Updated Dec. 22, 2015 with finalized report from the AIDS Foundation of Chicago (AFC) and Center for Health Law and Policy Innovation of Harvard Law School

To help people living with HIV and hepatitis C (HCV) choose health insurance marketplace plans, the AIDS Foundation of Chicago (AFC) and Center for Health Law and Policy Innovation of Harvard Law School have collected information on HIV and HCV medication coverage for each plan.

Provided are examples of what a person living with HIV might pay for HIV medications and coverage. Keep in mind:

  • Do not rely solely on the information in this document to choose a plan — it is only a guide.
  • Need help choosing a plan? Consult a trained enrollment assister for help in selecting a plan. People with HIV and co-infected with HCV in the Chicago area can reach AFC’s navigators at 312-784-9060. People living with HCV only or people with HIV living outside the Chicago area can call 1 (866) 311-1119 and visit www.getcovered.illinois.gov. 
  • Always verify medication coverage directly with a plan before enrolling. Insurance companies can change their coverage without telling consumers.
  • We only looked at the cost and coverage of a few HIV and HCV medications. Contact the plans directly if you take medications that are not listed here.
  • Act fast! You must enroll by Tuesday, Dec. 15, 2015, for coverage to begin on Jan. 1, 2016. The deadline for enrolling in a marketplace plan for 2016 is Friday, Jan. 15, 2016.
  • The Illinois Medication Assistance Program (MAP) (formerly ADAP) and the Premium Assistance Program (PAP-formerly CHIC) can help! If you sign up for the MAP and/or PAP and enroll in a coordinating plan, you won’t pay premiums or any out-of-pocket costs for HIV medications. Read more about MAP below. Please be reminded that MAP pays for the medication portions, PAP pays for the premiums.
 
2016 plan assessments by insurance provider
Aetna Ambetter Blue Cross Blue Shield
Coventry Health Care Harken Health Health Alliance
Humana Land of Lincoln Health UnitedHealthcare

 

The Illinois Medication Assistance Program (MAP) can help!

Fortunately, the Illinois Medication Assistance Program (MAP-formerly ADAP) and the Premium Assistance Program (PAP-formerly CHIC) can help people with HIV afford medications on plans purchased through the marketplace. MAP covers these costs because successfully treating HIV has significant benefits for individuals with HIV, as well as the community. People with HIV who have an undetectable viral load have better health outcomes. Moreover, they are far less likely to transmit HIV in the community.

People enrolled in MAP and PAP won’t pay monthly premiums or any out-of-pocket costs for HIV medications that are part of the MAP Formulary. However, to benefit from these programs, you must select a silver plan from one of these insurance companies:

Ambetter – Silver Plans Only
Aetna – Silver Plans Only
BlueCross BlueShield – Silver Plans Only
Health Alliance – Silver Plans Only
Humana – Silver Plans Only
United Healthcare – Silver Plans Only

PAP can help individuals pay up to $750 per month toward monthly premiums.

If you are eligible for MAP or PAP, you must select one of these plans in order to receive any benefits. To apply or for more information about the programs, including eligibility requirements, contact MAP/PAP at 800-825-3518 or visit iladap.providecm.net.

MAP does not cover HCV treatment or assist people who are mono-infected with HCV.

 

Pre-Exposure Prophylaxis (PrEP)

People who are not infected with HIV may be able to take a medication to help prevent infection. Currently only one medication, Truvada, is approved for this use. To date, AFC has not heard reports of insurance companies denying coverage of Truvada as PrEP. The monthly cost of Truvada can be found in AFC’s PrEP plan assessment, found here. 

Important notes

The medications we chose to examine make up the “recommended” and “alternative” regimens according to the Department of Health and Human Services’ Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.

All coverage information was accessed between Nov. 1 and Dec. 7, 2015, using the marketplace website (healthcare.gov), the health insurance companies’ websites, and via calls to insurance companies’ customer service representatives. This information can change at any time and should be verified with the insurance company before enrolling in any plan.

Actual prices will vary between pharmacies, and consumers should check with pharmacies before purchasing medications or selecting a plan that relies on coinsurance. Consumers should consider selecting a plan that requires a copay rather than coinsurance. A copay is a fixed and predictable amount of money and is typically considerably less than a coinsurance when applied to the costly medications used to treat HIV.