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Category: Obamacare (ACA)

Obamacare Crushed Choice. This Reform Helps Restore It

admin | April 21, 2026

By Sally Pipes

President Obama
“Multi-year plans wouldn’t just make coverage more stable. They could make it smarter—aligning incentives around long-term health,” says health expert Sally Pipes. “Perhaps most importantly, these reforms would reintroduce something Obamacare largely eliminated: choice.”

Every fall, millions of Americans log onto the Affordable Care Act’s exchanges hoping to find a health plan that fits their needs. This year, roughly 23 million people have signed up through the marketplaces.

Many are discovering that their options all look more or less the same—expensive and ill-suited to how they use care.

That’s no accident. Obamacare standardized health insurance into a one-size-fits-all product and left little room for innovation.

Now, the Trump administration is signaling a long-overdue shift. A new rule from the Centers for Medicare and Medicaid Services would loosen restrictions on catastrophic health plans and pave the way for multi-year policies that could last up to a decade.

That’s a welcome change—one that could make coverage more affordable and more useful.

Catastrophic plans are designed to do what insurance does in nearly every other market—protect against worst-case scenarios. They come with lower premiums and higher deductibles, cover major medical events and leave routine expenses to patients.

For many Americans, especially younger and healthier ones, that’s exactly the kind of coverage they want.

Yet under Obamacare, these plans have largely been off-limits. Until this year, only people under 30 or those who qualified for a hardship exemption could enroll. Everyone else was steered into more comprehensive—and more expensive—coverage, whether they needed it or not.

Now, anyone ineligible for federal premium or cost-sharing reduction subsidies can claim that exemption and purchase a catastrophic plan.

Critics dismiss catastrophic plans as “junk coverage.” But in virtually every other market—auto, home, even life—this is what insurance looks like. We don’t expect car insurance to cover oil changes. We expect it to protect us in a crash.

Health insurance used to work the same way. Over time, it has morphed into something closer to prepaid medical care.

The new CMS proposal would begin to reverse that trend. By expanding access to catastrophic coverage and encouraging longer-term plans, it would give consumers more control.

The move toward multi-year plans is especially promising.

Under the status quo, most Americans must shop for coverage every year—often with little certainty about premiums, plan availability or benefits. Fewer than one in five people remain with the same insurer over a five-year period, according to research from the Paragon Health Institute.

That churn makes it harder for consumers to plan—and harder for insurers to design better products.

Multi-year plans could change that.

By allowing individuals to lock in coverage for several years at a time, these policies would offer something rare in today’s market: predictability. Enrollees could protect themselves from sudden premium spikes and avoid the annual disruptions that come with switching plans.

That stability would open the door to real innovation.

Consider a patient with diabetes. Today, that person may switch plans every year—bouncing between formularies, provider networks and care programs. Insurers have little incentive to invest in long-term disease management if the patient may be gone in 12 months.

A multi-year plan changes that calculus. If an insurer knows it will cover a patient for several years, it has a strong incentive to keep that person healthy—by investing in prevention, medication adherence and better chronic disease management. Avoiding complications isn’t just good medicine; it’s good business.

Longer-term coverage would also make benefits more predictable and patient-friendly.

Instead of forcing patients to restart their deductible every January, a multi-year plan could spread cost-sharing over time. Patients who face a major medical event wouldn’t be forced to start from scratch the following year, and insurers could design coverage that is more stable and transparent.

In short, multi-year plans wouldn’t just make coverage more stable. They could make it smarter—aligning incentives around long-term health, not short-term accounting.

Perhaps most importantly, these reforms would reintroduce something Obamacare largely eliminated: choice.

A significant share of uninsured Americans don’t lack coverage simply because of cost. According to research from the Centers for Disease Control and Prevention, many say they don’t want or need the plans available—or that those plans don’t meet their needs.

That’s what happens when a market offers what is effectively the same product to everyone, regardless of age, health status or personal preference.

