Problems and Troubleshooting
If you have questions or need help enrolling in coverage, go to www.healthcare.gov. You’ll find information about your options and resources to help you understand what you need to do.
Many HIV organizations and clinics are also available to assist people with HIV assess their options and obtain new coverage. You can find HIV providers in your community here and links to your state’s Ryan White HIV/AIDS Program and AIDS Drug Assistance Program (ADAP) here.
You may also be able to get help in person from a navigator or patient assistor, a trained person whose job is to help you learn about new Affordable Care Act (ACA) coverage options. Search for navigators or patient assistors in your area here.
The Affordable Care Act (or ACA) prevents insurance companies from denying coverage, dropping coverage or charging higher premiums because people have HIV or any other pre-existing health condition. Health plans may, however, cancel your coverage if you fail to pay the required premiums. Plans sold through the marketplace are required to offer you a 90-day grace period if you fall behind on your premiums. Insurers cannot cancel your coverage during the grace period, though they can hold your claims and not pay them until you get caught up on your premium payments. If you have trouble paying your premiums, the Ryan White HIV/AIDS Program and AIDS Drug Assistance Program (ADAP) may be available to help you pay.
It is important for people with HIV to get regular medical care and avoid any interruptions in prescription drug therapy. If you are denied a medication or other critical service, you can appeal, and your health plan will need to respond to your request promptly. You can also request that it gives you a temporary supply of a medication until your appeal is resolved. The AIDS Drug Assistance Program (ADAP) also may be able to assist you with drug coverage to prevent any gaps in your treatment regimen.
The Affordable Care Act (or ACA) requires insurance sold to individuals in the marketplace and expanded Medicaid programs to offer a minimum set of benefits, known as essential health benefits, which include many services that are important to quality HIV care, such as prescription drugs. Health plans are not required, however, to cover all drugs within a drug category or class. For example, a category of drugs would be antiretrovirals and a class of drugs would be protease inhibitors.
Marketplace health plans are prohibited from discriminating against individuals based on their race, gender, health status or disability, sexuality or gender identity or national origin. For persons with limited English proficiency, plans are required to provide written information and translation services in other languages. Plans sold through the marketplaces are required to include essential community providers in their provider networks. If you have a complaint about a health plan sold through the marketplace, you can register your complaint with the marketplace and ask for help seeking a resolution.
If you live in a state with a consumer assistance program (CAP), you can also seek help there.