What Health Reform Means for People Living with HIV

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Health Coverage, HIV & YOU helps people living with HIV understand their options under the Affordable Care Act (ACA). The online tool includes tailored resources for people living with HIV, who are among those who may make the greatest gains from the new law.

The campaign website is currently under construction and coming soon. In the meantime, please find key information below.

commonly asked questions

IMPORTANT CHANGES FOR SOMEONE WITH HIV

As a result of the ACA no one can be denied health insurance or charged more because of a pre-existing health condition, such as HIV. And insurers can no longer limit how much they’ll spend on your medical care—over a year or your lifetime. These are important changes for someone with HIV. Check out the top five things to know about HIV and the ACA.

5 Things To KnowCOVERAGE OPTIONS

Many people today get health insurance through an employer. Some purchase coverage on their own. And, others, including many people with HIV, are covered by the government-run health programs Medicaid and Medicare.

Most Americans are required to have health insurance or pay a fine if they don’t.

If you already have coverage that you are satisfied with, you don’t need to do anything. If you are in need of health insurance, there are now some more options available to you.

You can now buy your own coverage from health insurance marketplaces in each state.

Financial assistance may be available to reduce how much you pay each month for your insurance and also what you pay out of your own pocket when you seek medical care. You may be eligible for financial help in the marketplace if you don’t have another source of coverage and you earn between $11,670 and $46,680 as a single person (income ranges vary depending on your family size).

Another possible option for coverage is Medicaid. As part of the ACA, states can choose to expand Medicaid to cover more people. This means you may now be eligible for Medicaid even if you were not before. If you live in a state that is expanding Medicaid and you earn about $16,000 a year or less as a single person (or $21,000 or less as couple) you likely can get coverage under the program.

Also important for someone with HIV is that you no longer need an AIDS diagnosis or to be very sick or disabled to get coverage under these expanded Medicaid programs.

Not all states are expanding Medicaid, but even if yours is not you may still be eligible for coverage in the program.

To find out about the health insurance marketplace, including financial aid, and Medicaid coverage options in your state, click here.

ESSENTIAL HEALTH BENEFITS

Plans sold through the health insurance marketplaces must provide a minimum set of health benefits. These include benefits you may find especially helpful for your HIV care, like prescription drugs, doctor visits, hospital care, mental health care as well as certain preventative services, including HIV tests.

Many insurance plans offered by employers include similar benefits, but they are not required to provide them. You will need to check your plan to see if the benefits you need are included.

For a complete list of the “Essential Health Benefits” under the ACA, click here.

 ENROLLMENT PROCESS

In the fall, you can go online, or get assistance in person, to buy your own plan in the health insurance marketplace. During the open enrollment period you can select new coverage or choose a new plan. To find out the date when open enrollment begins for this year, click here.

If you are eligible for Medicaid, you can enroll any time of year. Information about Medicaid is also available through the health insurance marketplace.

In all states, there will be trained people who may be able to help you understand your health insurance options and help you enroll you in a plan.

This checklist provides guidance on the documents and other information you’ll need to enroll in new healthcare coverage made available by the Affordable Care Act (ACA). You can fill it out on your computer or print it out. Once you are finished, you can email it to yourself or print a hard copy to refer to when you sign up for health insurance. Download the check list here.

Unless your situation changes and you no longer have coverage, you do not need to do anything and likely you won’t notice any changes.

If you are currently buying your own health insurance, you may want to compare benefits and costs with what you can get through health insurance marketplace. The marketplace is the only place where you can get access to subsidies to help make coverage more affordable if you qualify.

 RYAN WHITE AND ADAP

If you are currently receiving support for your HIV care and treatment from the Ryan White HIV/AIDS Program and the AIDS Drug Assistance Program (ADAP) you will still need to have health coverage.

These programs will continue to be available, but some of the services these programs currently cover may be replaced by your insurance.

For more information about Ryan White and ADAP, click here. To find out about Ryan White and ADAP in your state click here.

For a helpful list of definitions of key terms that are part of the health reform law, check out the glossary.

Glossary

If you are not able to find what you’re looking for, please contact Greater Than AIDS at greaterthan@kff.org.