If my state is not expanding Medicaid and I can’t afford to buy insurance on my own, what are my options?
Even if your state is not expanding Medicaid, you may be eligible for the program, but not know it. (You can find details on your state’s program here.) Even if you are not eligible, you may be able to get financial assistance to pay for coverage in the marketplace in your state; to qualify, your income must fall between 100 percent ($12,060 a year for a single person) and 400 percent of the federal poverty level (about $48,240 a year for a single person). However, financial assistance for marketplace plans is not available if your income is below 100 percent of the poverty level. If your income is below the federal poverty level and you can’t access affordable coverage, you will not be fined for not having health coverage.
If you are not eligible for financial assistance, or you receive financial assistance in the marketplace but still can’t afford to pay for coverage, you may be able to get help from the Ryan White HIV/AIDS Program, including its AIDS Drug Assistance Program (ADAP). These programs can help you pay for insurance or help provide HIV services if you can’t get insurance. Even if you have insurance, they may be able to provide you with HIV services that your insurance plan does not cover.
Medicaid is the nation’s health insurance program for low-income individuals and families. Medicaid is operated as a partnership between the federal government and the states. Some states give their Medicaid programs special names, such as Medi-Cal in California. Other states may simply call Medicaid their “medical assistance program.”
Before 2014, individuals with low incomes generally had to fall within one of four categories to receive Medicaid: low-income children, parents of dependent children, seniors and people with disabilities. The income limit for each eligible group varies across the states. This coverage will remain unchanged. Since 2014, in states that expanded their Medicaid programs, individuals with income up to 138 percent of the federal poverty level, about $16,643 a year, and meet residency requirements are eligible for coverage, even if they do not fall into one of these categories. This means that you no longer need an AIDS diagnosis or be very sick or considered disabled to get coverage from the program. Even if your state is not expanding Medicaid, you may still be eligible for the program.
Medicare is a federal health insurance program for seniors, aged 65 or older, and people under age 65 with permanent disabilities. The Affordable Care Act (or ACA) includes provisions to help make prescription drugs under Medicare more affordable and to provide free preventive services to those on Medicare.
Medicaid is the nation’s health insurance program for low-income individuals. You may qualify for Medicaid based on your household income and the size of your family or because you fall into a certain category (such as having a disability or being pregnant). You must be a U.S. citizen or a legal resident for at least five years to be eligible for Medicaid.
Under the Affordable Care Act (or ACA), states have the option to expand Medicaid to a higher income level – up to 138 percent of the federal poverty level, about $16,643 a year or less for a single person (or $22,411 or less as a couple). And you no longer need an AIDS diagnosis or to be very sick or disabled to get coverage under these expanded Medicaid programs. However, not all states are expanding Medicaid. But even if yours is not, you may still be eligible for coverage in the program.
Before 2014 and in non-Medicaid expansion, to receive Medicaid benefits, individuals generally had to have a low income and fall into an additional category which ranged by state but could include: low-income children, parents of dependent children, pregnant women, and people with disabilities. The income limit for each group varies across the states. This coverage is still available in states that are not expanding Medicaid.
To find out more visit your state page.
Under the Affordable Care Act (or ACA), many states are expanding Medicaid coverage to newly eligible individuals with incomes up to 138 percent of the poverty level, about $16,643 a year or less for a single person (or $22,411 or less for a couple). Expanded Medicaid coverage must provide the same basic benefits, called essential health benefits, as the coverage options now available through health insurance marketplaces (also called exchanges).
The Essential Health Benefits (EHB) include prescription drugs, various preventive services, mental health care and other services that are important for managing HIV. HIV testing is now an essential benefit as well, which generally means you won’t have to pay for it.
Medicaid covers a broad range of services, many of which are critical for people with HIV/AIDS. State Medicaid programs must cover certain services like inpatient and outpatient hospital services, physician and nurse practitioner services and family planning. Medicaid covers prescription drugs in all states, whether the state expands Medicaid or not.
States have broad flexibility in designing their Medicaid benefits packages, however, so visit your state page for the details.