Comprehensive guide on all 50 states government sponsored and private insurance major medical plans

1. U.S. Directory
of Health Coverage
Options

2. How to use this Directory:
Use the Income Worksheet(page “iii”) to determine the Federal Poverty Level
percentage of you or the person whom you are trying to assist. This percentage
usually determines if an individual is eligible for various public programs.
Find your state’s Health Coverage Options Matrix for a complete list of private and
public health coverage programs, along with additional valuable resources.
Consult the Appendices for our QR code, state-by-state program contact
information, uninsured statistics for each state, as well as the glossary of terms
found within this book.
Foundation for Health Coverage Education
101 Metro Drive, Suite 250 • San Jose, CA 95110 • www.CoverageForAll.org
ISBN-13: 978-1-42432862-8
© Copyright 2012 by Philip Lebherz & Foundation for Health Coverage Education
All Rights Reserved.
Updated February 2012
For the most up-to-date version, please visit:
www.CoverageForAll.org.
iv

3. U.S. Directory
of Health Coverage
Options
A state-by-state guide to helping Americans navigate their
public and private health coverage options
Created by
Phil Lebherz
Foundation for Health Coverage Education

4. table of contents
Acknowledgments ii New Mexico 61
Income Worksheet iii New York 63
Federal Poverty Level Chart iv North Carolina 65
Health Care Options Matrices by State North Dakota 67
Alabama 1 Ohio 69
Alaska 3 Oklahoma 71
Arizona 5 Oregon 73
Arkansas 7 Pennsylvania 75
California 9 Rhode Island 77
Colorado 11 South Carolina 79
Connecticut 13 South Dakota 81
Delaware 15 Tennessee 83
Florida 17 Texas 85
Georgia 19 Utah 87
Hawaii 21 Vermont 89
Idaho 23 Virginia 91
Illinois 25 Washington 93
Indiana 27 Washington, D.C. 95
Iowa 29 West Virginia 97
Kansas 31 Wisconsin 99
Kentucky 33 Wyoming 101
Louisiana 35
Maine 37
Appendices
Maryland 39
Other Services (by State) 103
Massachusetts 41
State-by-State Comparison 110
Michigan 43
The Uninsured In America 111
Minnesota 45
Glossary of Terms 112
Mississippi 47
Missouri 49 About FHCE 115
Montana 51
Nebraska 53
Nevada 55
New Hampshire 57
New Jersey 59
i

5. I want to dedicate this book to the thousands of workers in the private and public health insurance systems
across the country who are attempting to reach our goal of lowering the number of uninsured people in
America. I especially want to thank Leonard Schaeffer who provided his knowledge, inspiration, and vision
to this project.
- Phil Lebherz
Acknowledgments
The following individuals and associations generously donated their time, energy, and resources to
creating this resource:
Aetna Foundation Health Coverage Foundation, Inc. Professional Exchange
Alain Enthoven Health Net of California Service Corporation
Beere & Purves, Inc. Kaiser Foundation Rio Grande Association
Blue Shield of California Los Angeles Unified School District Saint Joseph Health Center
Foundation
CAHU Charitable Larry Glasscock
Community Foundation Schmitt Family Foundation
Leonard & Pamela Schaeffer
Cal Locket San Diego Office of Education
LISI
CAHU Sharp Health Plan
NAHU (& State Chapters)
California State Legislators Spahr Insurance
Peter & Renuka Patel
Cathay Post No. 384 The Rauser Agency
Peter Farrell
David & Nancy Helwig Family The Sugg Group
Pfizer, Inc.
Fund Word & Brown
Philip & Vivian Reed
Dickerson Employee Benefits, Inc. Warner Pacific
Placer County Office of Education
Ernie Ramirez WellPoint Foundation
Poizner Family Trust
George & Clare Schmitt
Collaborative Efforts
We would like to recognize the following organizations for their collaborative efforts in helping lower the
ranks of the uninsured by using FHCE’s resources:
Aetna Inc. California Department of Insurance NAIC
American Cancer Society Community Medical Centers Sharp HealthCare
American Diabetes Association Daughters of Charity Health Systems United Way-211 Call Centers
American Heart Association eHealthInsurance United Health Care
American Lung Association Google, Inc. WellPoint, Inc.
Dignity Health NAHU
Appreciated Media Support
FHCE’s resources have had over 4 billion media impressions thanks to the following media outlets:
AARP Hospital Access Management San Francisco Business Times
ABC News Kiplinger’s Personal Finance San Francisco Chronicle
American Medical News KFWB 980 AM Self Magazine
Becker’s Hospital Review KTLA TV Channel 5 Smart Money, AOL Money &
CBS Bay Sunday Los Angeles Times Finance
Chicago Tribune Men’s Health Magazine The Angie Strader Show
CNN Modern Healthcare The New York Times
Consumer Digest MSNBC The Wall Street Journal
Costco Connection New York Daily News The Washington Post
DailyFinance Parenting.com USA Today
Health Affairs Parents Magazine U.S. News & World Report
ii

6. iNCOME WORKSHEET
Step One
Use this worksheet to calculate your family or household total income after deductions.
