AHCCCS Health Insurance Plan Detail


Medicaid Expansion and Other Assistance

AHCCCS was expanded under the Affordable Care Act and now accepts childless adults earning up to 138 percent of the federal poverty guideline. Beginning January 1, 2014, low-income Arizonans between ages 18 and 64 are able to enroll in the state’s Medicaid program to receive affordable health insurance. Residents can find out if they qualify for Medicaid by using the Health-e-Arizona website and apply directly through the site. This additional eligibility group has access to full AHCCCS benefits, including emergency care, hospitalization, prescriptions, physician services and maternity care, as other members do currently.

If your income is too high for AHCCCS, you likely will be eligible for subsidized coverage at a low cost on the Arizona Health Insurance Marketplace. The marketplace accepts enrollees and provides substantial tax credits to those who earn 138 percent FPL or greater, with financial assistance for medical care as well as monthly premiums. If you discover your income is over the limit for AHCCCS, you can apply for coverage on the exchange by calling 888.803.5917 and speaking with a licensed agent to find out if you qualify for tax credits.

 

Covered Medical Services

If you qualify for one of the AHCCCS health insurance programs in this section, your coverage will include the following benefits.

Operating similarly to a health maintenance organization (HMO), the AHCCCS program is provided by multiple health insurance companies throughout Arizona who connect you with a primary care physician and a network of other providers including specialists, hospitals, pharmacies, and medical facilities. Once enrolled, you select a PCP through your health plan to coordinate your care. A primary care physician is responsible for being your key provider, and will always be the first one you see for care. Additionally, your PCP will provide referrals to specialists under certain circumstances and give approval to obtain other medical care which is not an emergency. If you have a medical emergency, you are not required to speak with your PCP beforehand.

 

AHCCCS Health Plans

Each health plan will provide the same selection of benefits though your provider choice will vary based on the plan in which you are enrolled. While you have options as to the health plan you choose, your location will determine which are available to you. All counties have a choice of health plans, providing all AHCCCS members with managed care. When choosing a plan, you’ll want to consider the plans that contract with a specific doctor or other providers you prefer to use. Check with your doctor by calling their office and inquiring as to whether they accept your AHCCCS health plan, and you can also visit your health plan’s website for a provider list or contact the plan directly through the Member Services number.

Contact an AHCCCS health plan in your area.

 

For American Indian Applicants

American Indians have the option of selecting a health plan, or enrolling in the American Indian Health Program (AIHP) and obtaining medical care through tribally operated Indian Health Service, or urban clinics (ITUs).

 

AHCCCS Benefits

Once enrolled in an AHCCCS health plan, you have access to a numerous covered medical services, including preventive and primary care, emergency room visits, maternity care and more. Vision, dental, and hearing services and supplies are also covered for children under age 21.

  • Physician’s Office Visits
  • Emergency Care
  • Prescriptions (except for Medicare members)
  • Lab and X-rays
  • Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services (children under age 21)
  • Inpatient/Outpatient Hospital
  • Specialists
  • Vaccinations
  • Medical Transportation
  • Prenatal and Maternity Care
  • Podiatry Services
  • Surgery Services
  • Family Planning Services
  • Physical Exams
  • Behavioral Health
  • Dialysis
  • Yearly Well Woman Visits
  • Glasses (for children under age 21)
  • Vision Exams (for children under age 21)
  • Dental Care (for children under age 21)
  • Hearing Exams (for children under age 21)
  • Hearing Aids (for children under age 21)