Is AHCCCS Medicaid, Medicare, or Something Different?

AHCCCS is Arizona's Medicaid program, not Medicare

AHCCCS (Arizona Health Care Cost Containment System) is the name Arizona uses for its Medicaid program. It is not Medicare. Medicaid is a federal program that each state runs under its own name and rules — Arizona calls theirs AHCCCS, California calls theirs Medi-Cal, New York calls theirs Medicaid. Medicare is a separate federal program for people 65 and older or with certain disabilities, regardless of income.

If you live in Arizona and have been told you might be covered by Medicaid, you will apply through AHCCCS. If you are 65 or older or have been on Social Security Disability for 24 months, you may be covered by Medicare instead, or by both programs at the same time (called "dual may be able to access"). The two programs work differently, cover different things, and have different income limits.

Key Takeaways

AHCCCS is Arizona's version of Medicaid — a joint federal and state health insurance program for people with low income.
Medicare is a separate federal program for people 65 and older or with certain disabilities, and it exists in every state under the same name.
You can be covered by both AHCCCS and Medicare at the same time if you meet the age or disability requirement for Medicare and the income requirement for AHCCCS.
AHCCCS covers doctor visits, hospital care, prescription drugs, and behavioral health services; what Medicare covers depends on which parts you have enrolled in.

How AHCCCS and Medicaid are the same thing

Medicaid is a federal program created in 1965. The federal government sets broad rules — who can be covered, what services must be offered, how much the federal government will pay — but each state runs its own Medicaid program and decides additional details like income limits and which doctors participate.

Arizona's Medicaid program is called AHCCCS. When you hear someone in Arizona say "I have Medicaid," they mean AHCCCS. When you apply for Medicaid in Arizona, you apply to AHCCCS. The two terms refer to the same program. Other states use different names: Illinois has Medicaid (also called Medicaid), Texas has CHIP, Pennsylvania has Medicaid (also called Medicaid). The federal program is Medicaid; the state version is what you actually use.

How Medicare is different from AHCCCS

Medicare is a federal health insurance program for people 65 and older, people under 65 with certain disabilities, and people with end-stage renal disease. It is the same in every state. You do not apply to a state program; you apply to Social Security or Centers for Medicare & Medicaid Services (CMS). Your Medicare card comes from the federal government, not from Arizona.

Medicare has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative way to get Parts A, B, and D through a private insurance company. AHCCCS is a single program that covers hospital, doctor, prescription, and behavioral health services all together.

Income does not matter for Medicare. If you are 65 or older, you are covered regardless of how much money you make. AHCCCS has income limits — you must earn below a certain amount to be covered. In Arizona, the income limit varies by family size and the type of AHCCCS coverage you are seeking.

When you might have both AHCCCS and Medicare

If you are 65 or older and your income is low enough, you can be covered by both Medicare and AHCCCS at the same time. This is called being "dual may be able to access." Medicare is your primary insurance and pays first; AHCCCS is secondary and may pay costs Medicare does not cover, like copays or services Medicare does not include.

If you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you automatically become may be able to access for Medicare. If your income is also low enough, you can have both Medicare and AHCCCS. Some people under 65 with disabilities may have access to for AHCCCS only, without Medicare.

Knowing which program is primary matters when you go to the doctor or fill a prescription. You will give the doctor or pharmacy your Medicare card first. If Medicare does not cover the full cost, you give them your AHCCCS card. The order matters because it affects how much you pay.

What AHCCCS covers

AHCCCS covers inpatient and outpatient hospital care, doctor visits, emergency services, prescription drugs, mental health and substance use treatment, dental care (for children and some adults), vision care, and medical equipment. Coverage varies slightly depending on which AHCCCS category you are in — there are different programs for children, pregnant people, parents and caretakers, people with disabilities, and seniors.

AHCCCS is managed care in most of Arizona, meaning you choose a health plan (like Banner, Aetna, or UnitedHealthcare) and that plan coordinates your care. Some rural areas use fee-for-service AHCCCS, where there is no plan — you just go to any doctor who accepts AHCCCS.

What Medicare covers

Medicare Part A covers hospital inpatient stays, skilled nursing facility care after a hospital stay, hospice, and some home health services. Medicare Part B covers doctor office visits, outpatient surgery, diagnostic tests, and some preventive care. Medicare Part D covers prescription drugs. Medicare Part C (Medicare Advantage) is sold by private insurance companies and bundles Parts A, B, and D, usually with added benefits like dental or vision, but with different networks and copays.

Medicare does not cover long-term custodial care (like assisted living or nursing home care for non-medical reasons), dental care, vision care, or hearing aids, unless you have a Medicare Advantage plan that includes those benefits. If you have both Medicare and AHCCCS, AHCCCS may cover some of these gaps.

How to find out which program covers you

If you are 65 or older, you are automatically enrolled in Medicare Part A and Part B when you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to do anything. If you are under 65 and have been on SSDI for 24 months, you are automatically enrolled in Medicare.

To learn about you are covered by AHCCCS, you can contact AHCCCS directly at 1-855-432-7587 or visit azahcccs.gov. You can also call 211 (a free referral line) and ask about Medicaid coverage in Arizona. Have your Social Security number, birth date, and information about your household income and size ready.

If you think you might be covered by both programs, tell the person you speak with that you are 65 or older (or have been on disability for 24 months) and ask them to check both Medicare and AHCCCS. You may need to contact Social Security separately to confirm your Medicare status.

Frequently Asked Questions

Is AHCCCS the same as regular Medicaid?

Yes. AHCCCS is Arizona's name for its Medicaid program. Medicaid is the federal program; AHCCCS is how Arizona runs it. If you live in Arizona and are covered by Medicaid, your coverage is through AHCCCS.

Can I have AHCCCS and Medicare at the same time?

Yes, if you meet the requirements for both. You must be 65 or older (or have been on disability for 24 months) to have Medicare, and your income must be low enough to may have access to for AHCCCS. Medicare pays first, and AHCCCS may cover costs Medicare does not.

Do I have to pay for AHCCCS?

AHCCCS is free or low-cost depending on your income. Most people with very low income pay nothing. Some people pay small copays when they see a doctor or fill a prescription. You do not pay a monthly premium like you might with other insurance.

What if I move out of Arizona?

Your AHCCCS coverage ends when you move. You will need to apply for Medicaid in your new state. Each state has its own Medicaid program with its own name, income limits, and covered services. Contact your new state's Medicaid office or call 211 to find out how to apply.

How do I know if my doctor accepts AHCCCS?

Call your AHCCCS health plan (the name is on your card) and ask if your doctor is in network. You can also ask the doctor's office directly if they accept AHCCCS. If you are in fee-for-service AHCCCS, call AHCCCS at 1-855-432-7587 to confirm your doctor participates.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.