Step Two
Look for the income amount closest to the number in step one within the chart on the opposite
page to determine which percentage of the Federal Poverty Level (FPL) you are.
Step Three
Remember this percentage, as it will help you determine for which public programs you are
eligible.
Your monthly income + __________________
Spouse’s monthly income + __________________
TOTAL INCOME = __________________
Please fill in the following information, separate from amount that you just calculated:
Begin with $0. For each working
parent in the household, add $90. + __________________
If you pay for childcare for children under the age
of 2, add $200 for each child. + __________________
If you pay for childcare for children over the age of
2, or for a child with disabilities,
add $175 for each child. + __________________
If you receive child support, add $50 for each child. + __________________
If you pay alimony and/or child support,
enter the amount. + __________________
Total Deductions = __________________
Now, subtract your Total Deductions from your Total Income.
TOTAL INCOME __________________
TOTAL DEDUCTIONS - __________________
T
OTAL INCOME AFTER DEDUCTIONS =________________
Find an amount closest to this total within the chart on the opposite page to determine your Federal
Poverty Level (FPL) percentage.
Note: This income worksheet is only intended to serve as a guide. Some factors in determining
your eligibility may not be represented above. Deductions listed here are typical for most public
programs, but may vary by agency.
iii

7. Federal Poverty Level Chart
Your Federal Poverty Level (FPL)
Based on monthly family gross income
Family Size
(House- 100% 133% 175% 200% 250% 300% 400%
hold)
1 $931 $1,238 $1,629 $1,862 $2,327 $2,793 $3,723
2 $1,261 $1,677 $2,206 $2,522 $3,152 $3,783 $5,043
3 $1,591 $2,116 $2,784 $3,182 $3,977 $4,773 $6,363
4 $1,921 $2,555 $3,361 $3,842 $4,802 $5,763 $7,683
5 $2,251 $2,994 $3,939 $4,502 $5,627 $6,753 $9,003
6 $2,581 $3,433 $4,516 $5,162 $6,452 $7,743 $10,323
7 $2,911 $3,871 $5,094 $5,822 $7,277 $8,733 $11,643
8 $3,241 $4,310 $5,671 $6,482 $8,102 $9,723 $12,963
Based on yearly family gross income
1 $11,170 $14,856 $19,548 $22,340 $27,925 $33,510 $44,680
2 $15,130 $20,123 $26,478 $30,260 $37,825 $45,390 $60,520
3 $19,090 $25,390 $33,408 $38,180 $47,725 $57,270 $76,360
4 $23,050 $30,657 $40,338 $46,100 $57,625 $69,150 $92,200
5 $27,010 $35,923 $47,268 $54,020 $67,525 $81,030 $108,040
6 $30,970 $41,190 $54,198 $61,940 $77,425 $92,910 $123,880
7 $34,930 $46,457 $61,128 $69,860 $87,325 $104,790 $139,720
8 $38,890 $51,724 $68,058 $77,780 $97,225 $116,670 $155,560
• A pregnant woman counts as two for the purpose of this chart.
• Add $330/month for each additional family member after eight.
• ontact individual programs for deduction allowances on child/dependent care; working parent’s work expenses;
C
alimony/child support received or court ordered amount paid.
The following figures are the 2012 HHS poverty guidelines as of January 26, 2012. (Source: http://aspe.hhs.gov/poverty/12poverty.shtml)
Monthly percentage data calculated by FHCE and rounded to the nearest dollar.
Please visit www.CoverageForAll.org for further details and updates on the 48 continuous states, Hawaii and Alaska FPL charts.