Americans don’t just need cheaper insurance. They need better options. Expanding access to catastrophic plans—and allowing them to evolve into long-term, flexible coverage—would be a major step in that direction.

After years of rigid rules and rising costs, it’s time for Washington to let the health insurance market breathe again.

Learn what options are available to you from your local health insurance broker in Arizona.

Andy Orlikoff

www.azhealth.us

call/text 623-742-3878

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Posted in Health Insurance, Individual Insurance, Obamacare (ACA)Tagged health insurance broker Arizona

Arizona PPO Health Insurance 2026: Affordable Alternatives to Expensive ACA HMO Plans

Andy | March 2, 2026

If you’re shopping for ACA health insurance in Arizona for 2026, you’ve likely noticed two major changes:

  • Premiums are significantly higher

  • Nearly all available plans are HMO-only

For many Arizona individuals, families, and self-employed professionals, this means paying more each month while having fewer choices of doctors and hospitals.

But there are alternatives worth exploring.


Why ACA (Obamacare) Plans Feel So Expensive in 2026 Across Arizona, most 2026 marketplace plans are structured as HMOs. That means:

  • You must stay in-network

  • Referrals are often required

  • Out-of-network care is not covered

  • Premiums continue to rise year after year

If you don’t qualify for large subsidies — or you’re relatively healthy — you may feel like you’re overpaying for coverage you rarely use.

Many Arizona residents are now looking for PPO alternatives to Obamacare that provide flexibility and affordability.


Catastrophic PPO Plans Are Back in Arizona

Recent regulatory updates have expanded access to catastrophic-style coverage options.

These plans are designed for:

  • Individuals

  • Families

  • Self-employed (1099 earners & small business owners)

  • Healthy applicants seeking lower premiums

Unlike ACA HMO plans, many of these options operate as PPO networks, giving you broader access to providers without referral restrictions.


PPO Networks Available in Arizona

Several alternative plans use nationally recognized provider networks, including Cigna and Aetna

Blue Cross Blue Shield PPO (Group Plan for Individuals)

One exciting development is access to a group-based PPO plan available to individuals, utilizing the Blue Cross Blue Shield network.

This allows qualifying individuals to access a broad PPO network typically associated with employer group plans — not limited marketplace HMOs.


Why Catastrophic PPO Plans Are So Popular

 

These plans are structured differently than ACA coverage and can offer major advantages:

Lower Monthly Premiums

Designed primarily to protect against major medical events rather than routine care.

PPO Flexibility

No primary care referral requirements. Greater provider choice.

Fast Start Dates

Coverage can often begin as soon as the next day after approval.

Nationwide Access

Ideal for travelers, snowbirds, and families with children out of state.


Who Should Consider ACA Alternatives in Arizona?

These options may be a strong fit for:

  • Healthy individuals under 65

  • Families who rarely hit their deductible

  • Self-employed professionals

  • Contractors and 1099 earners

  • Early retirees not yet eligible for Medicare

If you’re paying high ACA premiums and rarely using your coverage, exploring PPO alternatives may significantly reduce your monthly cost.


Compare Your 2026 Options Before You Renew

Before automatically renewing your ACA marketplace plan, it’s smart to compare:

  • HMO marketplace coverage

  • Catastrophic PPO plans

  • Group PPO options for individuals

  • Coverage for families and self-employed

You may find better pricing and broader network access than you expected.


Get Personalized Help in Arizona

If you live in Surprise, Phoenix, Peoria, Glendale, Buckeye, Goodyear, or anywhere in Arizona, I’m happy to help you review your options.

Andy Orlikoff

American Insurance Benefits

📍 Surprise

📞 Call or Text: 623-742-3878

📧 Email: [email protected]

🌐 Website: www.azhealth.us

Call, email, or text anytime. I’ll provide a side-by-side comparison so you can make the best decision for your health and budget in 2026.

