Presented By

David Cardinali

Work Incentives Consultant

DIRECT Center for Independence, Inc.

Presented By

David Cardinali

Work Incentives Consultant

DIRECT Center for Independence, Inc.

AHCCCS Freedom To Workand Medicare Cost Sharing

Medicaid Coverage in Arizona

AZ’s Medicaid program is called the Arizona Health Care Cost Containment

System, or AHCCCS

To qualify for regular AHCCCS a single individual cannot have income that exceeds 100% of the 2012 Federal

Poverty Level, or $931

Programs With Additional Eligibility Requirements

Freedom To Work (FTW) -

•Medicaid buy-In for the disabled

Medicare Cost Sharing (MCS) -

•Help pay for some Medicare premiums, co-pays & deductibles

Freedom To Work (FTW)

AHCCCS for disabled individuals ages 16 to 64 who are employed.

• Net countable monthly earnings limit of 250% of the FPL ($2,679.17 in 2012). Countable is after $85 is deducted then divided in half.

• Social Security Disability Income not counted.• Resources are not counted.• Monthly premium of $0 to $35.• Renewals completed every 12 months.

*

FTW Basic Coverage

Disabled if… Receiving Social Security Disability (SSDI)

Determined Medically Eligible by a PAS(Pre-Admission Screening)

Determined Disabled by DDSA(Disability Determination Services Administration)

FTW Basic Coverage Groups

Employed if…

Working Full or Part Time (at least 40 hours per month)

Paid at least minimum wage for working

Paying Social Security and Medicare taxes on earnings

NOTE: This also applies for self-employed

FTW Six Month GuaranteeThe customer is guaranteed six months of AHCCCS coverage the first time he or she is approved for AHCCCS Medical Services.

Unless: Fails to pay the FTW premium Moves out-of-state Voluntarily withdraws from AHCCCS program Is an inmate of a public institution Dies

FTW Premiums

Net Countable Monthly Income Premium

$0 to $ 500.00 $0 $500.01 to $ 750.00 $10.00 $750.01 to $1000.00 $15.00 $1000.01 to $1250.00 $20.00 $1250.00 to $1500.00 $25.00 $1500.01 to $1750.00 $30.00 $1750.00 to $2679.00 $35.00

Where To Apply for FTW

AHCCCS Freedom To Work Unit

801 East Jefferson MD 1600

Phoenix AZ 85034

Phone Number: 602-417-6677

Fax Number: 602-417-6675

www.azahcccs.gov or

www.healtheariona.org

Medicare Coverage Medicare Part A Coverage

• Most individuals do not pay a premium based on FICA deductions from wages.

Medicare Part B Coverage• Monthly premium ($99.90 in 2012).

Medicare Part D Coverage• Prescription drug plan through Medicare.

• Medicaid customer’s get their prescription drugs through a Medicare drug plan.

Medicare Cost Sharing (MCS)

Qualified Medicare Beneficiary (QMB)

• AHCCCS Pays Premiums for Parts A and B

• AHCCCS Pays Deductibles, Co-Insurance, and Co-Pays

• 100% of Federal Poverty Level ($931) Specified Low-Income Medicare Beneficiary (SLMB)

• Receives Medicare Part A

• AHCCCS Pays Premium for Part B

• 120% of Federal Poverty Level ($1117) Qualified Individual 1 (QI-1) – may end on 12/31/12

• AHCCCS Pays Premium for Part B

• 135% of Federal Poverty Level ($1,257)

Medicare Buy In

There is no automatic Medicare buy-in under the AHCCCS Freedom to Work program

Customers who are approved for AHCCCS

Freedom to Work will continue to be responsible for payment of their Medicare premiums.

Freedom to Work customers can also apply for Medicare Cost Sharing.

Where To Apply for MCS

AHCCCS - SSIMAO Office

801East Jefferson MD 3800

Phoenix AZ 85034

Phone Number: 602-417-5010

Fax Number: 602-258-4619

www.azahcccs.gov or

www.healtheariona.org

Thanks to our presenters:

Dan Frey, Office of Congressman Ron Barber, Constituent Services Rep.

Dave Cardinali, Work Incentives Counselor, DIRECT Center for Independence

Questions?