Reminder
There is no universal administrative definition of income that is valid for all programs that use the
poverty guidelines. The office or organization that administers a particular program or activity is
responsible for making decisions about the definition of income used by that program (to the extent
that the definition is not already contained in legislation or regulation). To find out the specific definition
of income used by a particular program or activity, you must consult the office or organization that
administers that program. iv

8. Demographic Private Health Insurance
Individuals Individuals with
Low-Income
Small Businesses Recently Covered Individuals Pre-Existing, Severe,
Individuals
(2-50 Employees) by an Employer Families or Chronic Medical
Families
Health Plan Conditions
Group Plans COBRA Individual Plans Alabama Health Medicaid
National Association of Health Then convert to a plan under: National Association of Insurance Plan (AHIP) (SOBRA MLIF)
Underwriters Health Underwriters Alabama Health 334-242-5000
703-276-0220 703-276-0220 Insurance Plan SOBRA: 800-362-1504
www.nahu.org HIPAA www.nahu.org 866-833-3375 MLIF: 800-362-1504
Health Insurance Portability 334-263-8311 insurealabama.adph.state.al.us
Accountability Act www.alseib.org
Program
866-487-2365
www.dol.gov Pre-Existing Condition
Insurance Plan (PCIP)
HIPP Run by the U.S. Department of
Health Insurance Premium Health and Human Services
Payment Program 866-717-5826
334-242-3722 www.PCIP.gov
www.medicaid.state.al.us
There is a maximum 6-month COBRA: Coverage available for Assorted plans depending on AHIP: Two plans offered: indemnity Medicaid (SOBRA and MLIF): Among
look-back/12-month 18–36 months depending on medical needs. and managed care. Both cover some of the services: Ambulatory
exclusionary period for qualifying events. Benefits Prescription drugs, Outpatient surgical center, Birth center
pre-existing conditions on are what you had with your There is a maximum look- and in-patient care, Durable services, Child health check-
enrollees that do not have prior previous employer. back period of 60 months medical equipment, Mental up, Chiropractic care, Durable
coverage. and a maximum exclusion health, Substance abuse, and medical equipment and supplies,
HIPAA: Benefits are based on period of 24 months for Away-from-home emergency care. Federally qualified health centers,
Benefits will vary depending program selected. There is no pre-existing conditions on Managed care also covers Labs, Home health, Hospital inpatient/
Coverage
on the chosen plan. expiration of coverage. enrollees that do not have X-rays, Transplants, Maternity, and outpatient care, Laboratory,
prior coverage. Rehabilitation care. Licensed midwife, Physician,
Pre-Existing Health HIPP: Benefits are the same Podiatry, Prescriptions, Rural health
Conditions Covered as what you had with your Elimination riders are PCIP: Covers broad range of clinics, Therapy, and X-rays.
previous employer, HIPP is a permitted. benefits, including primary and
premium assistance program. specialty care, hospital care, and SOBRA: Pregnant women ONLY
Limits on Pre-Existing Health prescription drugs. get pregnancy related services
Pre-Existing Health Conditions May Apply covered.
Conditions Covered Pre-Existing Health Conditions
Covered Pre-Existing Health
Conditions Covered
GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE
Company size 2-50 employees. COBRA: Available for employees Eligibility is subject to AHIP: You must have chosen to Medicaid (SOBRA and MLIF): Must be
who work for businesses with medical underwriting. extend coverage under COBRA, a U.S. citizen or legal alien and an
Eligible employees must work 20 or more employees. Have 60 group health plan, government Alabama resident.
at least 30 hours a week. days from date of termination If you are denied coverage plan, or church plan and
to sign up for COBRA coverage. for a medical condition, you exhausted those benefits and Income limits:
Owner can count as an may be eligible for AHIP, or submitted your application
employee. HIPAA: Must have had 18 months PCIP. within 63 days of your last day of Pregnant Women: 133% FPL.
of continuous coverage and coverage to sign up for AHIP. Children (ages 0–5): 133% FPL.
Owner name on business completely exhausted COBRA Must be a permanent Alabama
license must draw wages from or state continuation coverage. resident with at least 18 months Children (ages 6–18): 100% FPL.
the company. Must not have lost coverage of continuous coverage without
Eligibility
due to fraud or non-payment of being terminated due to fraud or Parents/caretakers living with
premiums. You have 63 days to failure to pay. children ages 0–18: 24% FPL.
enroll in a HIPAA-eligible plan. Aged, blind and disabled: Singles
AHIP is specifically aimed at those with incomes up to 75% FPL and
HIPP: You may be eligible for HIPP who have purchased coverage asset limit of $2,000, and couples
if you have a high-cost health from their employer and whose with incomes up to 83% FPL with
condition. benefits have run out. asset limit of $3,000.
PCIP: Must have been uninsured for
at least 6 months prior to applying. SOBRA: Must not be eligible for ALL
Must prove being a U.S. citizen or Kids.
legal U.S. resident, an Alabama
resident, and having problems
getting insurance due to a pre-
existing condition.
Costs depend on employer COBRA: Premiums range from Costs for individual coverage AHIP: Traditional Indemnity Plan Medicaid: $0–$3 for office visits,
contribution and ± 20% of the 102%–150% of group health vary. There are no rate caps. premiums could range between prescription drugs and some other
insurance company’s index rates. $147 to $1,150 depending on age, services.
rate. sex, smoker or non-smoker, and plan
Monthly Cost
HIPAA: Premiums will depend you choose. SOBRA: $50 co-payment for each
on plan chosen. inpatient hospital stay.
Managed Care Plan premiums could
HIPP: $0 or minimal share of range between $283 to $1,068
cost. depending on age, sex, and smoker
or non-smoker.
PCIP: Monthly premiums range
from $110 to $471 depending on
your age.
2
1 Alabama

9. Publicly-Sponsored Programs
Demographic
Children in Trade Dislocated
Moderate Income Women Seniors Disabled Workers Veterans
Families (TAA Recipients)
ALL Kids Breast and Cervical Medicare Health Coverage VA Medical
888-373-5437
334-206-5568
Cancer Early 800-633-4227
www.medicare.gov
Tax Credit Benefits Package
877-774-9521 Detection Program 866-628-4282
www.irs.gov
877-222-8387
www.va.gov
insurealabama.adph.state.al.us (ABCCEDP) Medicare (Search: HCTC)
or 877-252-3324
www.adph.org/allkids www.adph.org/earlydetection Prescription Drug
Program
Program
AL Child Caring Plan First 800-633-4227
(Family Planning)
Program 888-737-2083
800-726-2289 www.adph.org/planfirst Alabama State
insurealabama.adph.state.al.us
www.accf.net Health Insurance
Assistance Program
Note: AL Child Caring Program 800-243-5463
closed on January 1, 2011. The
children in the program have
been referred to Medicaid and
ALL Kids.
