor networks, required referrals, and no out-of-network coverage. However, there are alternatives. In this guide, you’ll see what Arizona PPO health insurance options still exist in 2026 — and how to find the right one for your situation.
Why Most 2026 ACA Plans in Arizona Are HMOs
The ACA marketplace in Arizona has shifted heavily toward HMO-style plans. As a result, most plans now require you to stay in-network, get referrals to see specialists, and forfeit coverage if you go outside the plan’s network.
For healthy individuals and families who rarely use their insurance, this structure can feel like paying a lot for very little flexibility. In addition, premiums have risen sharply in 2026 — especially for those who don’t qualify for subsidies.
Arizona PPO Health Insurance: What’s Still Available
Despite the marketplace shift, Arizona PPO health insurance options do still exist outside the ACA exchange. These include:
Off-exchange PPO plans — Available from select carriers, these plans offer broader networks and no referral requirements. However, they don’t qualify for ACA subsidies.
Short-term medical plans — These plans offer PPO-style access at significantly lower premiums. They work well for healthy individuals between jobs or waiting for open enrollment.
Level-funded group plans — Self-employed individuals and small business owners may qualify for group-style PPO coverage, often at lower cost than individual ACA plans.
Catastrophic PPO plans — Recent regulatory changes have expanded access to lower-premium, higher-deductible plans with PPO networks for qualifying individuals.
Is Arizona PPO Health Insurance Right for You?
A PPO plan makes the most sense in these situations:
You want access to Mayo Clinic or other major specialty hospitals
You see specialists regularly and don’t want referral requirements
You travel frequently and need out-of-state coverage
You earn too much to qualify for meaningful ACA subsidies
You’re generally healthy and want flexibility over comprehensive coverage
On the other hand, if you qualify for a large ACA subsidy, an HMO marketplace plan may still be the better financial choice. That’s why comparing both options side by side matters.
Mayo Clinic and Arizona PPO Plans
One of the most common questions I hear is whether a plan covers Mayo Clinic Arizona. The answer depends entirely on your plan type.
Most ACA HMO plans do not include Mayo Clinic in their networks. However, select off-exchange PPO plans do. If keeping Mayo Clinic as an option matters to you, this is one of the most important reasons to explore Arizona PPO health insurance outside the marketplace.
How Much Does Arizona PPO Health Insurance Cost in 2026?
Costs vary based on your age, household size, and the specific plan. However, as a general benchmark:
Short-term PPO plans: $100–$300/month for a healthy individual
Off-exchange PPO plans: $300–$600/month depending on coverage level
ACA HMO plans without subsidy: $450–$700+/month for comparable coverage
For many healthy Arizonans who don’t qualify for subsidies, an off-exchange or short-term PPO plan can cost significantly less while providing better network access.
Get a Free Arizona PPO Health Insurance Quote
I’m Andy Orlikoff, an independent health insurance broker based in Surprise, AZ. I’ve been helping Arizona residents compare Arizona PPO health insurance and ACA marketplace plans since 2004. I work with multiple carriers and show you both options side by side — no pressure, no commissions steering my advice.
Your premium is the same whether you use a broker or go direct. You’re just getting 20+ years of Arizona experience at no extra charge.
If your income in retirement is above a certain threshold, you may be paying significantly more for Medicare than your neighbors — and most people don’t find out until they receive their first bill. This extra charge is called the Medicare IRMAA surcharge, and in 2026 it kicks in at $106,000 for single filers. Here’s what it is, how it works, and what you can do about it.
What Is the Medicare IRMAA Surcharge?
IRMAA stands for Income-Related Monthly Adjustment Amount. It’s an additional premium that higher-income Medicare beneficiaries pay on top of standard Part B and Part D premiums. The Medicare IRMAA surcharge is determined by Medicare.gov and adjusted annually.
In 2026, the standard Medicare Part B premium is $202.90 per month. However, if your income exceeds the threshold, you pay considerably more — potentially hundreds of dollars more per month.
Who Gets Hit by the Medicare IRMAA Surcharge?
The Medicare IRMAA surcharge is based on your Modified Adjusted Gross Income (MAGI) from two years prior. So your 2026 Medicare premiums are based on your 2024 tax return. That two-year lag catches many retirees off guard — especially those who had a high-income year due to:
Selling a home or investment property
Large capital gains from selling stocks or a business
Required Minimum Distributions (RMDs) from retirement accounts
Roth IRA conversions
A final year of high employment income before retiring
2026 Medicare IRMAA Surcharge Brackets
Here are the 2026 IRMAA thresholds and the resulting Part B premiums:
Individual Income
Joint Income
Monthly Part B Premium
Up to $109,000
Up to $218,000
$202.90
$109,001–$137,000
$218,001–$274,000
$284.10
$137,001–$171,000
$274,001–$342,000
$405.80
$171,001–$205,000
$342,001–$410,000
$527.50
$205,001–$499,999
$410,001–$749,999
$649.20
$500,000 and above
$750,000 and above
$689.90
At the highest bracket, a married couple could each pay $689.90/month — over $16,500 per year combined just for Part B alone, before any other Medicare costs.
If your income dropped for any of these reasons, you may be able to reduce or eliminate the surcharge immediately rather than waiting for Social Security to use a more recent tax year.
How Medicare Supplement Plan G Protects You
The Medicare IRMAA surcharge increases your Part B premium — but it doesn’t change what Medicare covers or what you owe for services. That’s where a Medicare Supplement Plan G comes in.
With Plan G, once you pay the annual Part B deductible ($283 in 2026), you pay nothing out of pocket for covered Medicare services for the rest of the year. If you’re already paying higher premiums due to IRMAA, the last thing you want is additional copays and coinsurance on top. Plan G eliminates that exposure entirely.
Questions About Your Medicare Costs?
I’m Andy Orlikoff, an independent Medicare broker based in Surprise, AZ. I help Arizona retirees understand their Medicare costs — including the Medicare IRMAA surcharge — and choose the right supplement plan. My help costs you nothing extra.