 

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Serving clients throughout Surprise, Phoenix, Peoria, Glendale, Goodyear, Buckeye, and all of Arizona. If you’re searching for an experienced Arizona health insurance broker who can compare PPO and ACA options, contact Andy Orlikoff today.

Posted in Health Insurance, Obamacare (ACA)Tagged 1099 health insurance Arizona, ACA 2026 Arizona, ACA vs PPO Arizona, Aetna PPO Arizona, Affordable health insurance Arizona, Arizona group health insurance for individuals, Arizona health insurance, Arizona HMO plans, Arizona insurance broker, Arizona PPO health insurance 2026, Blue Cross PPO Arizona, Catastrophic health insurance Arizona, Cigna PPO Arizona, Compare Arizona health insurance plans, Family health insurance Arizona, Health insurance Surprise Arizona, Individual health insurance Arizona, Obamacare alternatives Arizona, Phoenix health insurance broker, PPO health insurance Arizona, Private health insurance Arizona, Self-employed health insurance Arizona, Small business health insurance Arizona, Surprise AZ health insurance broker, West Valley AZ health insurance

Millions may drop ACA coverage — and raise health insurance costs for everyone else

Andy | February 5, 2026

If you are in this position reach out to us, there may be more affordable option that you can qualify for.

www.AZhealth.us | Andy Orlikoff | 623-742-3878

Greg Iacurci

Millions of people are likely to drop their health insurance now that enhanced premium subsidies for consumers who buy coverage on the Affordable Care Act marketplace have expired. That could increase costs for remaining enrollees, leading some experts to warn of a potential “death spiral” in the ACA market.

The lapse of enhanced premium tax credits at the end of 2025 led insurance premiums to more than double for the average subsidy recipient, to $1,904 per month in 2026 from $888 last year, according to estimates from KFF, a nonpartisan health policy research group.

Young, relatively healthy people are the most likely to drop their policy if they deem premiums to be too high and think coverage is not worth the cost, economists said.

That would leave an older, sicker population of enrollees, who are more likely to use their insurance and require costly care, economists said — which might prompt insurers to raise premiums further to offset the higher costs in a self-reinforcing cycle.

“If these [relatively young, healthy] individuals, whose health care costs are lower on average, exit the risk pool, the average cost of care will increase and thereby cause premiums to increase further,” Meredith Rosenthal, chair of the Department of Health Policy and Management at Harvard University’s T.H. Chan School of Public Health, said recently in a written interview with the university.

“The worry is that this process can spiral (known as a “death spiral”) and lead to further disenrollment and even higher premiums,” she said.

Millions of young people may drop ACA coverage

An Obamacare sign at a Miami insurance agency on Nov. 12, 2025.

Joe Raedle | Getty Images

About 22 million Americans received enhanced premium subsidies in 2025.

The Urban Institute and The Commonwealth Fund estimate that 7.3 million people will leave the ACA marketplace in 2026 due to the loss of enhanced premium subsidies. About 5 million of them would go uninsured, they wrote in a joint analysis, rather than find insurance elsewhere.

Young adults would see the largest increase in the number of uninsured people, they said.

In fact, 19- to 34-year-olds account for nearly half — about 2.3 million — of the anticipated increase in the number of uninsured people, according to Jessica Banthin, a senior fellow at the Urban Institute and co-author of the analysis.

By comparison, about 500,000 of those who will be uninsured are 55 to 64 years old, Banthin said.

“It all comes down to who really feels like they need to have health insurance,” said Emma Wager, a senior Affordable Care Act policy analyst at KFF.

There’s evidence insurers raised premiums for 2026 due to a riskier population of insured consumers, experts said.

Insurers raised their gross premiums by an estimated 26% for 2026, on average, according to KFF. This is the total premium, including the consumer’s share and whatever is covered by premium tax credits.

Insurers indicated in filings to state regulators that 4 percentage points of that 26% is due to their expectations that healthier people would drop coverage if the enhanced premium tax credit lapsed, Wager said.

