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 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.

Alternatives for employed people with disabilities

AHCCCS Freedom to Work is just one option for people with disabilities who work. Depending on your situation, other ways for you to get health coverage could include:

These options may be better for you. Read more about them in DB101’s Health Programs section.

AHCCCS Freedom to Work Basic Eligibility Requirements

To qualify for AHCCCS Freedom to Work, you must:

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.

Example

Tim has a brain injury. He’s been on standard AHCCCS for several years and needs the services it pays for. Tim wants to start working again and has a great job offer, but the job is part-time and does not come with health insurance.

Tim should consider AHCCCS Freedom to Work. It pays for the same services that standard AHCCCS covers. With AHCCCS Freedom to Work, Tim could take the job, earn some money, and be able to get his medical needs taken care of, while just paying a small monthly premium.

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 ($2,602 for an individual), you may qualify for AHCCCS Freedom to Work.

Countable income is not the same as your real, full income

In this article, we talk about how there is a limit for how much countable income you can have and still qualify for AHCCCS. The confusing thing is that “countable income” is not the same as your total income. For example, if you make $4,000 per month at a job and have no other income, that’s only $1,957.50 in countable monthly income.

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

**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):

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, including the donut hole. All you would pay for prescription drugs are Part D’s copayments, which range from $1.25 to $8.50.

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

Who pays when you have more than one health coverage

Depending on your situation, you might get employer-sponsored coverage, AHCCCS Freedom to Work, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.

The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.

Generally speaking, AHCCCS Freedom to Work will only pay for expenses that it covers and that your other coverage won't pay for.

Note: If you use a health provider that is not covered by AHCCCS Freedom to Work, AHCCCS Freedom to Work will not pay any medical expenses. So, if your health care provider doesn’t take AHCCCS Freedom to Work and your private insurance or Medicare won’t cover everything, AHCCCS Freedom to Work won’t help pay the rest. Make sure to find providers who accept AHCCCS Freedom to Work.

The Centers for Medicaid and Medicare Services has a helpful pamphlet on Medicare and Other Health Benefits: Your Guide to Who Pays First.