Medicaid, Medicare And Extra Help

Medicaid & AHCCCS

Because of the similarity in naming, Medicaid and Medicare, are sometimes confused with each other. Medicaid provides health coverage for individuals including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. As such, the Arizona Health Care Cost Containment System (AHCCCS) is the state-specific program for Arizona residents of any age needing financial assistance with health and medical costs. Since Medicaid is a “means-tested” program, individuals seeking benefits must qualify. Additional information on AHCCCS can be found online at https://azahcccs.gov/.

Medicare

Medicare is the US health insurance program for people who are 65 or older, certain younger people with disabilities as well as people with End-Stage Renal Disease (ESRD). Medicare has many parts and programs that seek to provide the needed benefits for older Americans including hospital insurance (Part A), medical insurance (Part B), Advantage Plans (Part C) and prescription drug coverage (Part D). There are other parts and programs for certain individuals that provide additional benefits. One such program is Medicare Extra Help.

Extra Help & Medicare

Extra Help is a program set up to assist low-income individuals on Medicare pay for prescription drug program costs, like premiums, deductibles, and coinsurance. As this program is set up to help limited income adults with prescription drug costs, individuals must be approved to receive the Extra Help subsidy. There are two categories, those who “must apply” and those who are in the group as “Deemed Eligibles”. Those in the “must apply” category are those that are not currently under another approved subsidy program and must apply for the Extra Help program directly. The “Deemed Eligible” group consists of those currently receiving an approved subsidy program such as Medicaid. 1

People who have full Medicaid coverage through AHCCCS are generally deemed eligible for Medicare Extra Help, which can reduce Part D premiums, deductibles and cost sharing. Eligibility and cost amounts can change, so verify current details through Medicare.gov's Extra Help guidance.

When and How to Apply for Medicare Extra Help

Special Enrollment Period rules for people with Medicaid or Extra Help changed in 2025. They do not provide a general once-per-quarter right to switch any Medicare Advantage or Part D plan. The timing and plan changes allowed depend on your eligibility and current coverage. Review Medicare.gov's current Special Enrollment Period guidance or call 1-800-MEDICARE before making a change. A CSG Insurance Pros agent can also explain plan options from the carriers CSG represents.