AHCCCS Freedom To Workand Medicare Cost Sharing Presented By David Cardinali Work Incentives Consultant DIRECT Center for Independence, Inc.
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 Guarantee The 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