AHCCCS Freedom To Work and Medicare Cost Sharing

1. AHCCCS Freedom To Workand Medicare Cost Sharing Presented By David Cardinali Work Incentives Consultant DIRECT Center for Independence, Inc.

2. Medicaid Coverage in Arizona • AZ’s Medicaid program is called the Arizona Health Care Cost Containment System, or AHCCCS To qualify for regular AHCCCS a single individual cannot have income that exceeds 100% of the 2012 Federal Poverty Level, or $931

3. Programs With Additional Eligibility Requirements Freedom To Work (FTW) - • Medicaid buy-In for the disabled • Medicare Cost Sharing (MCS) - • Help pay for some Medicare premiums, co-pays & deductibles

4. Freedom To Work (FTW) AHCCCS for disabled individuals ages 16 to 64 who are employed. • Net countable monthly earnings limit of 250% of the FPL ($2,679.17 in 2012). Countable is after $85 is deducted then divided in half. • Social Security Disability Income not counted. • Resources are not counted. • Monthly premium of $0 to $35. • Renewals completed every 12 months. • *

5. FTW Basic Coverage Disabled if… • Receiving Social Security Disability (SSDI) • Determined Medically Eligible by a PAS (Pre-Admission Screening) • Determined Disabled by DDSA (Disability Determination Services Administration)

6. FTW Basic Coverage Groups Employed if… • Working Full or Part Time (at least 40 hours per month) • Paid at least minimum wage for working • Paying Social Security and Medicare taxes on earnings NOTE: This also applies for self-employed

7. FTW Six Month Guarantee The customer is guaranteed six months of AHCCCS coverage the first time he or she is approved for AHCCCS Medical Services. Unless: • Fails to pay the FTW premium • Moves out-of-state • Voluntarily withdraws from AHCCCS program • Is an inmate of a public institution • Dies

8. FTW Premiums Net Countable Monthly Income Premium $0 to $ 500.00 $0 $500.01 to $ 750.00 $10.00 $750.01 to $1000.00 $15.00 $1000.01 to $1250.00 $20.00 $1250.00 to $1500.00 $25.00 $1500.01 to $1750.00 $30.00 $1750.00 to $2679.00 $35.00

9. Where To Apply for FTW AHCCCS Freedom To Work Unit 801 East Jefferson MD 1600 Phoenix AZ 85034 Phone Number: 602-417-6677 Fax Number: 602-417-6675 www.azahcccs.gov or www.healtheariona.org

10. Medicare Coverage • Medicare Part A Coverage • Most individuals do not pay a premium based on FICA deductions from wages. • Medicare Part B Coverage • Monthly premium ($99.90 in 2012). • Medicare Part D Coverage • Prescription drug plan through Medicare. • Medicaid customer’s get their prescription drugs through a Medicare drug plan.

11. Medicare Cost Sharing (MCS) • Qualified Medicare Beneficiary (QMB) • AHCCCS Pays Premiums for Parts A and B • AHCCCS Pays Deductibles, Co-Insurance, and Co-Pays • 100% of Federal Poverty Level ($931) • Specified Low-Income Medicare Beneficiary (SLMB) • Receives Medicare Part A • AHCCCS Pays Premium for Part B • 120% of Federal Poverty Level ($1117) • Qualified Individual 1 (QI-1) – may end on 12/31/12 • AHCCCS Pays Premium for Part B • 135% of Federal Poverty Level ($1,257)

12. Medicare Buy In • There is no automatic Medicare buy-in under the AHCCCS Freedom to Work program • Customers who are approved for AHCCCS Freedom to Work will continue to be responsible for payment of their Medicare premiums. • Freedom to Work customers can also apply for Medicare Cost Sharing.

13. Where To Apply for MCS AHCCCS - SSIMAO Office 801East Jefferson MD 3800 Phoenix AZ 85034 Phone Number: 602-417-5010 Fax Number: 602-258-4619 www.azahcccs.gov or www.healtheariona.org

14. Thanks to our presenters: • Dan Frey, Office of Congressman Ron Barber, Constituent Services Rep. • Dave Cardinali, Work Incentives Counselor, DIRECT Center for Independence

15. Questions?