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.
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.
Even health insurance companies now admit that the prior authorization process is broken. Major insurers including UnitedHealthcare, Cigna, CVS/Aetna, and Humana publicly acknowledged the problem in congressional testimony and industry statements — while still continuing to use prior authorization as a cost-control mechanism. Here’s what’s happening and what it means for Medicare enrollees in Arizona.
Insurers Admit the Prior Authorization Process Is Broken
The insurance industry’s own trade association, AHIP, has called for prior authorization reform — acknowledging that the current system creates unnecessary delays and burdens for patients and physicians. Several major insurers committed to reducing the use of prior authorization for certain services, following mounting pressure from Congress, physicians, and patient advocates.
But commitments and action are different things. Despite these acknowledgments, KFF research shows that Medicare Advantage plans continue to require prior authorization for a wide range of services — and denial rates remain high.
Why the Prior Authorization Process Is Broken by Design
The prior authorization process is broken not by accident but by financial incentive. Every time a prior authorization is denied and a patient doesn’t appeal, the insurer keeps the premium without paying the claim. The system financially rewards denial — which is why reform commitments rarely translate to meaningful change.
Common services requiring prior authorization in Medicare Advantage plans include:
Inpatient hospital admissions
Skilled nursing facility stays
Chemotherapy and cancer treatments
Imaging (MRI, CT scans)
Home health services
Durable medical equipment
What Congress and CMS Are Doing
The Centers for Medicare and Medicaid Services (CMS) has implemented new prior authorization rules requiring Medicare Advantage plans to make decisions faster and to align coverage criteria more closely with Original Medicare. However, these reforms don’t eliminate prior authorization — they only constrain how it’s administered.
The Alternative: No Prior Authorization Required
Original Medicare does not require prior authorization for most services. If Medicare covers a procedure and your doctor orders it, it’s covered — without an insurance company’s approval process standing in the way.
With a Medicare Supplement Plan G, your costs after the Part B deductible ($257 in 2026) are zero for covered services. No delays. No denials. No fighting with insurance companies.
Questions About Your Coverage in Arizona?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I don’t sell Medicare Advantage. I help Arizona seniors avoid the prior authorization process entirely by choosing Original Medicare with Plan G.
Millions of Americans could drop ACA coverage in 2026 if enhanced premium subsidies expire — and the ripple effect could drive up costs for everyone who stays enrolled. For Arizona residents who rely on the ACA marketplace, here’s what’s at stake and what your options are if prices spike.
Why Millions May Drop ACA Coverage
The enhanced premium subsidies introduced by the American Rescue Plan Act significantly reduced ACA marketplace premiums for millions of enrollees. Many people who previously couldn’t afford marketplace coverage were suddenly able to enroll — and did.
If those enhanced subsidies expire or are reduced, the same people who enrolled would face premium increases they can no longer afford — and many would drop ACA coverage entirely. According to Kaiser Family Foundation, millions of enrollees could lose coverage if enhanced subsidies end.
The Market Stability Problem
When healthier, lower-income people drop ACA coverage because they can no longer afford it, the remaining pool of enrollees skews sicker and older. This drives up costs for insurers — who then raise premiums for everyone still enrolled.
This is the “adverse selection spiral” that insurance market economists worry about: coverage becomes unaffordable, healthy people leave, costs rise, more people leave, costs rise further.
What Arizona Residents Should Do Now
If you’re currently on an ACA plan in Arizona and concerned about rising costs, here are your options:
Check your subsidy eligibility — income changes could mean larger subsidies than you currently receive
Compare off-exchange plans — if you earn too much for meaningful subsidies, a private PPO may cost less
Explore short-term medical plans — for healthy individuals between jobs or waiting for open enrollment
Contact a local broker — an independent broker can compare all options at no extra cost to you
Free Help Comparing Arizona Health Insurance Options
I’m Andy Orlikoff, an independent health insurance broker in Surprise, AZ. I help Arizona residents find affordable health coverage — whether that’s an ACA marketplace plan, a private PPO, or a short-term plan. My help is free. Your premium is the same whether you use a broker or go direct.
The ACA subsidy cliff is one of the most frustrating aspects of health insurance for middle-income Arizona residents. If your income is just slightly above the subsidy threshold, you could face full unsubsidized premiums — a financial cliff that makes coverage unaffordable for many. Here’s how the ACA subsidy cliff works and what your options are in 2026.
If you get your health insurance through the Affordable Care Act (ACA) Marketplace, you might be facing sticker shock during this year’s Open Enrollment. While the underlying cost of health coverage is undeniably rising, a massive policy change—the expiration of crucial pandemic-era subsidies—is set to hit millions of Americans’ wallets with a significant increase in 2026.
Here is a summary of the expected increases and what is driving them:
1. The Shocking Rise in Premiums
Insurance companies are proposing major premium hikes for ACA plans. The base cost (gross premium) for coverage on the Marketplace is increasing by an estimated 26% on average for 2026 plans.
However, the real blow for many will come from the net premium—the amount enrollees pay after financial assistance.
2. The Expiration of Enhanced Subsidies (The “Subsidy Cliff”)
The main catalyst for the massive increase in out-of-pocket costs is the scheduled expiration of the enhanced Premium Tax Credits (PTCs) at the end of 2025.
Massive Cost Shift: If Congress does not renew these enhanced subsidies, the average subsidized enrollee’s monthly premium payment is estimated to more than double, increasing by about 114% on average.
Real-World Impact: An analysis suggests the annual out-of-pocket premium for the average subsidized household could jump from approximately $888 to over $1,900 for 2026 coverage.
The Loss of the “No Cliff” Rule: Before the temporary enhancements, individuals with incomes above 400% of the federal poverty line were ineligible for any subsidy (a “subsidy cliff”). The enhanced credits removed this cliff. If they expire, these higher-income enrollees will face the full, unsubsidized cost of their plan, potentially paying tens of thousands of dollars more a year.
3. The Problem of High Deductibles
While monthly premiums capture attention, high deductibles remain a core issue for many ACA enrollees. Even with subsidized premiums, many families still face very high out-of-pocket maximums. For some lower-income families, deductibles can be set as high as $14,700 for a family of four.
Furthermore, as insurers and employers look for ways to offset rising gross costs, there is concern that a new wave of rising deductibles will be implemented to keep premium costs down, shifting more financial risk onto the consumer.
4. Why Are Underlying Costs Rising?
The subsidy expiration only exacerbates a pre-existing trend of rising healthcare costs. Key drivers include:
Inflation & Labor Costs: General economic inflation and rising costs for healthcare workers and services.
Specialty Medications: The increasing use and high price of expensive specialty drugs, particularly weight-loss medications like GLP-1s, are cited by insurers as a significant factor in premium increases.
Anticipation of Risk: Insurers are factoring in a higher-risk pool, anticipating that healthier individuals—who will see the sharpest price increases—will drop their coverage, leaving the Marketplace with a higher concentration of older and sicker people.
What to Do Next: As the Open Enrollment period is underway, it is critical for consumers to check their new premium costs and shop for plans, as the best value plan may have changed significantly from the previous year. Lawmakers continue to debate solutions, including proposals to extend the subsidies or redirect the funding directly to patients to help offset high out-of-pocket costs.
As a health insurance broker in Surprise, AZ I can help. Plans off exchange and outside the ACA are available.
Contact Andy Orlikoff Today! 623-742-3878 andy@azhealth.us
Struggling with the ACA subsidy cliff in Arizona? I compare all your options — ACA marketplace, off-exchange PPO plans, and short-term coverage. Call Andy Orlikoff at (623) 742-3878 or fill out the contact form. My help is free.
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