ALL Kids: Coverage will begin ABCCEDP: Pelvic exam, Pap Medicare offers Part A, Inpatient and outpatient care Comprehensive preventive and
on the first day of the month smear, Clinical breast exam, inpatient care in hospitals and (lab tests, x-rays, etc.), Doctor primary care, outpatient and
after application is received. Mammogram, and Diagnostic rehabilitative centers; Part B, visits, Preventive and major inpatient services.
Benefits include 12 months services, such as an ultrasound, doctor and some preventive medical care (surgery, physical
continuous coverage, doctor colonoscopy, or biopsy, if services and outpatient care; therapy, Durable medical Pre-Existing Health
visits, check-ups, hospital and needed. Part C allows Medicare benefits equipment, etc.), Mental health Conditions Covered
physician care, immunizations, through private insurance and substance abuse care, and
prescriptions, dental and vision Plan First: Yearly family planning (Medicare Advantage); Part C Prescription drugs.
Coverage
care, emergency services, and exams, Care support from a includes Parts A, B, and C not
mental health/substance abuse social worker or nurse, Some covered by Medicare. Part D Pre-Existing Health
services with dedicated phone types of birth control (such covers prescription drugs. Conditions Covered
number available 24 hours a as birth control pills and
day, 7 days a week. Depo-Provera shots), Tubal ASHIAP is a Medicare counseling
ligation (tube tying) for women service.
AL Child Caring Program: 21 years or older, Lab work
Outpatient services only. (pregnancy and STD testing), Pre-Existing Health
and Family planning help. Conditions Covered
Pre-Existing Health
Conditions Covered
GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE
Both: Must be under the age of ABCCEDP: Women without Medicare and ASHIAP: Must be Must be receiving TAA (Trade ”Veteran status” = active duty
19 and an Alabama resident, insurance or who are U.S. citizen or permanent U.S. Adjustment Assistance), or in the U.S. military, naval, or air
not be covered by any other underinsured ages 40–64, resident, and: service and a discharge or release
health insurance, and be earning up to 200% FPL. Must be 55 years or older and from active military service
ineligible for Medicaid. 1) If 65 years or older, you or receiving pension from the under other than dishonorable
Women under age 40 who your spouse worked for at least Pension Benefit Guaranty conditions.
ALL Kids: Must be a U.S. citizen or have problems with their 10 years in Medicare-covered Corporation (PBGC).
eligible immigrant, not be in an breasts can undergo a clinical employment, or Certain veterans must have
institution. Children 0–5 years breast exam to determine if Must not be enrolled in certain completed 24 continuous months
old must have family incomes they are eligible to receive a 2) You have a disability or end- state plans, or in prison, or of service.
of 133%–300% FPL. Children free breast cancer screening stage renal disease (permanent receiving 65% COBRA premium
Eligibility
6–18 years old must have family through the program. kidney failure requiring dialysis reduction, or be claimed as a
incomes of 100% - 300% FPL. or transplant) at any age. dependent in tax returns.
Plan First: Must be a U.S. citizen
AL Child Caring Program: Must not or legal alien and an Alabama Must be enrolled in qualified
be eligible for ALL Kids and resident. Must be a woman health plans where you pay
all other plans; be enrolled in between the ages of 19 and 55 more than 50% of the premiums.
school (if of age). with an income limit of 133%
FPL and have not had surgery Individuals who are eligible
to prevent pregnancy. for the federal Health Care Tax
Credit can also use their credit
funds to purchase a private
health insurance product
developed by Blue Cross Blue
Shield of Alabama.
Both: $0 or small co-pays. ABCCEDP: $0 or minimal share Medicare and ASHIAP: $0 and 20% of the insurance $0 and share of cost and
of cost. share of cost for certain premium including COBRA co-pays depending on income
ALL Kids: Yearly costs range services; deductibles for premium if employer
from $50 to $100 per child up to Plan First: $0 for family certain plans. Part A: $0–$450 level.
Monthly Cost
contributes less than 50%.
the first 3 children (no cost for planning services only. based on length of Medicare-
additional children). Small co- covered employment; Part B:
pays are required at the time of $96.40–$369.10 depending on
service. There are no co-pays for annual income; Part C: Based on
preventive services. provider; Part D: Varies in cost
and drugs covered.