The rest of the increase is due to other factors inflating the cost of health care, such as new specialty drugs becoming available, the cost of labor and consolidation among medical providers, Wager said.

The public will get a clearer picture of how many people dropped their ACA marketplace coverage and the demographics of those individuals when data becomes available over the summer, Wager said.

Why death spiral concerns may be premature

Colorado residents fill out cards and share their stories for content to send to congressional representatives regarding health-care cuts on Nov. 1, 2025, the first day of ACA open enrollment, in Northglenn, Colorado.

Tom Cooper | Getty Images Entertainment | Getty Images

Some policy experts say that warnings of a death spiral in the ACA marketplace are premature.

For one, the disappearance of enhanced subsidies seems to be a one-time shock to the system, they said.

“I think the death spiral concern is understandable, but may be a slight exaggeration,” Michael Gusmano, a professor of health policy at Lehigh University, wrote in an e-mail. “What seems likely is that the loss of people from the overall pool will lead to increases in price — and this will further erode the willingness of people to sign up.”

Additionally, the way premium tax credits were designed should prevent a death spiral, policy experts said.

The tax credit structure caps households’ out-of-pocket expenses for insurance premiums as a percentage of household income. For example, the enhanced federal subsidies capped outlays at 8% of household income, while the lowest earners paid 0%.

While the enhanced subsidies have disappeared, the standard premium tax credits — which have been in place since 2014 — remain.

Now, out-of-pocket premiums are capped at roughly 10% of annual income for qualifying consumers. The cap declines on a sliding scale, down to about 2% for lower earners.

The more money you take away from the subsidies the greater the prospect of death spiral is.

Gerard Anderson

professor of health policy and management at Johns Hopkins Bloomberg School of Public Health

These income caps would likely prevent a death spiral, economists said. If insurers raise premiums, those increases are borne largely by the federal government via tax credits, not consumers, they said.

“All those higher premium costs mostly get translated into higher government subsidies,” John Graves, a professor of health policy and medicine at Vanderbilt University, wrote in an e-mail.

Millions fewer people may enroll, but there would still be “stable risk pools” by virtue of the income caps, he wrote.

Consumers least likely to sign up

Patients are prepared for surgery on the opening day of UCI Health – Irvine in Irvine, California, Dec. 10, 2025.

Paul Bersebach/MediaNews Group/Orange County Register via Getty Images

Aside from young consumers, those least likely to sign up or re-enroll in ACA marketplace coverage are people who no longer qualify for any premium tax credits, experts said.

These are consumers who earn more than 400% of the federal poverty level, which equates to $62,600 for a one-person household.

Many of these households qualified for enhanced subsidies but are no longer eligible — meaning they must pay the full, unsubsidized insurance premium out of pocket.

The Urban Institute and The Commonwealth Fund estimate that the average annual premium for consumers over the subsidy cliff jumped to about $8,500 in 2026 from about $4,400 in 2025.

In 2025, about 3% of ACA enrollees — nearly 725,000 people — earned between 400% and 500% of the federal poverty line, for example, according to a Bipartisan Policy Center analysis of federal data.

How an ACA death spiral becomes more likely

Something that policy experts say would be more likely to trigger a death spiral: Converting the current subsidy structure into a fixed-dollar payment for consumers, an idea that Republican lawmakers and President Donald Trump have broached.

In that case, the premium increase would be borne entirely by individuals rather than by the federal government, Graves said.

“The more money you take away from the subsidies, the greater the prospect of death spiral is,” said Gerard Anderson, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health.

