AHCCCS Eligibility
Arizona Health Care Cost Containment System
North Country accepts Health Choice, Phoenix Health Plan IHS, Evercare and Mercy Care Plans offered by AHCCCS. Patients not already on AHCCCS who appear eligible may apply with our AHCCCS eligibility department. You will need identification, your social security card, birth certificate, income verification for the last 30 days and proof of residency. If you are accepted by the AHCCCS program, they are able to cover more of your medical expenses than we can. If you are denied medical coverage, bring a copy of the current denial letter to verify that you complied, so we can continue to serve you on a sliding fee basis.
There are five health insurance programs available under the AHCCCS Administration:
* Arizona’s Medicaid
* KidsCare
* Health Insurance for Parents
* Medicare Cost Sharing
* Healthcare Group
* Social Security Disability Insurance-Temporary Medical Coverage (SSDI-TMC)
Covered Medical Services
AHCCCS contracts with several health plans to provide covered services. An AHCCCS health plan works like a Health Maintenance Organization (HMO). The health plan works with doctors, hospitals, pharmacies, specialists, etc. to provide care. You will choose a health plan that covers your zip code area. If you are approved, you will choose a primary care doctor that works with that health plan. Your primary doctor will:
* Be the first person you go to for care
* Authorize your non-emergency medical services
* Send you to a specialist when needed
AHCCCS health plans provide the following medical services:
* Doctor’s Visits
* Immunizations (shots)
* Prescriptions (Not covered if you have Medicare)
* Lab and X-rays
* Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services for Medicaid eligible children under age 21
* Specialist Care
* Hospital Services
* Transportation to doctor
* Emergency Care
* Pregnancy Care
* Podiatry Services
* Surgery Services
* Physical Exams
* Behavioral Health
* Family Planning Services
* Dialysis
* Annual well women exams
* Glasses (for children under age 21)
* Vision Exams (for children under age 21)
* Dental Screening (for children under age 21)
* Dental Treatment (for children under age 21)
* Hearing Exams (for children under age 21)
* Hearing Aids (for children under age 21)
For more information on AHCCCS, visit their website: www.azahcccs.gov
For more information on AHCCCS Eligibility, please go here
For more information on AHCCCS Covered Services, please go here
KidsCare Program
KidsCare is healthcare insurance made available by the State of Arizona. KidsCare offers healthcare at low cost to Arizona children 18 years old or younger. KidsCare allows children to visit the doctor, get eye exams, visit the dentist, and receive emergency care if needed. North Country is a KidsCare provider through Phoenix Health Plan or Health Choice. If your children are eligible, they will be referred to KidsCare by our eligibility workers.
Learn What's Covered
KidsCare members work with their health plan to pick the doctors and dentists who will provide their care. KidsCare covers a wide range of quality services kids need to stay healthy, strong, and get better when they're hurt or sick.
Medical care includes:
* Doctor office visits
* Well Child visits and immunizations
* Physical exams
* Prescriptions and medical supplies
* Laboratory & x-rays
* Specialist care
* Hearing tests, aids
* Hospital services
* Emergency medical transportation
* Behavioral health
* 24-hour emergency care
* Care for pre-existing conditions
* Dental screenings, treatments
* Eye exams, glasses
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program
Did you know that AHCCCS has a great program to help keep kids and teens healthy?
It’s called Early and Periodic Screening, Diagnosis and Treatment or EPSDT and it’s for anyone on AHCCCS or KidsCare programs. These programs offer screening and pay for the care for illnesses that are detected.
KidsCare Parents
Parents of children covered by KidsCare health insurance may also qualify for health insurance. Parents receive the same quality healthcare as their children.
When parents are also enrolled, KidsCare will charge a Family Premium based on the number of people in the household and the monthly income. For example:
Household size = 4 people (1 adult + 3 children)
Gross monthly household income = $2,800.00
Family Premium = $2,800.00 x .05% = $140.00 per month
The application requirements for parents are the same as for children, and a parent can only be covered as long as a child is enrolled.
Application Requirements
To qualify for KidsCare you must:
* Be a resident of Arizona
* Be 18 years old or younger
* Be a U.S. citizen or a qualified eligible immigrant - regardless of the status of the parents
* Not currently be covered by other health insurance
* Not qualify for coverage through a state agency employee
* Be a member of a household that meets the KidsCare income guidelines
* Be a member of a household that is willing to pay a premium
Income Limits
Depending on your family size and income, you may qualify for KidsCare or AHCCCS (Medicaid). KidsCare applications are screened first for AHCCCS and then KidsCare. If you or your child qualifies for AHCCCS, your application will be sent to the Department of Economic Security and they may ask you for more information.
