Exploring Payment Options
The Affordable Care Act (ACA-or-Obamacare) has made available insurance coverage for millions of uninsured Americans. Before the ACA was signed into law, insurance companies could deny coverage to someone on the basis of pre-existing conditions like HIV. After being challenged, the Supreme Court’s decision to uphold the “Individual Mandate” portion of the ACA was a victory for people living with HIV who had previously been shut out of the health insurance market.
These changes to the health care system and insurance can be complicated and vary state-by-state. Make sure before choosing a plan that your specific HIV meds are covered by your plan.
AIDS Drug Assistance Program (ADAP)
ADAP continues to be financially strained and always at the mercy of both state and federal budgets. Although waiting lists decreased in most states from an all-time high in 2011 some wait lists may exist in certain states. Look at the ADAP list that follows for your state to check on the waiting lists and qualifiers.
Disability and Medicaid
Years ago, people with HIV were automatically assumed to be "disabled." Now, of course, they are not. But since issues like fatigue, depression and even diarrhea are very difficult to disprove, you can possibly be "disabled" by HIV if you need to be. Don't jump at it if you have other options! Disability becomes a trap that many people have a hard time getting out of!
When you go on disability, you may get cash income from Social Security, depending on how much other income you receive and what you own. But it's not much! To find out how much you may receive, contact your local Social Security office.
Qualifying for SSI usually also qualifies you for food stamps and - more importantly - Medicaid (which is called Medi-Cal in California and has different names in some other states as well.) Medicaid is a lifeline to HIV care for approximately 50% of people living with HIV (and 90% of HIV-positive children.) Medicaid pays for inpatient and outpatient treatment, home health care, prescription drugs and medical supplies.
If you're relying on Medicaid or plan to, ask your local ASO for help from a case manager who has experience dealing with your state's Medicaid program. It's complicated and getting more so! The Affordable Care Act (ACA) also affects Medicaid. The ACA cleared the way for all states to expand their Medicaid programs although some states aren’t willing to do so, which could shut out low-income individuals to access to health care coverage. The good news is that many states are expanding their Medicaid programs.
Patient Assistance Programs
The drug companies’ patient assistance programs have become extremely important in this era of budget cutting and tight money. The drug companies have picked up the slack for thousands of people with HIV who cannot get help from ADAP because of under funding.
Partnership for Prescription Assistance
Copyright 2018, Positive Health Publications, Inc.
This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!