ACA plans are the right choice for most Arizonans. But for college students living out of state, healthy people between jobs, early retirees bridging to Medicare, and others in specific situations — short-term medical may be a smarter, more flexible fit. Understanding the difference is exactly what a licensed broker is for.
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Understanding the Landscape
Knowing when an ACA plan is the wrong tool for the job is just as important as knowing when it's the right one.
The ACA marketplace was built to ensure broad, comprehensive access to health coverage, and for the majority of Arizonans it does exactly that. Pre-existing condition protections, essential health benefits, and financial subsidies make ACA plans the correct starting point for nearly anyone evaluating their options.
However, one significant limitation affects a large and specific group of Arizonans: the majority of ACA marketplace plans are structured as HMOs. HMO plans tie your coverage to a defined local provider network. Outside that network — except in emergencies — your coverage is either severely limited or nonexistent. For people whose lives don't stay in one geographic place, that structure creates real, practical problems.
Short-term medical plans are not a replacement for ACA coverage in a general sense. They are a specific tool with real strengths and significant limitations. Used correctly, with professional guidance, for the right person and the right situation, they provide meaningful protection. Used incorrectly — or chosen without fully understanding what they don't cover — they can leave someone seriously exposed. That nuance is exactly what makes broker guidance so important with these plans.
With enhanced ACA subsidies having expired at the end of 2025, some Arizonans who previously found ACA plans affordable are now seeing significantly higher premiums. For healthy individuals in certain income brackets, short-term medical has become a more relevant conversation than it was a year ago — making it even more important to evaluate both options carefully with a licensed broker.
College students: An Arizona parent's HMO plan covers care in Arizona. It does not cover their child's doctor visits, urgent care, or specialist appointments in the state where the student actually lives and goes to school — only emergencies.
Frequent travelers: Someone who regularly travels for work and needs care outside Arizona while on the road will find most ACA HMO networks provide little practical coverage away from home.
Snowbirds in reverse: Arizonans who spend significant time in other states — whether for family, work, or lifestyle — may find a nationwide PPO more practically useful than an Arizona-network HMO.
Short transition periods: Someone starting a new job in 60 days who needs bridge coverage during the gap may find short-term medical a more cost-effective tool than COBRA or a full ACA plan for a brief window.
Who Short-Term Medical May Be Right For
These are the most common circumstances where short-term medical becomes a legitimate option worth considering. In every case, a broker comparison of both ACA and STM options is essential before deciding.
An Arizona parent's ACA HMO covers the student in Arizona but provides only emergency care in the state where the student actually lives. A short-term PPO plan with nationwide network coverage covers the student at doctors and urgent care in their college town — where they actually need it.
Strong Fit — Geographic CoverageSomeone leaving a job and starting a new position in 60–90 days faces a coverage gap. COBRA can be prohibitively expensive. For a healthy individual with no significant health needs, a short-term plan can provide meaningful protection during the transition at a fraction of the COBRA cost.
Possible Fit — Bridge CoverageArizonans who missed the open enrollment window without a qualifying life event cannot enroll in an ACA plan until November. For a healthy person facing months without coverage, a short-term plan can serve as a bridge — with clear understanding of its limitations.
Possible Fit — Enrollment GapSomeone who retires at 62 or 63 and needs coverage until Medicare at 65 may find short-term medical a cost-effective bridge — particularly if they're in good health, have no significant pre-existing conditions, and their income is too high for meaningful ACA subsidies.
Careful Evaluation RequiredWith enhanced ACA subsidies having expired in 2026, Arizonans above subsidy thresholds face full-price ACA premiums. A healthy person in their 30s or 40s with no pre-existing conditions may find short-term premiums significantly lower — but the coverage tradeoff must be fully understood.
Careful Evaluation RequiredA healthy person who regularly needs care outside Arizona and finds their ACA HMO's out-of-network limitations a practical problem may find a nationwide PPO short-term plan more useful for their lifestyle — provided they fully understand what the plan excludes.
Situational — Broker Review EssentialUnlike ACA marketplace plans — which require a primary adult enrollee — STM plans allow children to be the primary certificate holder with no parent or spouse on the same policy. For healthy children needing coverage independently of a parent's plan, this is a structural advantage ACA simply doesn't offer.
