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 Freedom to Work, and if you do, how you can have AHCCCS Freedom to Work and other health coverage at the same time. If you don’t qualify for AHCCCS Freedom to Work, you may still qualify for AHCCCS based on other rules and you should consider other options we will introduce, including Medicare and private health insurance.

AHCCCS Freedom to Work Basic Eligibility Requirements

To qualify for AHCCCS Freedom to Work, you must:

• Be age 16 – 64
• Have been determined to be blind or have a disability according to Social Security Administration rules
• Be a U.S. citizen or meet specific noncitizen requirements
• Be working and paying Social Security and Medicare taxes, and
• Meet certain income requirements.

Note: If you’re on Supplemental Security Income (SSI) or SSI’s 1619(b) provision, you will automatically qualify for AHCCCS and do not need to apply for AHCCCS Freedom to Work separately. You will not need to pay a premium and you do not need to worry about the qualifying rules discussed on this page. Read more in DB101’s AHCCCS for People with Disabilities article.

Disability Determination

To get AHCCCS due to your disability, you must be determined disabled by the Disability Determination Services Administration (DDSA), which handles disability determination for SSA and AHCCCS. To get a disability determination, you will have to get medical documentation specified by DDSA.

They’ll say you have a disability if:

• You have a physical or mental impairment or combination of impairments, and
• Your condition has lasted or is expected to last for at least 12 months.

For AHCCCS Freedom to Work, SSA’s disability rules related to earned income do not apply.

Note: If you get Social Security Disability Insurance (SSDI) benefits, you automatically meet this requirement.

Citizenship and Noncitizen Requirements

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

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 DES/Family Assistance Administration office.

Income

AHCCCS Freedom to Work is for people with disabilities who have moderate incomes from work. If you are in this situation, you may qualify if your countable monthly income is at or below an income limit.

To see whether your income would qualify for AHCCCS Freedom to Work due to your disability, AHCCCS will look at your countable earned income and compare it to the Federal Poverty Guidelines (FPG). For eligibility, only your earned income is counted, not the income of other household members.

If your countable monthly income is below 250% of FPG ($3,260 for an individual), you may qualify for AHCCCS Freedom to Work.

Figuring Out Your Countable Income

Follow these steps to find out your countable income:

1. Add up your gross monthly earned income (income from work before taxes are deducted), including wages, tips, bonuses, and self-employment earnings.
2. Subtract a $65 Earned Income Exclusion and a $20 General Exclusion.
3. Then divide the result by 2. The result is your countable earned income.

AHCCCS Freedom to Work Countable Income

Earned Income

Minus the $20 General Exclusion

Minus the $65 Earned Income Exclusion

= Subtotal

Divide by two

= Countable Income (Freedom to Work)

**Depending on your situation, Impairment Related Work Expenses (IRWEs), if you have them, may be subtracted before or after dividing by 2. Talk to a Work Incentive Consultant if you have any questions about this.

Your AHCCCS Freedom to Work Countable Income (compared to FPG):

Your Monthly Earned Income	$
	20.00
	65.00
Your Monthly Countable Income
Federal Poverty Guidelines	$1,305.00
Your Countable Income as a Percent of FPG

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If you are working, paying taxes and have countable monthly income that is 250% of FPG or less, you may qualify for AHCCCS Freedom to Work.

AHCCCS Freedom to Work, Private Health Coverage, and Medicare

Here we will look at what signing up for AHCCCS Freedom to Work might mean if you also have or want private coverage or Medicare.

AHCCCS Freedom to Work and Private Health Coverage

You can be enrolled in both AHCCCS Freedom to Work and private coverage at the same time. There are 2 main advantages to this:

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

The disadvantage is that you would have to pay premiums for both programs and private coverage usually has higher copayments than AHCCCS Freedom to Work, so it might not be worth the expense.

AHCCCS Freedom to Work and Medicare

If you are eligible for both AHCCCS Freedom to Work and Medicare, it will help you to have both because:

• If your income is low enough, AHCCCS Freedom to Work may pay your Part B premium (and your Part A premium, if you have one). In some cases it may even pay for Medicare deductibles, co-insurance, and copayments.
• You will automatically qualify for the Part D Low Income Subsidy. The Low Income Subsidy means you may not have to pay a premium for your Part D or any deductibles. All you would pay for prescription drugs are Part D’s copayments, which range from $1.60 to $12.15.