Alabama
www.CoverageForAll.org 2

10. Demographic Private Health Insurance
Individuals Individuals with
Small Businesses Recently Covered Individuals Pre-Existing, Low-Income Children
(2-50 Employees) by an Employer Families Severe, or Chronic Families
Health Plan Medical Conditions
Group Plans COBRA Individual Plans Alaska Medicaid
Comprehensive 907-465-3347
800-780-9972
Alaska Association of Health Alaska Association of Health
Underwriters Then convert to a plan under: Underwriters Health Insurance www.hss.state.ak.us
www.alaskaahu.org www.alaskaahu.org Association (ACHIA) (Search: Medicaid)
Program
HIPAA 888-290-0616
Health Insurance Portability www.achia.com
Accountability Act
866-487-2365 Pre-Existing
www.dol.gov Condition Insurance
Plan (PCIP)
Federal program run by the
ACHIA
877-505-0510
www.PCIP.gov
www.achia.com/ACHIA-FED
There is a 6-month look- COBRA: Coverage available for Assorted deductible and plan ACHIA: Offers 6 different Inpatient and outpatient hospital
back/12-month exclusionary 18–36 months depending on design options for selection. comprehensive PPO plans with services, Mental health and
period for pre-existing qualifying events. Benefits are different deductibles. Offers substance abuse care, Rural
conditions if enrollee had what you had with your previous There are no limits to look-back one traditional non-PPO plan health clinics, Nurse, Midwife,
no prior coverage, or if prior employer. and exclusionary periods for paying 80% of the allowed Dentist, Optometrist, Physician
coverage had a break of more pre-existing conditions. charges after the $1,000 annual care, Prescription drugs, Physical
than 63 days. HIPAA: Benefits are based on deductible is satisfied. After therapy, Medical equipment and
program selected. There is no Limits on Pre-Existing Health deductible and out-of-pocket devices (prosthetics, eyeglasses,
Group coverage as selected by expiration of coverage. Conditions May Apply maximum have been satisfied, dentures, etc.), Preventive care
employer with a variety of plan ACHIA will pay claims at 100%. and diagnostic services, Family
designs available. Pre-Existing Health planning, Labs and x-rays, Home
Coverage
Conditions Covered PCIP: Inpatient and outpatient health services (such as nursing
Pre-Existing Health hospital services, physician services, home health aides).
Conditions Covered services, prescription drugs,
skilled nursing, home health, Pre-Existing Health Conditions
hospice, chemotherapy, Covered
anesthesia, prosthesis, durable
medical equipment, x-rays
and laboratory services, oral
surgery, physical therapy,
substance abuse treatment,
mental health services,
ambulance, maternity, PKU
formula, Pap smear and
mammograms.
Pre-Existing Health
Conditions Covered
GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE
Company size 2–50. COBRA: Available for employees Eligibility is subject to medical ACHIA: Must be a U.S. citizen Must be U.S. citizen or qualified alien
who work for businesses with 20 underwriting. or legal resident living in and Alaska resident.
Eligible employees must work or more employees. You have 60 Alaska and at least one of the
at least 30 hours a week. days from date of termination to If you are denied coverage following: 1) You were rejected Income limits:
sign up for COBRA coverage. for a medical condition, you for health insurance in the last 6
Owner can count as an may be eligible for an Alaska months, or received restrictive Family: 185% FPL.
employee. Proprietor name on HIPAA: Must have had 18 months Comprehensive Health riders that reduced coverage, Working disabled: 250% FPL.
license must draw wages. of continuous coverage and Insurance Association plan, or or 2) You have a qualified
completely exhausted COBRA PCIP. See next column. pre-existing condition, or 3) Aged, blind, and disabled: Singles
or state continuation coverage. You had exhausted COBRA, are with incomes up to 109% FPL and
Must not have lost coverage uninsured, not eligible for any asset limit of $2,000, and couples
Eligibility
due to fraud or non-payment of group coverage from private or with incomes up to 120% FPL and
premiums. You have 63 days to public sources (e.g. Medicaid, asset limit of $3,000.
enroll in a HIPAA-eligible plan. Native Health Care, etc.), and
you were covered under a For pregnant women and children,
group health plan in the prior see “Moderate Income Children
18 months with no break of Families” column.
more than 90 days, or 4) You Contact your local Division of
are receiving Trade Adjustment Public Assistance office or your
Assistance (TAA). community’s village fee agent for
more information.
PCIP: Must have been uninsured
for at least 6 months prior to
applying. Must prove being a
U.S. citizen or legal U.S. resident,
an Alaska resident, and having
problems getting insurance due
to a pre-existing condition.
Costs depend on employer
contribution and ± 35% of the
COBRA: Premiums range from
102%-150% of group health rates.
Costs vary dependent on age
and medical underwriting.
ACHIA: Premiums range from
$107–$2,950 depending on your
$0 for families below 100% FPL.
Monthly Cost
insurance company’s index There are no rate caps. age and plan chosen.
rate. HIPAA: Premiums will depend on $50–$200 per day for hospital
plan chosen. PCIP: Monthly premiums range admission (except for mental
from $452 to $1,806 . institutions).