Good Fit — If Healthy, No Pre-Existing ConditionsThe PPO Advantage
One of the most significant practical differences between short-term medical and most ACA marketplace plans is the provider network structure — and for certain Arizonans, it's the deciding factor.
The majority of ACA plans available on the Arizona marketplace are structured as HMOs — Health Maintenance Organizations. HMO plans restrict your coverage to a defined network of providers within a specific geographic service area. If you receive non-emergency care outside that network, you're typically responsible for the full cost. For a person whose life stays within the Phoenix or Tucson metro, this rarely presents a problem. For anyone else, it's a significant limitation.
Short-term medical plans use large national PPO networks that in many cases are broader and more flexible than anything available on the Arizona ACA marketplace. While virtually every ACA plan in Arizona is an HMO — locking you into a defined local network with no out-of-state coverage except emergencies — leading STM carriers access networks like the Aetna Open Choice PPO and Cigna PPO, which are among the largest and most widely accepted in the country. These aren't fallback networks. They're the same premium PPO networks used by large employer group plans, accepted at hospitals and physician offices in all 50 states.
For a college student in Colorado, a traveling contractor working in Texas, or a retiree spending summers in Michigan — a nationwide PPO with genuine out-of-state access delivers coverage that an Arizona ACA HMO simply cannot match. That practical reality is why, for the right person in the right situation, short-term medical isn't just a cheaper alternative. It's a legitimately superior-fitting product.
Leading Arizona STM carriers provide access to two of the country's most widely accepted PPO networks — covering physicians, specialists, urgent care centers, and hospitals nationwide. Both networks include far more providers than any ACA HMO in Arizona, with no geographic restrictions outside of emergencies.
Aetna Open Choice PPO — More than 690,000 primary care doctors and specialists across 5,700 hospitals nationwide. HSA-compatible plans access an even broader network of 850,000+ providers across 6,900 hospitals. Search providers at goperspecta.com.
Cigna PPO — More than 1,000,000 primary care doctors and specialists across 6,300 hospitals nationwide. Search providers at mynatgen.com/CignaPPO.
A broker can verify that your specific doctors and local hospital are in-network on either plan before you enroll — at no cost to you. Premiums are state-filed; you pay the same rate whether you use a broker or not.
Unlike Arizona ACA HMO plans that restrict coverage to the state or metro area, short-term PPO plans provide in-network access to providers nationwide — critical for students, travelers, and those splitting time between states.
PPO plans don't require a primary care physician referral to see a specialist. You can go directly to the specialist you need, anywhere in the network — a flexibility that HMO plans don't offer.
Short-term medical plans cover emergency care regardless of network status — just like ACA plans. If you're in an emergency anywhere in the country, you're covered. The PPO advantage is that routine and specialist care is also covered nationwide, not just emergencies.
When you use an in-network PPO provider, the carrier's negotiated rates apply — significantly reducing what you pay even before you hit your deductible. This network discount applies at providers across the country, not just in Arizona.
Most short-term medical carriers provide online provider search tools so you can verify network participation before you enroll or before you seek care. A broker can also verify your specific doctors and hospitals are in-network during the application process.
This section is not a footnote — it is central to making an informed decision. Short-term medical plans provide real value for the right person, but they exclude categories of coverage that ACA plans are required to include. Every person considering a short-term plan must fully understand these exclusions before enrolling. A licensed broker will walk through each of these with you.
This is the most significant exclusion — and it operates on two levels. First, applicants with certain serious conditions are ineligible entirely: the application includes hard knockout questions covering pregnancy/infertility, 13 serious condition categories with a 5-year lookback (heart disorders, stroke, diabetes or prediabetes, cancer, COPD, kidney/liver disorders, Crohn's, lupus, MS, bipolar disorder, alcoholism, neck/back disorders, and joint replacement), HIV/AIDS with no time limit, and any pending unresolved tests or undiagnosed symptoms in the last 12 months. Second, for applicants who do qualify, the plan excludes any condition for which you received treatment, a diagnosis, prescription, or had signs and symptoms in the 12 months prior to your effective date — regardless of whether it was formally diagnosed. This 1-year lookback is the pre-existing condition exclusion window. It is lifted starting in month 13 on Renewable and Consecutive multi-year plans, at which point those conditions become covered. ACA plans are prohibited from both types of exclusion. STM plans are not — which is why they work well for genuinely healthy people, and poorly for anyone with recent or ongoing health conditions.