To learn more, read DB101’s detailed information on Medicare Savings Programs for Parts A and B and the Part D Low Income Subsidy.

If you get AHCCCS Freedom to Work, it will pay for a broad range of medical services. If you’re not sure if a particular service is covered by AHCCCS Freedom to Work, or if you need prior authorization, ask your doctor or your AHCCCS Freedom to Work managed care program.

Here is a list of the main services that AHCCCS Freedom to Work provides:

• Doctor’s Visits
• Immunizations (shots)
• Prescriptions (not covered if you have Medicare)
• Lab and X-rays
• Specialist Care
• Hospital Services
• Transportation to Doctor
• Emergency Care
• Pregnancy Care
• Surgery Services
• Physical Exams
• Behavioral Health
• Family Planning Services
• Dialysis

For children under age 21, AHCCCS Freedom to Work also provides:

• Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services
• Glasses
• Vision Exams
• Dental Screening
• Dental Treatment
• Hearing Exams
• Hearing Aids

Coverage for some long-term care services, including nursing homes, may require a separate application for a program called the Arizona Long Term Care System (ALTCS), which has some additional eligibility requirements. To learn more, see DB101’s information about ALTCS in the Personal Assistance Services article or contact your local DES/Family Assistance Administration office.

If you get AHCCCS Freedom to Work, you may need to pay a monthly premium and copayments for certain services.

Premiums

The monthly premium for AHCCCS Freedom to Work coverage is based on your countable earned income. The higher your income is, the higher your premium will be. The maximum premium is $35.

Use this tool to see your countable income and then check the table below to see how much your premium will be.

Your AHCCCS Freedom to Work Countable Income:

Your Monthly Earned Income	$
	20.00
	65.00
Your Monthly Countable Income

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Note: American Indians who verify their tribal enrollment are not charged a premium, regardless of their income.

To get a better idea of whether you qualify for AHCCCS Freedom to Work and how much your premium might be, use the AHCCCS Freedom to Work Estimator.

When Can My Premium Change?

If your income changes, your premium may also change. AHCCCS Freedom to Work will review your eligibility and premium at least every 12 months. Depending on your situation, your premium could go up or down.

Be sure to report any changes in income to the AHCCCS Freedom to Work office within 10 days of when the change occurs. You can call them at 1-855-432-7587 or 1-602-417-5010.

Billing

If you have to pay a monthly premium to get AHCCCS Freedom to Work, the state will send you a bill on the first workday of every month. If you have questions about billing, contact the AHCCCS Freedom to Work office for help at 1-855-432-7587 or 1-602-417-5010. If you prefer, you can pay your premium online.

If you miss a payment, you get a letter, called a “notice of adverse action,” that lets you know what you need to do to get back into good standing. If AHCCCS gets full payment from you by the due date shown in that letter, then your coverage will be reinstated. If not, then you will lose your coverage for not paying the premium.

Copayments When You Get Services

Generally, if you are 19 years old or older, you may have to pay small copayments as low as $2.30 when you use certain medical services that AHCCCS covers.

You do not need to make copayments if you are:

• Less than 19 years old
• A child eligible to get services from the Children's Rehabilitative Services (CRS) program
• A pregnant woman
• Enrolled with American Indian Health Program (AIHP)
• Diagnosed as Seriously Mentally Ill (SMI) by the Arizona Department of Health Services (ADHS)
• An Acute Care AHCCCS member who is temporarily residing in a nursing home or residential facilities, if your medical condition would otherwise require hospitalization, or
• In hospice care.

Application

There are different ways to apply for AHCCCS Freedom to Work:

• Online using Health-e-Arizona. Health-e-Arizona lets you apply for other programs, like Nutrition Assistance or TANF Cash Assistance, at the same time.
• Online using HealthCare.gov, an online one-stop shop where you can learn about your public and private coverage options.
• Using a paper application the AHCCCS Freedom to Work office can mail you. To ask for an application, call 1-855-432-7587 or 1-602-417-5010.