Family Income Limits
May Qualify for AHCCCS
(Medicaid, with no monthly premium)
Family Size Monthly Family Income Annual Family Income
1 $903 $10,830
2 $1,215 $14,570
3 $1,526 $18,310
4 $1,838 $22,050
5 $2,150 $25,790
6 $2,461 $29,530
May Qualify for KidsCare
Family Size Monthly Family Income Annual Family Income
1 $1,805 $21,660
2 $2,429 $29,140
3 $3,052 $36,620
4 $3,675 $44,100
5 $4,299 $51,580
6 $4,922 $59,060
This chart shows how much your family can make in gross monthly income, which is all the money your family gets during a calendar month, before any taxes or deductions. If you are paid weekly, KidsCare counts 4.3 times your gross weekly pay. If you are paid every other week, KidsCare counts 2.15 times your gross biweekly pay.
Proof
All applicants must provide proof of information given on the application.
To speed up the processing of your application, send the information listed below with your application:
* If you are working for someone other than yourself, include copies of check stubs or a letter from employer showing your gross earnings last month and this month. If someone listed on the application lost a job within the last two months, send proof of the last day worked and the gross amount of the last check received.
* If you are self-employed, include copies of current Federal tax forms: 1040, SE and applicable schedule C, C-EZ, E, F, K-1, etc. or proof of business income and expenses for the last calendar month.
* Other Income: Include proof of any other income or money your family got from anyone for any reason, this month and last. This includes award letters from the Division of Child Support Enforcement, Social Security Administration, Unemployment Insurance, Veterans Administration, Railroad Retirement, or other retirement or disability pension.
* Health Insurance: Include copies of insurance cards for persons who are applying but who already have health insurance, or attach a piece of paper that lists the company name and policy number.
* Citizenship: KidsCare will need to see the original document for persons applying who are U.S. citizens, such as a birth certificate, U.S. passport, etc.
* Immigration Status: Copies of both sides of immigration documents for persons who are applying. Receiving KidsCare/AHCCCS will not affect anyone's immigrant status.
* Daycare: Proof of the amount of money paid for the care of a child or an incapacitated adult.
Health Plan
When you fill out the application for KidsCare you must choose a health plan.
Pick a Health Plan
Each health plan provides the same quality services, but each may work with different doctors, dentists, and hospitals. Health Plans differ depending on where you live in Arizona. There are health plans in every county. When picking a health plan:
1. Find out which plan contracts with your doctor
2. Contact each health plan for more information
Once enrolled in KidsCare you will get a member handbook from your selected health plan with important information about how to pick a doctor, how to get transportation, and more.
Monthly Premiums
KidsCare will cost no more than $50 a month for one child or no more than $70 a month no matter how many children are in the household. Per federal law, Native Americans enrolled with a federally recognized tribe and certain Alaskan Natives do not have to pay a premium. To get KidsCare at no cost, you must give us proof of tribal enrollment. View Sample Billing
If children and parents are enrolled, premiums are charged as a family. Learn more about KidsCare Family Premiums and KidsCare Parents.
Premium Payment Options
Paying a KidsCare premium is simple! You can pay by:
* Personal Check
* Money Order
* Cashier's Check
* Pay Premium Online (https://www.myahcccs.com/)
You can mail or bring your payment to the central office located at:
AHCCCS Administration
701 E. Jefferson Street
Phoenix, AZ 85034
Drop box is in lobby. No cash please.
Premium Payment Deadlines
* When to Pay: On the last day of each month, a reminder about your premium payment is mailed. You will have until the 15th day of the month to pay your premium.
* When Premiums Aren't Paid: Payments made for KidsCare are applied to the children's account first and then the parents. If payments fall more than one month behind, KidsCare coverage will end.
Learn more about KidsCare here: www.azkidscare.gov
Payment arrangements
If you are concerned about paying your bill, please talk to someone in our billing department who will work out a convenient payment plan for you. Unless prior arrangements are made, payments are expected on the day the service is performed. You may pay by cash, personal check, money order, care credit, MasterCard, Visa, American Express, or Discover.
If you should receive a bill and have a question please call our billing department at 928.233.5110
