Paying for Treatment and Care
Last updated: March 2022
The cost of healthcare in the United States continues to soar and can make securing coverage a difficult task. If you are living with HIV, figuring out how to pay for your treatment and care and how to actively navigate healthcare options can be quite overwhelming. Our eligibility for coverage depends on the state you live in, income, employment, health status, and even your age and citizenship.
Help with affording HIV medications
The Affordable Care Act (ACA)
The passing of the Affordable Care Act (ACA), otherwise known as “Obamacare”, has expanded insurance coverage for millions of people, again depending on where you live. It is important to work with your provider, case manager, or other healthcare professionals to determine your course of treatment.
The Ryan White CARE Act & AIDS Drug Assistance Program (ADAP)
For many who are uninsured or underinsured the Ryan White CARE Act is the largest federally funded program for people living with HIV. Ryan White programs provide care and support services to people who do not have insurance or do not have enough coverage through their other plans.1
It’s important to know the Ryan White program also provides funding for the AIDS Drug Assistance Program (ADAP). This covers about one-third of Americans who are in care for HIV and who get their meds through this federal-state partnership. There are income requirements and what ADAP covers can be very different from state to state; some states may have a waiting list.
Medicaid & Medicare
Many others access treatment through Medicaid and/or Medicare. Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare.2 These federal programs support many Americans living with HIV to get their treatment and care through these federal programs. You may qualify for Medicaid if you have a low income, are a child, a parent with dependent children, pregnant, or have a disability. Some states have the option of allowing people to gain eligibility for Medicaid without being disabled.
People can qualify for Medicare if you are 65 years of age or older, or if you have a permanent disability. With the ACA available, depending on where you live, you pay only half of what you used to pay for brand-name prescription medications.
Health insurance through an employer
Health insurance may be available through your job. Employers with 50 or more employees are required by law to offer health insurance. Many small businesses also offer insurance to their employees. In my experience, buying into those plans can be extremely expensive if you are only making minimum wage.
If you have health insurance or are considering getting insurance through your employer, it’s important to know that employers who offer health care cannot discriminate against employees based on their health status.
Patient Assistance Programs (PAP)
When other options are not available, obtaining medications through Patient Assistance Programs (PAP) can be the option of last resort. Nearly all the pharmaceutical companies have come together to offer free or heavily discounted drugs to help people with low incomes who do not qualify for any other insurance or assistance programs.
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