Health Insurance Marketplace
Name: Arizona uses the Federally-Facilitated Marketplace
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: Arizona Medicaid
Helpline In-State: 1-800-654-8713 (Outside Maricopa County)
Helpline Out-of-State: 1-800-523-0231
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. Your state has expanded Medicaid to cover more people. If you earn about $16,643 a year or less as a single person (or $22,411 or less as a couple), you likely can get coverage under the program.
You no longer need to be disabled (including through an AIDS diagnosis), pregnant, or fall into another category to qualify for Medicaid. In your state, you can qualify based on being low income and meeting residency requirements.
If you already have Medicaid, it is likely that nothing will change, and you will continue to receive all the same benefits.
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
Phone: 1-602-364-3628 or 1-800-334-1540
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.