4
3 Alaska

11. Publicly-Sponsored Programs
Demographic
Trade Dislocated
Moderate Income Adults with Chronic Native American
Seniors Disabled Workers
Children Families Medical Conditions Indians
(TAA Recipients)
Denali Kid Care Chronic and Acute Indian Health Medicare Health Coverage
Toll Free Outside Anchorage
888-318-8890 Medical Assistance Services (IHS) 800-633-4227
www.medicare.gov
Tax Credit
(Alaska Area) 866-628-4282
Anchorage Area (CAMA) 907-729-3686 www.irs.gov
907-269-6529 800-780-9972 www.ihs.gov Medicare (Search: HCTC)
Program
www.hss.state.ak.us www.hss.state.ak.us (Search: Alaska)
(Search: Denali Kid Care) (Search: CAMA) Prescription Drug
Or contact the Division of Public
For eligibility information visit: Program
www.ihs.gov 800-633-4227
Assistance office nearest you or (Search: Eligibility)
the fee agent in your community.
Prevention and treatment Prescription drugs and medical IHS services are provided Medicare offers Part A, Inpatient and outpatient care
services such as: Doctor's visits, supplies, limited to 3 prescriptions directly and through tribally- inpatient care in hospitals and (lab tests, x-rays, etc.), Doctor
Check-ups and screenings, per month and no more than a 30- contracted and operated health rehabilitative centers; Part B, visits, Preventive and major
Vision exams and eyeglasses, day supply of any drug. programs. From private care doctor and some preventive medical care (surgery, physical
Dental checkups, Cleanings sources, tribal health programs services and outpatient care; therapy, Durable medical
and fillings, Hearing tests Physician services which are purchase services for Native Part C allows Medicare benefits equipment, etc.), Mental health
and Hearing aids, Speech directly related to the medical American patients in areas through private insurance and substance abuse care, and
therapy, Physical and Mental condition that qualifies you for where IHS facilities or services (Medicare Advantage); Part C Prescription drugs.
health therapy, Substance CAMA. are not readily available. includes Parts A, B, and C not
abuse treatment, Chiropractic covered by Medicare. Part D Pre-Existing Health
care, Foot doctor’s services, Chemotherapy and radiation IHS-funded, tribally-managed covers prescription drugs. Conditions Covered
Coverage
Hospital care, Laboratory tests, services for a recipient with hospitals are located in
Prescriptions, and Medical cancer requiring chemotherapy, if Anchorage, Barrow, Bethel, Pre-Existing Health
transportation. provided in an outpatient setting. Dillingham, Kotzebue, Nome Conditions Covered
and Sitka. There are 37 tribal
Pre-Existing Health Outpatient laboratory and x-ray health centers, 166 tribal
Conditions Covered services. community health aide clinics
and five residential substance
Pre-Existing Health abuse treatment centers.
Conditions Covered
Pre-Existing Health
Conditions Covered
GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE
Must be a U.S. citizen and Alaska Must be a U.S. citizen or legal alien Must exhaust all private, state, Must be U.S. citizen or Must be receiving TAA (Trade
resident. and resident of Alaska, and have and other federal programs. permanent U.S. resident, and: Adjustment Assistance), or
one of following: a terminal illness;
Income limits: cancer requiring chemotherapy; Must be regarded by the local 1) If 65 years or older, you or Must be 55 years or older and
chronic diabetes or diabetes community as an Indian; is a your spouse worked for at least receiving pension from the
Children 0–18 with health insipidus; chronic seizure disorders; member of an Indian or Alaska 10 years in Medicare-covered Pension Benefit Guaranty
insurance: 150% FPL. chronic mental illness; chronic Native Tribe or Group under employment, or Corporation (PBGC).
Children 0–18 with no health hypertension. Must have no other Federal supervision; resides
insurance: 175% FPL. resources to meet the health care on tax-exempt land or owns 2) You have a disability or end- Must not be enrolled in certain
you need. restricted property; actively stage renal disease (permanent state plans, or in prison, or
P
regnant with proof of participates in tribal affairs; kidney failure requiring dialysis receiving 65% COBRA premium
Eligibility
pregnancy from your health Income limit per household: any other reasonable factor or transplant) at any age. reduction, or be claimed as a
care provider with or without At or less than $300 a month for indicative of Indian descent; is dependent in tax returns.
health insurance: 175% FPL. one person. a non-Indian woman pregnant
At or less than $400 a month for with an eligible Indian’s child for Must be enrolled in qualified
two people. the duration of her pregnancy health plans where you
Add $100 for each additional through post-partum (usually pay more than 50% of the
person. 6 weeks); is a non-Indian premiums.
member of an eligible Indian’s
You must have $500 or less in household and the medical
countable resources that could officer in charge determines
be used to pay medical bills: cash, that services are necessary to
bank/credit union accounts, or control a public health hazard
personal property. CAMA does or an acute infectious disease
not count your home, one vehicle, which constitutes a public
income-producing property, health hazard.
property that is used for your
job (boat, fishing gear, etc.), or a
fishing permit.
