Is It Right for You?

Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?

This page looks at whether you might qualify for AHCCCS. If you do, it is your best choice and you won’t qualify for subsidized individual coverage. You can see if you qualify for AHCCCS at Health-e-Arizona or Healthcare.gov.

If you don’t qualify for AHCCCS, consider other options we will introduce, including Medicare and private health insurance.

Different ways to qualify for AHCCCS if you have a disability

If the Social Security Administration (SSA) says you are disabled, you may have additional ways of qualifying for AHCCCS, depending on your situation. Read DB101’s AHCCCS for People with Disabilities article.

AHCCCS Basic Eligibility Requirements

To qualify for AHCCCS, most people must meet several basic requirements:

  • Be under 65 years old
    • You can be 65 or older if you are the parent or caretaker of a child
  • Not be eligible for Medicare
    • You can be on Medicare if you are the parent or caretaker of a child or are pregnant
  • Be a U.S. citizen or meet specific noncitizen requirements, and
  • Have income below certain limits

Under Age 65

There are different ways to get AHCCCS and the way described here is usually for people under age 65. If you are 65 years old or older, read DB101’s Medicare article and talk to your local oficina de DES/Administración de Asistencia para Familias about whether you qualify for AHCCCS.

Exception: If you are 65 or older and are the parent or caretaker of a child, you may be able to get AHCCCS through the rules discussed in this article.

If you are under 65, continue reading this article.

Not Eligible for or Enrolled in Medicare

AHCCCS’s eligibility rules are different for most people who are eligible for or enrolled in Medicare. If you are eligible for or getting Medicare, read DB101’s Medicare article or contact your local oficina de DES/Administración de Asistencia para Familias.

Exception: If you are enrolled in Medicare and are the parent or caretaker of a child or are pregnant, you may be able to get AHCCCS through the rules discussed in this article.

If you are not on Medicare, keep reading this article.

Citizenship or Residency

You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for AHCCCS.

If you are legally in the United States, but do not qualify for AHCCCS, you may qualify for subsidized private insurance through Healthcare.gov.

If you are an undocumented immigrant, you may qualify for AHCCCS coverage for emergencies only. To learn more about this, contact your local oficina de DES/Administración de Asistencia para Familias.

If you are a U.S. citizen or meet the noncitizen requirements for AHCCCS, continue reading this article.

Income

If your family’s income is at or below 138% of the Federal Poverty Level (FPL) ($16,753 per year for an individual in 2019, $34,638 for a family of four), you may qualify for AHCCCS. Children who are 18 or younger can get AHCCCS KidsCare coverage if their family's income is 205% of FPG or less ($51,455 per year or less for a family of four).

Income-based AHCCCS counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based AHCCCS eligibility.

Is AHCCCS’s income limit 133% or 138% of FPL?

You may see the income limit for AHCCCS listed as 133% of FPL in some places. However, when AHCCCS counts your income, they’ll knock 5% of FPL off your income if you make more than 133% of FPL. That's why we show the limit as 138% of FPL, because it more accurately shows how much you could make and still get AHCCCS.

If you cannot get AHCCCS because your income is too high, consider buying an individual plan through Healthcare.gov. See DB101’s article about Buying Health Coverage on Healthcare.gov.

Límites de ingreso para beneficios de salud

The bottom line: If you meet the 4 main requirements described here, AHCCCS is a great program that you should sign up for. We explain how to sign up later in this article.

More ways to qualify for AHCCCS if you have a disability

If you have a disability, you may qualify for AHCCCS in more than one way. The good thing is that when you apply for AHCCCS, the people reviewing your application will automatically figure out which AHCCCS eligibility rules are right for you.

Reasons you might qualify for AHCCCS under disability rules instead of the rules described in this article:

  • Your income is higher than the 138% of FPL limit. AHCCCS’s eligibility rules for people with disabilities don’t count all of your earned income, so you may make more than that and qualify by disability rules. Furthermore, people with disabilities who work and have higher income may qualify through Programa de Libertad para Trabajar de AHCCCS.
  • You also get Medicare. Usually, AHCCCS isn’t available to most people getting Medicare, but AHCCCS for people with disabilities is. It may even help pay your monthly Medicare premiums.

Reasons you might qualify for AHCCCS under the rules described in this article, even if you have a disability:

  • Your disability does not meet Social Security’s definition of disability. AHCCCS for people with disabilities is only for people who have disabilities meeting this standard.
  • You make enough money that you would have to pay a monthly premium for Programa de Libertad para Trabajar de AHCCCS.

To learn more, read DB101’s articles about AHCCCS for people with disabilities and Programa de Libertad para Trabajar de AHCCCS, or contact your local oficina de DES/Administración de Asistencia para Familias.

AHCCCS and Private Health Coverage

If you qualify for AHCCCS, you should sign up for it. Here we will look at what signing up for AHCCCS might mean if you have or want private coverage.

AHCCCS and Employer-Sponsored Health Coverage

If you qualify for AHCCCS, it will always be your best choice, even if your employer offers health insurance. That’s because AHCCCS has no monthly premium and the copayments for services are usually much lower than copayments required by employer-sponsored plans. Also, AHCCCS may cover some services that your employer-sponsored coverage does not pay for.

However, there are a couple of advantages to having both AHCCCS and employer-sponsored coverage at the same time:

  • Private insurance may cover some benefits that AHCCCS doesn’t or the other way around.
  • Private coverage may let you choose from more doctors.
Example

Nelson is a single father living on his own with his daughter. He makes $10 an hour repairing shoes and works 30 hours a week, so he makes a total of about $1,200 a month. Because he works 30 hours a week, his employer offers him and his daughter health insurance, but to get it, he would have to pay a $200 premium each month.

Nelson decides to go to his local oficina de DES/Administración de Asistencia para Familias to see if his family would qualify for AHCCCS, because he doesn’t have enough money to pay the monthly premium for health coverage offered through his job. The case worker looks at his income and explains that he does qualify for AHCCCS, because his income is less than 138% of FPL for a family of 2. Nelson signs up for AHCCCS and does not sign up for the plan his job offered.

AHCCCS and Individual Plans

If you are eligible for AHCCCS, then you will not be eligible to get government help to pay for a private insurance plan. That means the private insurance plan would be expensive for you. If you qualify for AHCCCS, it will always be a better option for you than paying for an individual plan.