Pregnancy, prenatal visits, labor, delivery, and postpartum care are explicitly excluded from short-term medical plans. If there is any chance of pregnancy during the coverage period, a short-term plan is the wrong choice. ACA plans cover maternity as an essential health benefit.
Mental illness and substance abuse treatment are explicitly excluded by the policy certificate — not merely limited. This includes therapy, psychiatry, inpatient behavioral health, and substance use disorder treatment. The one exception: Autism Spectrum Disorder treatment is covered for covered persons age 16 and younger, with pre-authorization required. ACA plans are required to cover mental health with parity to physical health coverage. If ongoing mental health treatment is part of your life, a short-term plan is the wrong choice.
Annual physicals, cancer screenings, immunizations, and other preventive services covered at no cost under ACA plans are generally not covered under short-term medical. You will typically pay out of pocket for routine preventive visits.
Base plans do not include outpatient prescription drug coverage. Rx riders and discount options are available on select plans — the Copay Enhanced plans include a $10 generic drug copay with a $3,000 maximum benefit. If you take regular maintenance medications, evaluate the Rx options carefully before selecting a plan tier.
Chronic pain disorders are explicitly excluded by the certificate. Allergy treatment — including allergy shots and immunotherapy — is excluded, though emergency treatment of acute allergic reactions is covered. These are meaningful exclusions for a significant portion of the population.
Short-term plans are not required to cover the ten essential health benefits mandated under the ACA. Coverage focuses on major medical events — hospitalizations, surgeries, ER visits, and acute illness. Pediatric dental/vision, comprehensive preventive care, and other ACA-required benefits are not included.
The bottom line: Short-term medical plans are designed to protect genuinely healthy people from major unexpected medical events — hospitalizations, surgeries, accidents, sudden serious illness. Several additional facts from the policy certificate matter for decision-making:
The eligibility knockout questions are specific and unforgiving. If any apply, an ACA plan is almost certainly the right answer. For the genuinely healthy person in a coverage gap who understands these terms, STM provides real PPO coverage at a fraction of the ACA cost. A licensed broker will tell you honestly which category you fall into.
Side-by-Side Comparison
This comparison is intentionally honest in both directions. Neither plan type is universally better — the right choice depends entirely on your health situation, your life circumstances, and your budget. A broker reviews both options against your specific profile before making a recommendation.
| ACA Marketplace Plan healthcare.gov — Arizona | Short-Term Medical Plan Non-ACA Compliant | |
|---|---|---|
| Pre-Existing Conditions | ✓ Fully covered — cannot be denied or charged more based on health history | ⚠ Excluded first 12 months — pre-existing conditions are not covered during the initial exclusion period; coverage begins month 13 on multi-year plans |
| Essential Health Benefits | ✓ All 10 required — maternity, mental health, Rx, preventive care, and more | ✗ Limited — covers major medical events; essential benefits are not required |
| Monthly Premium | Moderate to high — significantly reduced by subsidies for qualifying income levels | Lower — often 30–60% less than ACA for healthy applicants who qualify |
| Provider Network | Usually HMO — Arizona network; limited or no coverage outside the state except emergencies | Nationwide PPO — leading carriers offer Aetna Open Choice PPO & Cigna PPO networks; accepted in all 50 states with no geographic restrictions |
| Maternity Coverage | ✓ Fully covered — prenatal, labor, delivery, and postpartum care included | ✗ Excluded — maternity is explicitly not covered on short-term plans |
| Mental Health Coverage | ✓ Covered with parity — mental health treated same as physical health | ✗ Limited or excluded — mental health typically not a covered benefit |
| Prescription Drugs | ✓ Covered — formulary-based Rx coverage included in all plans | Limited — Rx riders available at added cost; base plans often exclude |
| Preventive Care | ✓ Free — annual exams, screenings, and vaccines at $0 cost | ✗ Not covered — preventive services are not included in base plans |
| Term Length | Annual — aligned with calendar year and open enrollment | Flexible — 1 to 12 months depending on state rules; ideal for bridge coverage |
| Enrollment Timing | Open enrollment only — or qualifying life event SEP | Enroll anytime — no enrollment windows; coverage can start within days |
| Subsidy Eligibility | Yes — premium tax credits available for qualifying income levels | No — not eligible for ACA premium tax credits |
| Out-of-Pocket Maximum | Federally capped — $9,450 individual / $18,900 family in 2026 | Varies by plan — limits set by carrier, not federal regulation; review carefully |
| Best For | Anyone who answers "Yes" to the eligibility knockout questions: pregnant or in a family planning process; treated in the last 5 years for heart disorders, stroke, diabetes/prediabetes, cancer, COPD, kidney/liver disorders, Crohn's, lupus, MS, bipolar disorder, alcoholism, or neck/back/joint issues; HIV/AIDS history; or any pending unresolved tests or undiagnosed symptoms in the last 12 months. Also anyone who qualifies for meaningful ACA subsidies. Note: high BP, high cholesterol, anxiety, and depression affect rate tier only — not eligibility. | Healthy individuals needing bridge coverage, out-of-state coverage, or coverage outside enrollment windows |
Arizona STM Market
A few carriers write short-term medical coverage in Arizona. Understanding the key plan features — networks, duration, pricing tiers, and underwriting — helps you ask the right questions when comparing options with a broker.