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Posted in Health Insurance, Obamacare (ACA)

The Looming “Subsidy Cliff” and the Soaring Cost of Obamacare Coverage in 2026

Andy | November 12, 2025

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
[email protected]

Posted in Health Insurance, Obamacare (ACA)

🚨 Sticker Shock: Understanding the High Cost of ACA Plans and the Subsidy Cliff

Andy | November 8, 2025

🚨 Sticker Shock: Understanding the High Cost of ACA Plans and the Subsidy Cliff

 

The annual Open Enrollment period for the Affordable Care Act (ACA) Marketplace is here, and for many Americans, this year is bringing an unpleasant surprise: sticker shock. While the ACA remains a vital source of coverage for millions, the underlying cost of health insurance is rising, and a major federal policy decision is poised to make things even more difficult for consumers in the near future.

The conversation this year revolves around two critical factors: rising premiums and the looming expiration of the enhanced federal subsidies.


 

The Current High Cost of Coverage

 

Health insurance premiums across the board are on the rise. Several factors contribute to this:

  • General Inflation and Healthcare Costs: The cost of medical services, drugs, and hospital care continues to climb, naturally pushing up the price of the insurance designed to cover them.
  • Insurer Rate Hikes: Insurers are proposing and receiving approval for some of the largest rate increases seen since the ACA’s early days.

Even with these increases, the true bombshell for many enrollees isn’t just the price of the plan itself—it’s what happens when you remove the financial cushion of the expanded tax credits.


 

The Critical Role of Enhanced Subsidies (and the Looming Cliff)

 

The federal government provides Premium Tax Credits (PTCs) to make Marketplace coverage affordable. This assistance is critical for the vast majority of ACA enrollees.

In 2021, Congress temporarily passed enhanced premium tax credits as part of the American Rescue Plan Act, which were later extended through the end of 2025 by the Inflation Reduction Act. These enhancements achieved two major things:

  1. They eliminated the “Subsidy Cliff”: They removed the previous income cap (400% of the federal poverty level, or FPL) for subsidy eligibility. This meant that middle- and higher-income families who faced very high-cost premiums could still receive help, ensuring no one paid more than 8.5% of their household income for a benchmark Silver plan.
  2. They made subsidies more generous: They lowered the percentage of income that all eligible households had to pay toward their premiums.

 

What Happens Next? The 2026 Subsidy Cliff

 

Unless Congress acts soon, the enhanced subsidies are scheduled to expire on December 31, 2025. This expiration will have dramatic consequences, reverting the system back to the original, less generous ACA subsidy structure for 2026.

According to health policy analysts, the changes will hit millions of Americans hard:

Household Income Category Pre-Expiration Reality (Through 2025) Post-Expiration Reality (Scheduled for 2026)
Above 400% FPL Subsidies available if the benchmark plan costs more than 8.5% of income. Lose ALL subsidies (The “Subsidy Cliff” returns).
Below 400% FPL Pay a smaller percentage of income toward the premium. Subsidy amounts will shrink; consumers will pay a higher percentage of their income toward the premium.

The average subsidized enrollee is projected to see their net annual premium payments more than double if the enhanced tax credits are allowed to expire. For a middle-aged couple earning just over the 400% FPL threshold, the annual premium shock could be in the tens of thousands of dollars.


 

Navigating Your Options in a High-Cost Environment

 

If you’re shopping on the Marketplace now, here is what you need to know:

  1. The Enhanced Subsidies are Still in Effect for Your 2025 Plan: You can still benefit from the lower caps and expanded eligibility for this year’s coverage.
  2. Shop Around, Every Year: Don’t auto-renew! Plans and prices change significantly year to year. You may find that a different plan—even from a different metal level (Bronze, Silver, Gold)—offers a lower net premium thanks to how the subsidy calculation works.
  3. Know Your Income Estimate: Your subsidy is based on your expected household income for the year you are seeking coverage. A slight overestimate or underestimate can greatly affect your eligibility and monthly premium amount.

The clock is ticking on the enhanced subsidies. For the millions who rely on the Marketplace, the affordability of health insurance in the coming years rests on a looming legislative decision.

 

If you have been priced out of the marketplace we can help.

Posted in Obamacare (ACA)Tagged ACA, marketplace, Obamacare

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