AHCCCS and Medicare Are Separate Programs

AHCCCS is not Medicare. They are two different government health insurance programs run by different agencies, with different rules about who can join and what they cover.

AHCCCS (Arizona Health Care Cost Containment System) is Arizona's Medicaid program. It is run by the state of Arizona and covers people with low income, regardless of age. Medicare is a federal program run by the Centers for Medicare & Medicaid Services and covers people age 65 and older, plus some younger people with disabilities or end-stage renal disease.

You can have both programs at the same time. In fact, many people in Arizona do — they are called "dual may be able to access." But the two programs work separately, cover different services, and have different costs.

Key Takeaways

  • AHCCCS is Arizona's state Medicaid program for people with low income; Medicare is a federal program for people 65 and older or with certain disabilities.
  • You can hold both AHCCCS and Medicare at the same time, and many Arizona seniors do.
  • AHCCCS covers some services Medicare does not, such as dental care and transportation to medical appointments.
  • If you have both programs, Medicare pays first for most services, and AHCCCS covers costs Medicare does not pay.

Who Can Join Each Program

AHCCCS is based on income and family size. To join, your income must fall below a certain level set by Arizona. The exact limit depends on which AHCCCS category you fall into — there are separate tracks for children, pregnant people, parents, people with disabilities, and seniors. You do not have to be a U.S. citizen to join AHCCCS, though you must be a legal resident of Arizona.

Medicare is based on age and work history, not income. You become may be able to access at age 65 if you or your spouse paid Medicare taxes for at least 10 years while working. Younger people can join if they have been on Social Security Disability Insurance (SSDI) for 24 months, or if they have end-stage renal disease or ALS.

Because the two programs use different rules, a person can be too old or too wealthy for AHCCCS but still may have access to for Medicare, or vice versa. An Arizona resident age 67 with a high income would may have access to for Medicare but not AHCCCS. A 45-year-old with low income would may have access to for AHCCCS but not Medicare.

What Each Program Covers

Medicare has three main parts. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, lab work, imaging, and outpatient services. Part D covers prescription drugs. Most people pay a monthly premium for Part B and Part D, and there are deductibles and copays.

AHCCCS covers doctor visits, hospital care, prescription drugs, mental health services, and emergency dental care. It also covers some services Medicare does not: routine dental care, vision care, hearing aids, and transportation to medical appointments. Most AHCCCS members pay little or nothing out of pocket.

If you have both programs, Medicare is your primary payer. This means Medicare pays its share first, and AHCCCS pays what Medicare does not cover. For example, if Medicare covers 80 percent of a doctor visit and you owe 20 percent, AHCCCS may cover that 20 percent.

How to Know Which Program You Have

Your insurance card will tell you which program you are in. A Medicare card is issued by the federal government and has your name, a Medicare number, and the date you became may be able to access. It is red, white, and blue. An AHCCCS card is issued by the state of Arizona and has your name, a member ID number, and the AHCCCS logo. It is usually a different color — often green or blue.

If you have both programs, you will have both cards. You should bring both to every medical appointment. Tell the doctor's office that you have both Medicare and AHCCCS so they bill in the correct order.

You can also check your status online. For Medicare, go to ssa.gov and sign in to your account. For AHCCCS, go to azahcccs.gov or call the AHCCCS member line at 1-844-SOS-AHCCCS (1-844-767-2422).

Costs and Premiums

Most AHCCCS members pay no monthly premium and no copay at the doctor. Some AHCCCS categories have small copays for certain services, but the costs are low.

Medicare Part A has no monthly premium if you or your spouse paid Medicare taxes for 10 years. Part B has a monthly premium that changes each year — in 2024 it was $164.90 for most people, though higher earners pay more. Part D premiums vary by plan and insurance company. You also pay a deductible before coverage starts, and copays or coinsurance when you use services.

If you have both programs and low income, you may be able to join a Medicare Savings Program or Extra Help program that Arizona runs. These programs can pay your Medicare premiums and copays. You can ask about these when you contact AHCCCS.

What Happens If You Lose One Program

If your income rises, you may lose AHCCCS coverage but keep Medicare. This is common when someone returns to work or receives a raise. You will still have Medicare at age 65, and you can buy a Medigap plan (supplemental insurance) to cover costs Medicare does not pay.

If you turn 65 and become may be able to access for Medicare while you have AHCCCS, you keep both. You do not have to choose one or the other. AHCCCS will continue to cover services Medicare does not, like dental and vision care.

If you move out of Arizona, you lose AHCCCS because it is an Arizona program. You keep Medicare because it is federal. If you move to another state, you can join that state's Medicaid program if you meet the income rules.

How to Enroll in Each Program

To join AHCCCS, you contact the Arizona Department of Economic Security (DES) or explore online at azahcccs.gov. You will need proof of income, residency, and identity. Processing usually takes 30 to 45 days.

To join Medicare, you contact Social Security at ssa.gov or call 1-800-772-1213. You can also visit a local Social Security office. You become may be able to access automatically at 65 if you are already receiving Social Security. If you are not yet receiving Social Security, you must sign up for Medicare within three months of turning 65 or you may face a penalty.

If you are already on AHCCCS and turn 65, you do not have to do anything to keep AHCCCS. But you must still sign up for Medicare separately to avoid penalties.

Frequently Asked Questions

Can I have both AHCCCS and Medicare at the same time?

Yes. Many Arizona residents have both programs. When you have both, Medicare pays first for most services, and AHCCCS covers what Medicare does not pay. You should bring both cards to every doctor visit and tell the office you have both programs.

If I have AHCCCS, do I still need to sign up for Medicare at 65?

Yes. Having AHCCCS does not enroll you in Medicare automatically. You must sign up for Medicare within three months of turning 65, or you may face a late enrollment penalty that increases your premiums permanently. Contact Social Security to enroll.

What services does AHCCCS cover that Medicare does not?

AHCCCS covers routine dental care, vision care, hearing aids, and transportation to medical appointments. Medicare does not cover these services. If you have both programs, AHCCCS will cover these for you.

Will I lose AHCCCS if my income goes up?

Yes, if your income rises above the limit for your AHCCCS category, you will lose coverage. The income limits vary by category and family size. You can contact AHCCCS to find out the current limit for your situation. If you lose AHCCCS but are 65 or older, you will keep Medicare.

What is the difference between AHCCCS and Medicare Advantage?

AHCCCS is Arizona's Medicaid program. Medicare Advantage is a type of Medicare plan run by private insurance companies. They are different programs. Some people have AHCCCS and also choose a Medicare Advantage plan for their Medicare coverage, but the two programs remain separate.