Health Coverage, HIV, and You

Find out about insurance near you


Health Insurance Marketplace

Name: Virginia uses the Federally-Facilitated Marketplace
Helpline: 1-800-318-2596
TTY: 1-855-889-4325

Health insurance marketplaces are new programs set up in each state to make it easier to buy coverage on your own, especially if you don’t have another source of insurance, such as through an employer, Medicaid or Medicare. You cannot be denied coverage or be charged more because of a pre-existing health condition, including HIV. Financial assistance may be available to pay for your monthly premiums and out-of-pocket costs.

To see if you may be eligible for financial assistance in the marketplace, click here to use the Kaiser Family Foundation subsidy calculator.

All plans sold through the marketplace must provide a minimum set of benefits – called Essential Health Benefits (EHB). These include benefits that may be helpful to your ongoing HIV care, like prescription drugs, doctor visits, hospital care, mental health care and certain preventive services.

For coverage you must apply during the open enrollment period. You must pay your initial premium to be covered.


Name: Virginia Medicaid
Helpline: 1-804-786-6145

Medicaid is the nation’s health insurance program for people with lower incomes who are U.S. citizens or legal residents for at least five years. Eligibility for Medicaid is based on having a low income, though the level varies by state, and some states require you to fall into a specific category of eligible people, such as parents of dependent children and people with health conditions serious enough to be classified as having a disability. Many people with HIV qualify as disabled if their condition has progressed and they have been diagnosed with AIDS.

If you already have Medicaid, it is likely that nothing will change, and you will continue to receive all the same benefits.

In states that are expanding Medicaid, the program will cover low-income individuals who earn about $16,000 a year or less as a single person (or $21,000 or less as couple). In these states, people living with HIV no longer need to have an AIDS diagnosis to qualify for coverage. But in states that are not expanding Medicaid, such as Virginia, people with HIV will likely still need to show disability. Because your state has decided not to expand Medicaid at this time, most low-income adults without children and some parents will not be eligible, including some people with HIV. Check with your state’s marketplace to see if you are eligible under current rules. If you qualify for Medicaid, you can enroll any time.


Helpline: 1-800-633-4227

Medicare is the federal health insurance program for seniors and younger people with disabilities.

To be eligible, you must also be a U.S. citizen or legal resident for at least five years.
If you have Medicare, you do not need to do anything and may see some added benefits as a result of the Affordable Care Act. You can continue to rely on Medicare to help pay your hospital, physician and other medical expenses.

Medicare’s open enrollment period for existing policyholders (October 15-December 7) hasn’t changed. If you will soon become newly eligible for Medicare because of age, you can sign up during a seven-month period that starts three months before the month you turn 65 and ends three months afterwards. If you are under 65 and disabled, you can sign up for Medicare during the seven-month period that starts three months before your 25th month of getting benefits and ends three months after your 25th month of getting benefits.

Ryan White and the AIDS Drug Assistance Program

Ryan White Part B Resources
Helpline: 1-855-362-0658
Maximum Income: 400 percent of the federal poverty level or about $46,680 a year for a single person

ADAP Program
Helpline: 1-855-362-0658
Maximum Income: 400 percent of the federal poverty level or about $46,680 a year for a single person

The Ryan White HIV/AIDS Program, which includes the AIDS Drug Assistance Program (ADAP), is a program that provides financial assistance for healthcare services for people living with HIV.

Ryan White and ADAP have two missions. They help people with HIV who cannot get affordable health insurance pay for healthcare services. They also help boost the coverage available to people with HIV through their existing insurance–whether private, job-related, Medicaid or Medicare — by covering additional services or assisting with copays and cost sharing. Under the Affordable Care Act, there are new options for people with HIV to obtain insurance coverage that they have not had before, including purchasing coverage in the health insurance marketplace and expanded Medicaid.

Ryan White and ADAP will continue to be available, but some of the services these programs once covered may be replaced by your insurance. If you are currently receiving support for your HIV care and treatment from the Ryan White HIV/AIDS Program or the AIDS Drug Assistance Program (ADAP), you still need to get health insurance. If Ryan White or ADAP assist you with copays to help make your coverage affordable or even purchase your insurance coverage for you, they may be able to continue to help you in this way. Check with your Ryan White or ADAP program, as you may need to obtain new coverage through one of the Affordable Care Act’s new options.

For more information about your state’s plan use the tool above.
For more information about your state’s plan use the tool above.

5 Things to Know

5 Things to Know

Under the ACA you cannot be denied coverage or charged more because you have HIV or any other pre-existing health condition. For 5 Things everyone living with HIV should know about the ACA, click here.