$0 for eligible children, teens, $0 and $1 per prescription or $0 or minimal share of cost. $0 and share of cost for 20% of the insurance
and pregnant women. medical supply. certain services; deductibles for premium including COBRA
Monthly Cost
certain plans. Part A: $0–$450 premium if employer
18-year-olds may be required to based on length of Medicare- contributes less than 50%.
share a limited amount of the cost
for some services. covered employment; Part B:
$96.40–$369.10 depending on
annual income; Part C: Based
on provider; Part D: Varies in
cost and drugs covered.
Alaska
www.CoverageForAll.org 4

12. Demographic Private Health Insurance
Individuals with
Individuals Recently Low-Income
Small Businesses Individuals Pre-Existing, Severe,
Covered by an Families
(2-50 Employees) Families or Chronic Medical
Employer Health Plan Adults
Conditions
Group Plans COBRA Individual Plans Medical Expense AHCCCS
National Association National Association Deduction(MED) Arizona Health Care Cost
Then convert to a plan under: Containment System
of Health Underwriters of Health Underwriters Program (Arizona’s Medicaid)
703-276-0220 703-276-0220 Run by the Arizona Health 602-417-4000
www.nahu.org HIPAA www.nahu.org Care Cost Containment 800-654-8713
Health Insurance Portability System(AHCCCS) www.ahcccs.state.az.us
Program
Health Care Group of Arizona Accountability Act 602-417-4000
(HCG) 866-487-2365 800-352-8401
www.hcgaz.com www.dol.gov www.ahcccs.state.az.us
602-417-6755 (Search: Medical Expense
Deduction Program)
Pre-Existing Condition
Insurance Plan (PCIP)
Run by the U.S. Department of
Health and Human Services
866-717-5826
www.PCIP.gov
There is a 6-month look- COBRA: Coverage available for 18–36 Up to $5M. Assorted MED: Provides medical coverage Some benefits include
back/12-month exclusionary months depending on qualifying deductibles depending on for individuals who do not qualify Preventive care, Doctor’s
period for pre-existing events. Benefits are what you had with age and ZIP code. for other AHCCCS programs due visits, Hospital services, Lab
conditions on enrollees that do your previous employer. to income. May be eligible if and x-rays, Emergency care,
not have prior coverage. There are no limits to the they have medical expenses in Family planning, Dialysis,
HIPAA: Benefits are based on program look-back and exclusion the month of application (or the Surgery, Behavioral health
Benefits will vary depending on selected. There is no expiration of periods on pre-existing previous month) that reduce their services, Podiatry, pregnancy,
the chosen plan. coverage. conditions. monthly income to 40% FPL. immunizations, physical exams,
annual well-woman exams,
Pre-Existing Health Pre-Existing Health Elimination riders are PCIP: Covers broad range of specialist care, Prescription
Coverage
Conditions Covered Conditions Covered allowed. benefits, including primary and drugs for non-Medicare
specialty care, hospital care, and recipients. Children under 21
Limits on Pre-Existing prescription drugs. also receive dental, vision,
Health Conditions May hearing services, and Early and
Apply Pre-Existing Health Periodic Screening Diagnosis
Conditions Covered and Treatment (EPSDT).
Pre-Existing Health
Conditions Covered
GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE
Company size 2–50 employees. COBRA: Available for employees who Eligibility is subject to MED: Must be an Arizona resident. Must be an Arizona resident
work for businesses with 20 or more medical underwriting. Must not be eligible for other and a U.S. citizen or permanent
Eligible employees must work employees. You have 60 days from AHCCCS programs. Monthly resident.
at least 20 hours a week. date of termination to sign up for If you are denied coverage income cannot exceed $735 for
COBRA coverage. for a medical condition, a family of four, after deducting Income limits:
Owner can count as an you may be eligible for medical expenses, childcare, and
employee. HIPAA: Must have had 18 months the Medical Expense each person employed. Resources Children ages 0–5: Family
of continuous coverage and Deduction (MED) program cannot exceed $100K. Only $5K income up to 133% FPL.
Owner name on business completely exhausted COBRA or run by the AHCCCS, or PCIP. may be liquid assets: cash, bank Children ages 6–19: Family
license must draw wages from state continuation coverage. Must To learn more, see next accounts, stocks, bonds, etc. Home income up to 100% FPL.
the company. not have lost coverage due to fraud column. equity is counted toward the
Eligibility
or non-payment of premiums. You resource limit, but one vehicle is Pregnant women: Up to 200%
have 63 days to enroll in a HIPAA- not counted. FPL.
eligible plan.
PCIP: Must have been uninsured Childless adults: Up to 100%
for at least 6 months prior to FPL.
applying. Must prove being a Parents/caretakers living with
U.S. citizen or legal U.S. resident, their children ages 0–18: Up to
an Arizona resident, and having 100% FPL.
problems getting insurance due
to a pre-existing condition. Aged, blind, and disabled: Up
to 100% FPL.