Short-term medical plans in Arizona vary meaningfully across carriers in terms of network access, plan duration, underwriting approach, and pricing structure. The most important features to compare are the provider network (PPO breadth and out-of-state access), maximum plan duration, whether rate guarantees apply for the full term, and the underwriting questions asked during application. Notably, a Guaranteed Issue PPO option is available for applicants who prefer no health questionnaire — it provides guaranteed eligibility with no underwriting, though with lower coverage maximums ($100,000 per certificate) and higher cost-sharing than the fully underwritten plans.
Arizona STM plans are offered through a LIFE Association membership — a not-for-profit association established in 1990. It's important to understand that the Association membership and its benefits are non-insurance products, separate from and governed by different rules than the STM insurance policy itself. Membership is included with enrollment and provides access to additional member benefits including identity theft protection, wellness savings, travel services, and educational resources. Because these are non-insurance association benefits rather than insurance coverage, pre-existing condition exclusions do not apply to them — they are available to members regardless of health history.
STM plans commonly include or offer non-insurance benefits alongside the insurance policy. These include association memberships (like LIFE Association) and add-on service programs (like Recuro Health virtual care). Because they are not insurance products, they are governed by different rules:
Non-insurance benefits are optional add-ons or included membership perks — they are separate from and do not modify the terms of the STM insurance certificate.
Plan durations in Arizona go up to 3 years with two distinct options: a Renewable plan (rate guaranteed for the full term, deductible resets each period, coverage maximum does not reset) or a Consecutive plan (rates set at purchase, deductible and coverage maximum both reset each period, up to 2 years). Both options lift the pre-existing condition exclusion starting in month 13, so conditions treated before the plan began become covered without requiring a new application. HSA-compatible plans are also available with deductibles from $6,000–$7,500 and first-dollar preventive coverage.
Some STM carriers — including Allstate Health Solutions — use a two-tier pricing program: Preferred and Standard. Most healthy applicants qualify for at least the Standard rate. To qualify for Preferred pricing (a further discount), all of the following must apply for the Allstate Health Solutions program:
Important distinction: These are rate tier questions — not eligibility knockouts. Applicants who don't qualify for Preferred pricing are still eligible for coverage at the Standard rate. Separate eligibility questions (the knockout questions) determine whether a condition can be covered at all.
Child and dependent-only applicants are not eligible for preferred rate pricing. A broker can confirm your rate tier in minutes — before you apply.
Next-day effective dates are available from most Arizona STM carriers — a significant practical benefit for anyone in an unexpected coverage gap who needs protection quickly. Application approval can result in coverage beginning as soon as the following day.
The primary short-term medical carriers offering plans to Arizona residents are Allstate Health Solutions, UnitedHealthcare, and Pivot Health. Note: Philadelphia American Life, North American Company, Freedom Life, and LifeShield/National General do not currently offer short-term medical plans in Arizona. A licensed broker confirms current availability and compares plan structures across all carriers writing business in the state.
