HIV and Health Insurance

Access to health insurance for Americans with HIV has expanded thanks in part to the health care reform law, which has placed a higher emphasis on public programs. Individuals who have HIV/AIDS in America have several health insurance options through government sponsored plans, including Medicaid, Medicare and the Ryan White HIV/AIDS program, in addition to the option of coverage through an employer. Individual health insurance is also no longer limited for people with HIV or AIDS due to the Affordable Care Act elimination discrimination for health status and medical history.

Medicaid is a key source of coverage for low-income individuals with HIV/AIDS, covering a significant population of men, women and children affected by the illness. As the program accommodates those who have any illness, some of our continually disappearing tax dollars are at least supposedly going to serve this group of needy individuals. It is projected that the most insured individuals with HIV in America are covered by Medicaid. A lesser percentage is covered by Medicare or private coverage, and many remain without insurance and may use the Ryan White program as their sole source of health care assistance.

Each type of coverage mentioned has its own screening and eligibility process, which includes age, citizenship, income, employment, health status, among other factors to qualify. This leaves people with HIV scattered across the health insurance system, facing difficulties in finding the proper coverage, as well as left to resort to treating their disease without any insurance. However, the ACA will broaden the spectrum for this growing group of Americans, offering more opportunities to get care and be continually insured.

 

Expanding Coverage

Improving accessibility to care for everyone, especially those with conditions such as HIV is an essential part of health reform. The law is expanding access to all necessary and types of treatment that have proven effective, namely antiretroviral treatment (ART). ART has shown positive results in improving the overall health of individuals with HIV, and recent research also indicates the treatment reduces the risk of the disease’s transmission from an HIV positive to an HIV negative person.

Since the law was passed in 2010, health insurance plans began to make adjustments to provide more coverage for people with HIV. Though the most significant changes occurred in 2014, a gradual increase in much-needed coverage started before all individuals could be accepted for insurance. Availability of medical services and prescriptions designed to combat the illness has also taken place during this time. ART treatment has a great overall effect on our public health system by reducing the disease’s potential of spreading to non-infected individuals, as well as helping those with HIV live longer and healthier.

 

Insurance for HIV before the ACA

Prior to the Affordable Care Act, group coverage (through an employer) was the main source of health insurance for most people who live in this country. However, it was much more limited for workers with HIV. The individual market was even less welcoming, as AIDS is often found on the list of immediately declinable conditions for many private insurers, and HIV, considered an uninsurable, pre-existing condition. The prior knowledge of expensive treatment and medications caused insurers to be wary of individuals with HIV, frequently resulting in rejection of coverage, or vast increase in rates so high the applicant would be unable to afford it.

Due to the challenges brought about by the individual and employer-sponsored market, people with HIV heavily relied upon the public programs at hand. Medicaid being a primary choice for those with a low-income, a good portion also qualify for the program through being disabled. Many individuals with HIV have been eligible for Medicaid by fulfilling both characteristics. Before the health care law, the federal government made an exclusion for coverage of non-disabled adults without children through Medicaid, unless a state got a waiver or used state-only funds to cover this group.

Clearly not all adults affected by HIV are disabled, which brought hope of coverage to a screeching halt for many individuals who have a low enough income to qualify, but do not have children or a mental or physical disability. This unnecessary discrimination prevented a large population from receiving valuable medications covered by Medicaid for HIV. Though Medicaid, in fact, covers these necessary drugs to prevent HIV-related disability and suppress the life-threatening aspects of the illness.

Another source of coverage before expanding laws to assist people with HIV, again, was quite limited. Medicare is designed for groups of Americans who are age 65 or older, or permanently disabled, which provides coverage for the small window of disabled or elderly individuals with HIV. In other circumstances, if a state has a high-risk pool, people who do not qualify for Medicare or Medicaid would be able to apply for such coverage. However, the high-risk pools have not been known to cover HIV medications and treatments, which leaves the Ryan White program as the primary source of disease-specific care.

 

HIV Coverage During ACA Transition

During what was referred to as the ACA transition period (between 2010 and 2014), a a few more options were created, giving greater access to coverage. One of which was the Pre-Existing Condition Insurance Plan (PCIP), a temporary high-risk pool available for purchase on the private market, though a federally and state administered plan. Individuals with HIV were not discriminated against for having the condition, and it spread high-risk pools to all 50 states, where before these were only in select areas.

In addition to PCIP, the health reform law also restricted private health plans in both individual and group markets from imposing lifetime maximums. This provision made it possible for people who require costly treatment from running out of coverage, as they easily could have prior to the law. The dependent coverage option is also helpful for young adults with HIV, as they can now stay on their parent’s plans until age 26.

Medicaid was also addressed, offering coverage to adults without children in states who chose to do so, with incomes at or below 138 percent of the Federal Poverty Level. This has been implemented in multiple states, and perhaps in time every state will find this an important move. Despite the expansion in Medicaid and lift on limits, it was difficult to get coverage as a person living with HIV during this time. Ultimately, Ryan White still served as a major access point to care, because not every state implemented these provisions. Though slightly more options were available, there was not an apparent enough impact until 2014.

 

Health Reform and HIV

As of January 1, 2014, access to healthcare for people with HIV should improve at a staggering rate. All private health insurance plans will accept individuals with HIV on an equal basis, with no unfair rate-ups or exclusions. Individuals who can afford to pay for an individual health plan will be able to do so without it being such an enormous financial undertaking, and those who cannot afford these plans can apply on the exchange and receive subsidies to help them meet their premiums and other costs. Many more Americans will be able to receive the care they need with proper coverage, conditions aside, paying the same amount as everyone else.

Though that sounds a great solution, there is also the question of what happens to the low-income, and people in states without Medicaid expansion. Though the Supreme Court stripped the Medicaid program of its core responsibilities to our nation’s most needy by making expansion optional, the states who do participate give a larger number of people with HIV the coverage they require. Expanding the Medicaid program adds the group of childless adults with an income of up to 138 percent of FPL, as well as allowing more low-income adults with children who have HIV to enroll. In states where Medicaid has not changed, people whose earnings put them right at poverty will be accepted for coverage on the health insurance exchanges, with financial assistance to help cover medical bills and premiums.

 

Resources

Apply for Individual Health Insurance

Discuss your options with a licensed agent at 888 803 5917

Health Insurance Exchanges

Medicaid

Medicaid Expansion

HRSA HIV/AIDS Programs