Costs depend on employer COBRA: Premiums range from Costs for individual MED: $0 or minimal share of cost. $0–$5 co-pay for office
Monthly Cost
contribution and ± 60% of the 102%–150% of group health rates. coverage vary. There are no
insurance company’s index rate visits.
based on the health status of HIPAA: Premiums will depend on plan rate caps. PCIP: Monthly premium of $104 to
the group. chosen. $450 depending on your age and $30 for non-emergency visits
plan chosen. to ER.
6
5
Arizona

13. Publicly-Sponsored Programs
Demographic
Children in Pregnant
Native American
Moderate Income Women Women Seniors Disabled
Indians
Families Children
KidsCare Well Woman Health Baby Arizona Indian Health Medicare
877- 764-5437
602- 417-5437
Check Program 800-833-4642 Services (IHS) 800-633-4227
www.medicare.gov
Run by the Arizona Department www.babyarizona.gov
www.kidscare.state.az.us of Health Services Navajo
(An enrollment cap is in place
888-257-8502 928-871-4811 Medicare Prescription
www.wellwomanhealthcheck.org www.ihs.gov/Navajo
for KidsCare due to a lack Drug Program
Program
of funding. Individuals and Phoenix Area 800-633-4227
families can still apply and be 602-364-5179
placed on a waiting list, and www.ihs.gov/Phoenix
they will be contacted when
funding becomes available.) Tucson Area
520-295-2405
www.ihs.gov/Tucson
A wide array of medical services Cancer screening for women Gives prenatal care to pregnant Available programs vary Medicare offers Part A, inpatient
including behavioral health such as clinical breast exams, women while they wait to see depending on health center care in hospitals and rehabilitative
services. mammograms, pelvic exams if they are eligible for AHCCCS and may include primary and centers; Part B, doctor and some
and Pap smear tests. Health Insurance. Staff will put child care, prenatal and post preventive services and outpatient
Pre-Existing Health the woman in touch with a delivery care, family planning care; Part C allows Medicare benefits
Conditions Covered Provides financial help to doctor in her area that will help (birth control), minor through private insurance (Medicare
women who are diagnosed her apply for AHCCCS Health surgical and orthopedic Advantage); Part C includes Parts A,
with breast cancer through Insurance. care, pharmacy, dental and B, and C not covered by Medicare.
the program and are unable to orthodontics, optometry, Part D covers prescription drugs.
qualify for other assistance or Pre-Existing Health nursing, mental health,
Coverage
to pay for treatment on their Conditions Covered laboratory and radiology. Pre-Existing Health
own. Conditions Covered
Pre-Existing Health
Pre-Existing Health Conditions Covered
Conditions Covered
GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE
Must be an Arizona resident Must be a woman with income Must be an Arizona resident Must exhaust all private, Must be U.S. citizen or permanent
and U.S. citizen or a qualified at or below 250% FPL. Must and U.S. citizen or qualified state, and other federal U.S. resident, and:
immigrant, under age 19, with have no insurance, or have non-citizen. programs.
income at or below 200% insurance that does not cover 1) If 65 years or older, you or your
FPL, be ineligible for no-cost preventive services or that For pregnant women, the Must be regarded by the spouse worked for at least 10 years in
Medicaid or employer-based has a high deductible (as income limit is 150% FPL. local community as an Medicare-covered employment, or
coverage, with no health determined by the program). Indian; is a member of an
insurance for the last 3 months If the mother ends up NOT Indian or Group under 2) You have a disability or end-
at time of application. Parents For breast cancer screening, qualified for AHCCCS due to Federal supervision; resides stage renal disease (permanent
with incomes of 200% FPL can patient must be at least 40 on tax-exempt land or kidney failure requiring dialysis or
also qualify. years old or any age with income, then it’s possible to get owns restricted property; transplant) at any age.
Eligibility
qualifying symptoms. coverage from KidsCare (see actively participates in tribal
“Children in Moderate Income affairs; any other reasonable
For cervical cancer screening, Families” column). factor indicative of Indian
patient must be at least 18 descent; is a non-Indian
years old. woman pregnant with an
eligible Indian’s child for the
Women screened by the Well duration of her pregnancy
Woman HealthCheck Program through post-partum (usually
that are under age 65, who are 6 weeks); is a non-Indian
legal residents of the U.S. and member of an eligible
do not have credible coverage Indian’s household and the
may qualify for treatment medical officer in charge
through AHCCCS. determines that services are
necessary to control a public
health hazard or an acute
infectious disease which
constitutes a public health
hazard.
$10 to $50 a month for $0 or minimal share of cost. $0 when women begin $0 or minimal share of cost. $0 and share of cost for certain
Monthly Cost
one child or $15–$70 a month prenatal care while eligibility is services; deductibles for certain
for two or more children. processed. If found ineligible, plans. Part A: $0–$450 based
then coverage can be found on length of Medicare-covered
from KidsCare (see “Children employment; Part B: $96.40–$369.10
depending on annual income; Part C:
in Moderate Income Families”
Based on provider; Part D: Varies in
column).
cost and drugs covered.
Arizona
www.CoverageForAll.org 6