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Pima Community
Access Program
Frequently Asked Questions & Answers
What is PCAP?
PCAP is a unique, alternative health care delivery system that will allow the low income, uninsured residents of Pima County, access to coordinated and affordable health care. All potential enrollees are first screened for eligibility into any of the state or federally funded health care programs such as AHCCCS or DES prior to enrollment into PCAP. All enrollees must be residents of Pima County, have an income between 100% and 250% of the federal poverty level and must not be eligible for any state or employer sponsored health care coverage.
What services are covered?
PCAP offers discounted services for primary care visits, specialist visits, hospitalization, outpatient hospital services, laboratory services, radiology services, transportation, pharmacy discounts and vision services.
Can I use a non-contracted Primary Care Physician (PCP)?
Members established with a PCP outside of the PCAP network may remain with their current PCP however, fees will not be discounted under the PCAP fee schedule.
Are any services or conditions excluded?
Most medically necessary services are covered; there are no discounts currently available for dental, mental health services, substance abuse, organ transplant or obstetrics.
What will I have to pay?
See chart below.
Primary care visits |
Rates vary by Primary Care Provider. |
Specialist visits |
Office consultations are $30.00. Other procedures are discounted from the Medicare Allowable rate. |
Hospitalization |
Inpatient stay $500-$700 per day with a $2000 maximum per stay. Under $20,000 total bill: Inpatient stay $500-$700 with a $2000 maximum per stay. |
Outpatient hospital services |
Member pays 20% of the total billed charge plus medications. |
Prescription drugs |
5% to 40% discount off average wholesale price when using KPP (Fry’s) pharmacy, ScriptSave cards, Together RX Access or AZ Copper card. |
Laboratory services |
50% of the current Medicare allowable at a Sonora Quest facility Pathology is 100 % Medicare Allowable. Physician office or hospital rates vary. |
Radiology services |
Services will be discounted from the current Medicare Allowable rate. |
Urgent care services |
Concentra Urgent Care. 4600 S. Park Ave. 520-889-9574 |
* Medicare Allowable is an industry standard pricing structure. Members cannot be enrolled in Medicare.
How do the physicians/providers get paid?
The physicians and hospitals will be paid directly by the member as services are received. If members are unable to pay for services at the time of service, they will need to reschedule or make payment arrangements with the provider prior to receiving services.
Is the hospital charge all inclusive?
No, the hospital charge is only for the facility fee (room and board). There will be separate charges for physician/professional fees.
What about Emergency Room services?
Emergency room services are not discounted and you will need to pay for services when they are received. If you are admitted via the emergency room the hospital inpatient daily rates will apply.
What is the difference between PCAP and a private insurance?
PCAP is not an insurance plan but, a highly discounted pay as you go medical program for Pima County residents. Members pay no monthly premium. There is only an annual enrollment fee of $40.00 per person and then low fees at the time of service.
How do I qualify for PCAP?
You must be a resident of Pima County; you cannot be eligible for any state, or federal or employer sponsored health care coverage; you must meet the income requirements (see income chart). All potential members will be screened for eligibility in the state/federal programs (i.e. AHCCCS, DES) prior to enrollment into PCAP.
How can I enroll in PCAP?
Apply at a Primary Care Clinic of your choice, (see PCAP’s Primary Care Clinics & Hospital network) for locations, or call for appointment to apply in person at PCAP at 520.694.0418.
Will I need to bring any documents to enroll?
Yes; you will need to bring documents for proof of residency (a utility bill or rent receipt) and proof of income (Pay stubs for the past 30 days or your general ledger along with expense receipts if self employed).
What happens if I need to see a specialist?
When you enroll in PCAP you will be required to select a Medical Home or Primary Care Provider (PCP). All of your health care needs will be coordinated through them. If it is determined you need specialty services, your primary care provider will write a referral and provide you with the names of available specialists. You will contact the specialist’s office and schedule the appointment. If needed, your PCP may assist you in scheduling specialty appointments.
Does PCAP cost anything?
Members pay an annual enrollment fee of $40.00 per person, and then pay at discounted rates for services used. See question 5.
What if I have health insurance at work but it is too expensive?
If your employer contributes to your health care coverage, you as an employee would not be eligible for PCAP. However your spouse and/or dependents may be eligible.
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Contact Us
PCAP, 2501 E. Elm St.
Tucson, Arizona 85716
Phone: 520-694-0418
Fax: 520-309-2425