What to ask about when reviewing any Arizona STM plan
Plan Design Options
Both plan types provide PPO coverage through the same Aetna Open Choice network. The key differences are in deductible structure, tax strategy, and how costs apply. Understanding both helps you make the right choice for your situation.
| Standard STM PPO | HSA-Compatible STM PPO | |
|---|---|---|
| Deductible Options | $2,500 / $5,000 / $7,500 / $10,000 / $25,000 depending on plan tier | $6,000 / $7,500 — must meet IRS minimum deductible threshold for HSA eligibility |
| Coinsurance | 0% – 50% depending on tier (Essentials: 40%; Enhanced: 20%; Copay Enhanced: 0%) | 0% – 30% depending on design (four plan options, including 0% coinsurance plans) |
| Coverage Maximum | $250,000 (Essentials) / $1,000,000 (Enhanced) / $5,000,000 (Copay Enhanced) | $1,000,000 per certificate |
| HSA Contributions | ✗ Not eligible — standard STM does not qualify as an HDHP under IRS rules | ✓ Eligible — meets IRS HDHP requirements; you can contribute pre-tax dollars to an existing HSA |
| Preventive Care | Child immunizations first-dollar; adult screenings subject to deductible and coinsurance | First-dollar coverage for both child and adult preventive care — no deductible applies |
| Office Visit Copays | Available on Copay Enhanced tier ($40 PCP / $60 Specialist); other tiers subject to deductible | Subject to deductible and coinsurance — IRS rules prohibit first-dollar copays on HSA-compatible plans except for preventive care |
| Urgent Care | $50 access fee, deductible waived, subject to coinsurance | Subject to deductible and coinsurance — no access fee waiver (IRS HDHP rules require deductible to apply first) |
| Plan Duration | 30 days to 3 years (Renewable or Consecutive option) | 12-month, Renewable, and Consecutive options — 1 to 3 years |
| Rx Coverage | Rx rider available on select plans ($10 generic copay, $3,000 max benefit) | HSA funds can be used tax-free for any qualifying prescription — effectively makes Rx pre-tax |
| Best For | Someone who wants lower deductibles, copay options, or a shorter coverage period; not planning to use an HSA | Someone with an existing HSA who wants to keep contributing pre-tax; comfortable with a higher deductible offset by tax savings; planning a multi-year coverage period |
If you already have a Health Savings Account at your bank or credit union, an HSA-compatible STM plan lets you keep contributing pre-tax dollars. 2026 HSA contribution limits are $4,300 (individual) and $8,550 (family). Money contributed grows tax-free and withdrawals for qualified medical expenses are tax-free — including deductibles, coinsurance, Rx, dental, and vision. For a self-employed person in the 22% tax bracket, maxing an HSA contribution saves over $940/year in federal taxes alone.
If you want a $50 urgent care access fee with no deductible, office visit copays, or a lower deductible like $2,500 — choose Standard STM. HSA-compatible plans require a minimum $6,000 deductible and can't offer first-dollar benefits on non-preventive services per IRS rules. If you don't have or want an HSA, the Standard plan's lower deductibles and copay options will be more practical for day-to-day use.
A licensed broker will run side-by-side pricing on both plan types for your specific age, zip code, and coverage period — the premium difference between Standard and HSA-compatible plans is often smaller than expected, and the right choice depends heavily on whether you have an active HSA and how you expect to use the plan.
Real-World Scenarios
These scenarios represent situations where a licensed broker might legitimately recommend evaluating a short-term plan. Each situation is specific — and each requires a broker's individual assessment.
A family in Scottsdale has a daughter starting her sophomore year at the University of Colorado in Boulder. The family's ACA marketplace plan is an BCBS Arizona HMO — comprehensive coverage in the Phoenix metro, but only emergency coverage in Colorado. When the daughter gets strep throat, sees a dermatologist, or needs urgent care for a sprained ankle, the Arizona HMO leaves her on her own for those costs.
A healthy 38-year-old marketing professional in Tempe leaves his job at a tech company and is starting a new role in three months. COBRA to continue his former employer's coverage would cost $680/month. He has no pre-existing conditions, takes no regular medications, and is in excellent health. He needs 90 days of coverage before his new employer's plan kicks in.
A 63-year-old retired teacher in Tucson is two years away from Medicare eligibility. She retired early and her income is above the threshold for meaningful ACA subsidies. Full-price ACA premiums for someone her age in Arizona are substantial. She's in good health, has no significant pre-existing conditions, and simply needs coverage for a defined bridge period.
