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For Consumers

 

NEW: Guide to HIV medication coverage in 2018 Marketplace plans

NEW: 2018 National Marketplace Health Plan Finder for PrEP

 

Your right to health insurance

As of 2014, the Affordable Care Act (ACA) prohibits health insurance companies from denying coverage, dropping coverage or charging higher premiums to someone with HIV or any pre-existing condition. 

If you believe you have been discriminated against with regards to insurance due to your HIV status please visit SpeakUP.hiv

Get ready for Open Enrollment: 6 things to do before you enroll

Despite what you may have heard (or not heard) from the White House, you can still get a health insurance plan from the Health Insurance Marketplace. Open enrollment begins on Wednesday, Nov. 1, 2017 and ends on Friday, Dec. 15, 2017. Make sure you get the best health plan for you by taking the following steps before you enroll:

1. Pay off any balances on your current health insurance. If you owe a back-payment or have a balance you may not be able to enroll in a Marketplace plan.

2. Open your mail. Health insurers and state officials may send you information about changes to your eligibility, plan or Marketplace. Don’t toss it. Open it right away and save or respond appropriately.

3. Check your eligibility for Medicaid. Medicaid provides free or low-cost coverage to people with limited incomes. Medicaid isn’t part of the Marketplace and you’ll have to enroll separately. See if you qualify for Medicaid.

4. Renew your ADAP. If you are living with HIV, are eligible for the Ryan White program, - and use the Premium Assistance Program, make sure to renew your ADAP certification before you enroll in a Marketplace plan. ADAP certification must be renewed every six months. Ask your Case Manager, Medical Benefits Coordinator or Resource Specialist for help with renewal. Reach out to us at 1-312-784-9060 if you need help.

5. Collect your documents. This includes your Social Security number (if you have one), income information, tax information and information about your current health plan.

6. Call for assistance. The Marketplace Call Center at 1-800-318-2596 can help you enroll in a Marketplace plan 24 hours a day, 7 days a week. If you are living with HIV or eligible for Medicaid, call us at 1-312-784-9060 to learn which plans might best suit you.

Open enrollment begins on Wednesday, Nov. 1, 2017 and ends on Friday, Dec. 15, 2017. Make sure you get the plan that best meets your unique health needs.

AIDS Drug Assistance Program (ADAP) and the ACA

The AIDS Drug Assistance Program (ADAP) is a part of the Ryan White HIV/AIDS Program, which is operated to provide HIV medications and other medications to people living with HIV. For insured people with HIV, ADAP in many states can assist with paying premiums and sometimes cost sharing such as copayments or coinsurance for drugs and other services. Income eligibility requirements and other rules, including what costs are covered, vary by state. ADAP is NOT insurance, and having ADAP without other coverage does NOT satisfy the ACA’s requirement to have coverage.

In some states, ADAPs can only help with certain plans. If you think you will seek ADAP assistance with the cost of insurance, speak to your ADAP office first to find out which plans they support.

You can call AFC’s informational hotline at 312-784-9060 to speak with a certified in-person counselor who can answer your questions and help facilitate your enrollment into a health care plan.

New plans in 2018

Even if you currently have health care or insurance you need to remember that new plans and prices are available each year:

  • Every year, the plans available through the Marketplace may change, or there may be new options available. People who have already enrolled through the Marketplace will also need to update their financial information and renew their coverage. 

  • Each year, it’s important to take a look at how your financial help; your doctors, hospitals, and prescriptions; and your plan choices and prices have changed. 

  • Starting on November 1, you can look at plans available on the Health Insurance Marketplace and get a personalized estimate of your total yearly cost under each plan based on your medical and financial situation. You can also see if your prescription drugs and doctors are covered by the plans you are considering. 

  • AFC does a plan assessment each year to help consumers determine which plans are best for persons living with HIV or and those taking or interested in utilizing PrEP. Check the AFC website during open enrollment to access the plan assessments.  

  • To see plans and get a personalized estimate of your costs, visit www.getcoveredillinois.gov and click “Compare Plans.”

Need Help Enrolling?

To find someone in your community certified to sit down with you for free and schedule an appointment for help with the enrollment process, you can call AFC’s informational hotline at 312-784-9060 to speak with a certified in-person counselor who can answer your questions and help facilitate your enrollment into a health care plan. The phone line is open Monday through Friday, 9 a.m. to 5 p.m.  In addition, you can visit www.getcoveredillinois.gov and click “Make An Appointment” or you can visit http://www.ilcha.org/help.

When will the enrollment website be open?

During the open enrollment period, HealthCare.gov will be down periodically for scheduled maintenance. This is unprecedented. 

Outlined below is a general schedule for planned downtime.

  • Wednesday, November 1, 2017 - overnight
  • Sundays 12am-12pm ET, except on December 10, 2017

The duration of the outages are the maximum amount of time allowed for the maintenance. Actual outage times could be shorter.

For Providers