If your employer offers health insurance, can you still get Medicaid? Do you have to choose your employer’s insurance coverage, even if you’d rather use something else?

Arizona doesn’t have a law that requires employers to provide health insurance, but many businesses in the state do. If your employer offers health insurance to you, they’re also required to provide the same coverage to your children who are 25 or younger. Your employer may allow your spouse to join your health insurance plan, too, but this isn’t a legal requirement.

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I Don’t Want My Employer’s Insurance Plan- Now What?

Can your employer force you to take their health insurance? Can you buy your own health insurance even if your employer offers it? Some companies only offer inexpensive plans that don’t cover emergency or hospitalization services. Or perhaps your employer is offering you a plan that’s too expensive or more than you need.

If, for any reason, you don’t want to take the plan they’re providing, you may waive your coverage. Keep in mind that if you go this route, you can’t cover your dependents under the plan either. 

In 2019, the Affordable Care Act’s tax penalty for having no health insurance coverage is no longer in place. But health insurance is still a good idea to protect your finances or an unexpected accident could drain your savings.

Can I Still Get Medicaid if I Turned Down My Employer’s Insurance?

If you need laboratory services, rehabilitative care, maternity care, chronic disease management, or coverage for other services that your employer’s plan doesn’t cover, you can check to see if you’re eligible for Medicaid. You may meet the financial requirements necessary to receive benefits.

Arizona’s Medicaid Program

One component of Arizona’s Medicaid program is ALTCS, or the Arizona Long-Term Care System. This state program provides long-term care options for medically and financially eligible people in Arizona. ALTCS is for blind, elderly, and disabled people and offers services for little to no cost. If you don’t belong in one of these categories, there are other Medicaid programs that you may qualify for. 

If you’re eligible for ALTCS (or other Medicaid) benefits, you’ll apply and get assigned an agent who will put together a care plan that works for you. Your ALTCS assistance might pay for hospice, home care, outpatient treatment, nursing facility care, prescription medications, and more.

Requirements for Medicaid Eligibility

You may qualify for Medicaid based on your assets and income, while others will qualify because of their MAGI (modified adjusted gross income).

If you’re pregnant, between 19 and 64 years old with no children, or a caregiver living with relatives, you may qualify based on MAGI. Some people may qualify for reasons other than their MAGI, including some institutionalized individuals, foster and former foster kids, and others.

Eligibility for Medicaid benefits isn’t as simple as it used to be. While your income does play a role, you may qualify or not based on whether you participate in other government programs. 

It’s a good idea to work with a long-term care expert if you have any questions about what you may qualify for and how to apply for services.

Income Requirements

What is the maximum income for a single person to get Medicaid benefits?  The AHCCCS (Arizona Health Care Cost Containment System) is an expansion of Medicaid in Arizona. AHCCCS covers adult individuals who aren’t eligible for other Medicaid programs and earn a maximum of $1,385 to $2,854 monthly (according to their family size).

“Spending Down” to Qualify

If you’re single and applying for Medicaid services, you can’t have over $2,000 worth of countable assets (married individuals applying together with their spouse may have up to $3,000). It’s also against the rules to give away your resources in order to qualify for benefits within five years of applying for Medicaid.

ALTCS and other benefit programs may deny applicants who have too much value in assets. Spending down is one strategy you can use to qualify financially for Medicaid benefits in Arizona. To spend down means to reduce these assets and reapply later. 

If you decide to try this strategy, it’s ideal to work with an attorney to ensure you do it in  the best possible way.

Medicaid as Secondary Insurance

Can you use Medicaid as a secondary insurance? If you take your employer’s insurance or you have private coverage, you might still have trouble paying deductibles and co-pays. But qualified low-income families and individuals might be able to cover co-pays, deductibles, and insurance premiums by using Medicaid as a secondary insurance. 

Just keep in mind that Medicaid is always the last resort payer if you have coverage through another agency. Secondary payers usually cover the smaller amount, like coinsurance or co-pay, while primary insurance covers the bigger costs.

Will Medicaid Pay for Primary Insurance Copays?

Most Medicaid recipients in Arizona don’t owe a monthly premium for the services. Instead, you’ll only need to make payments while receiving care. 

If you’re 19 or older, you might have to make small copayments for Medicaid-covered services. You won’t have to cover copayments, however, if you’re 18 or younger, pregnant, in hospice care, or exempt under certain other conditions. 

Arizona Medicaid’s copayments will be much more affordable than copayments from private insurance companies. Keep in mind that if your primary insurance provider charges a copay to receive services, Medicaid may not cover that. You will need to contact your Medicaid service provider to find out.

Need Help Applying for ALTCS in Arizona?

There are several roadblocks you could encounter while figuring out ALTCS in Arizona. You may need to adjust your financial situation before you can apply or gather more detailed information based on your circumstances. Remember that there are already processing times when you apply and that taking a misstep during the application process can make everything run much slower.

Having a professional on your side who knows the rules can make applying a lot smoother. Whether you need help planning or have questions about the process, speak with an attorney today.
 

Call the JacksonWhite ALTCS team at (480)467-4337 to discuss your case today.

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