A 42-year-old general contractor in Mesa earns $85,000 net annually from his business — above the subsidy threshold for meaningful ACA credits in 2026 after the enhanced provisions expired. Full-price ACA premiums for his age bracket are around $650/month. He's healthy, exercises regularly, has no medications, and no significant health history.
A parent in Scottsdale has employer coverage for themselves but the cost to add their two healthy teenage children to the employer plan is prohibitive. ACA marketplace plans don't allow child-only enrollment for standard individual plans — a primary adult must be on the policy. The parent needs a standalone option for the kids.
The Broker's Role
Short-term medical is one of the insurance decisions where professional guidance isn't just helpful — it's genuinely important. Here's why.
A licensed broker compares both ACA and short-term options against your actual health situation and budget. Their job is to put you in the right plan — not to steer you toward the higher commission. If an ACA plan is the better fit, a good broker will tell you so.
Allstate Health Solutions STM underwriting has two distinct layers. The first is a set of hard eligibility knockout questions — pregnancy/infertility, a 5-year lookback covering 13 serious condition categories (heart disorders, stroke, diabetes/prediabetes, cancer, COPD, kidney/liver disorders, Crohn's, lupus, MS, bipolar disorder, alcoholism, neck/back disorders, and joint replacement), an HIV/AIDS question with no time limit, and a 12-month window for pending unresolved tests or undiagnosed symptoms. A "Yes" to any of these means the applicant is ineligible for STM. The second layer is the Preferred vs. Standard rate questions — factors like tobacco use, prior coverage continuity, driving record, and treatment for high blood pressure, high cholesterol, anxiety, or depression. These affect pricing only, not eligibility. A broker who places these plans regularly knows both sets of questions and will walk through them with you before you apply — five minutes that can save you from applying for the wrong product, or from paying a higher rate when you qualify for Preferred pricing.
Every short-term carrier defines exclusions slightly differently. A broker reads the actual policy language — not just the marketing summary — and flags anything that could affect you specifically based on your health history and anticipated needs.
Short-term plans are by definition temporary. A broker helps you think through what comes next — whether that's ACA open enrollment, an employer plan, Medicare, or another coverage option — so you don't find yourself in a gap when the short-term plan ends.
If a claim issue arises during your short-term coverage period, a broker is your advocate with the carrier. That ongoing relationship is something you don't have when you buy directly from a website without professional representation.
The right answer — ACA, short-term, COBRA, AHCCCS, or something else entirely — depends on your specific situation. A licensed Arizona broker will evaluate all of your options honestly and help you make an informed decision. Free service, no obligation.
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Short-term medical plans cover major medical events — but their higher deductibles create an out-of-pocket gap. Supplemental plans are designed specifically to fill it.
Say you choose an STM plan with a $5,000 deductible. You need emergency care — the bill is $12,900. Without supplemental, you pay $5,000 out of pocket.
Add a supplemental plan with a $250 deductible. That plan pays $4,750 — 98% of your STM deductible. Your total out of pocket: $250.
These plans typically cost $20–$60/month — a small addition to your premium that can prevent thousands in exposure from a single event.
Important: The STM policy certificate confirms the pairing works cleanly. Under the Coordination of Benefits section, hospital indemnity, accident, and specified disease plans are explicitly excluded from COB rules — meaning both plans pay their full benefits independently. The STM pays its full claim. The supplemental pays its full cash benefit on top. No offset. This is by design.
Common Questions
Short-term medical plans can be the right solution for a specific person in a specific situation. They can also be the wrong solution — and choosing incorrectly can result in unexpected medical bills, denied claims, and significant financial hardship.
Please do not purchase a short-term medical plan based on price alone. Understand every exclusion. Know your health history and how it will be treated during underwriting. Know what happens when the plan ends and how you will transition to other coverage. Have a licensed broker walk through the policy language with you before you enroll.
Our broker network is here to provide exactly that guidance — honestly, at no cost to you, with no pressure to choose any particular plan or carrier. The right answer for your situation may be an ACA plan, a short-term plan, AHCCCS, COBRA, or something else entirely. A licensed Arizona broker will help you find out which.
A licensed Arizona broker will compare your ACA and short-term medical options side by side, honestly and at no charge — so you can make a fully informed decision.
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