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.
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.
If you’ve experienced ACA sticker shock when shopping for health insurance, you’re not alone. Millions of Americans — especially those who earn just above the subsidy threshold — face premium prices that seem impossible to afford. Here’s why ACA premiums are so high, what the subsidy cliff means for Arizona residents, and what your alternatives are.
ACA Sticker Shock: Why Premiums Are So High
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:
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.
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:
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.
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.
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’ve experienced ACA sticker shock and been priced out of the marketplace, we can help find alternatives.
How to Avoid ACA Sticker Shock in Arizona
Struggling with ACA sticker shock? I compare ACA marketplace plans, off-exchange PPOs, and short-term options for Arizona residents — at no cost to you. Call Andy Orlikoff at (623) 742-3878 or fill out the contact form.
As 2026 open enrollment approaches, millions of Americans are bracing for significant health insurance cost increases. Enhanced ACA subsidies that dramatically reduced premiums may expire, and the political debate over their renewal has left many consumers uncertain about what to expect. Here’s what Arizona residents need to know heading into 2026 open enrollment.
Why 2026 Open Enrollment Costs Are Rising
The enhanced premium tax credits introduced by the American Rescue Plan made marketplace coverage affordable for millions who previously couldn’t qualify. If those subsidies expire, premiums could spike dramatically for people who earn between 100% and 400% of the federal poverty level — the group that benefits most from ACA subsidies.
According to healthcare.gov, 2026 open enrollment runs November 1 through January 15. Changes made during this window take effect January 1, 2027.
What Arizona Residents Should Do Before 2026 Open Enrollment
Don’t assume your current plan is still the best option — carriers adjust premiums, networks, and benefits every year
Check your subsidy eligibility — income changes could mean larger or smaller subsidies than last year
Compare all plan types — ACA marketplace plans, off-exchange PPOs, and short-term options all have different price points
Use an independent broker — a broker compares all options at no extra cost to you
Off-Exchange Options Worth Considering
If you earn too much for meaningful ACA subsidies, 2026 open enrollment is a good time to compare off-exchange PPO plans. Some carriers offer private PPO plans with broader networks — including Mayo Clinic Arizona — at competitive prices for healthy individuals.
Free Help With 2026 Open Enrollment in Arizona
I’m Andy Orlikoff, an independent health insurance broker in Surprise, AZ. I help Arizona residents compare all their options during 2026 open enrollment — marketplace plans, off-exchange PPOs, and more. My help is always free.