When you fill out your application, make sure to answer all questions completely, including questions about your income and whether you have a disability.

No matter how you apply, it is important to know that if you are not eligible for AHCCCS Freedom to Work, you may be able to get private insurance subsidized by the government.

Note: If you get Supplemental Security Income (SSI) or are on SSI 1619(b), you don’t need to apply for AHCCCS Freedom to Work, because you’ll get AHCCCS coverage automatically and won’t have to pay a premium.

Staying on AHCCCS

Usually, once you are approved for AHCCCS Freedom to Work, you will continue to get it for 12 months if your situation does not change. If your income, household size, or disability status changes or you turn 65, update your information on Health-e-Arizona or with the AHCCCS Freedom to Work office at 1-855-432-7587 or 1-602-417-5010.

When you report your changes, the eligibility system will tell you whether you will continue getting AHCCCS Freedom to Work or if you have new health coverage options. There should always be at least one health coverage option for your family.

Job Loss

To be on AHCCCS Freedom to Work, you must be employed. If you lose your job and your AHCCCS Freedom to Work coverage, there should be at least one health coverage option for you. You may become eligible for AHCCCS without a premium or an individual insurance plan that the government will help you pay for. Read more about these options in DB101’s Health Programs section.

Medical Leave

If you go on medical leave from work, using either Family Medical Leave or short-term disability insurance, you will continue to be covered by AHCCCS Freedom to Work.

Melanie’s Story

Melanie is 35 years old and has cerebral palsy. She hasn’t been able to work for the past 6 months due to her disability and been living on the $850 in Social Security Disability Insurance (SSDI) benefits she gets every month. AHCCCS covers her health care expenses.

She’s been feeling better recently and wants to go back to work. So she talks to some friends and passes her resume around. Soon enough, a former coworker offers her a part-time job at his new start-up company. Unfortunately, the job does not come with health insurance and she’d be earning too much money to keep her AHCCCS. She really wants to take this job but she cannot risk going without health insurance. Between her prescription drugs, physical therapy, and Personal Assistance Services (PAS), her total medical cost is several thousand dollars per month.

Melanie looks at getting an individual plan on HealthCare.gov. She knows that starting in 2014, nobody can be turned down for a plan, but she doesn’t know how good the available plans really are. After filling out her information, it turns out that she could sign up for a plan that would cost her about $150 a month for the premium. The problem is that the plan has a deductible and also has copayments that are way higher than her AHCCCS copayments were. Furthermore, it wouldn’t pay for the PAS she needs like AHCCCS does. She hopes to find another option.

She talks about the problem with her personal assistant, Samantha, who mentions the AHCCCS Freedom to Work program.

“It’s designed for people like you,” Samantha says. “You can go back to work and earn up to $6,606 per month, while still keeping your health coverage.”

“But what about my savings? Can I keep them?” Melanie asks.

“I think so,” says Samantha, “but you should talk to a Work Incentive Consultant to find out more.”

Together, Melanie and Samantha find the local Center for Independent Living and set up an appointment with a Work Incentive Consultant. They learn that Melanie can have any amount of resources and still qualify for AHCCCS Freedom to Work.

The Work Incentive Consultant tells them, “AHCCCS Freedom to Work pays for all the same services that your AHCCCS coverage has been paying for. You may have to pay a monthly premium, but that wouldn’t be more than $35 each month. You’ll also be responsible for small copayments for some services.”

“Plus,” the Work Incentive Consultant tells her, “if your condition gets worse and you have to take some time off work, you won’t necessarily lose your coverage as long as you are an employee.”

“This all sounds great,” says Melanie. “I can go back to work! So what do I do now?”

“Take that job,” says the Work Incentive Consultant, “and when you get your first check, call your AHCCCS caseworker within 10 days to report your earnings and ask about AHCCCS Freedom to Work coverage. Then we’ll go from there.”

Melanie is ecstatic. She’ll be able to go back to work, doing something she really enjoys. And she’ll be able to keep her health coverage for a reasonable monthly cost.