State of arizona ahcccs program 2026

1. Click ‘Get Form’ to open the AHCCCS application in the editor.
2. Begin by filling out your personal information on Page 1, including your name, date of birth, and Social Security number. Ensure all details are accurate.
3. Indicate whether you are applying for AHCCCS Health Insurance or Medicare cost assistance by checking 'YES' or 'NO'.
4. Complete the income section by detailing all sources of income for yourself and any dependents. Attach verification documents if necessary.
5. On Page 3, select your preferred health plan from the list provided based on your county. Make sure to check if your doctor is part of that plan.
6. Review all sections for completeness and accuracy before signing the application. If needed, attach additional sheets for more information.
7. Submit your completed application by mailing it to the designated AHCCCS office listed on Page 4.

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