Get covered: The Affordable Care Act and HIV

The official name is the Affordable Care Act. Some folks call it ACA or Obamacare.

Whatever you call it, the benefits are the same: health insurance policies for individuals and families that do not have health care coverage through an employer. These insurance policies can help pay for HIV testing, diagnosis, consultations, treatments and prescription drugs.

The drug benefits are especially important because they can help you pay for anti-retroviral drugs that have to be taken every day to treat HIV.

Getting signed up for ACA requires a lot of paperwork, but there are people who can help you do it. If you’ve been diagnosed with HIV, your social worker can talk to you about what to do.

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ACA is complicated — there’s no way around that, because our health system is so complex. The main thing is, don’t let these complications discourage you from getting enrolled. You may have to be a little stubborn to get signed up, but it’s worth it. You need your meds. And you may be eligible to get them at a discount.

Ask about ACA “navigators.” These are experts who can walk you through the entire enrollment process. It takes some patience and determination, but you don’t have to be a superhero to get signed up.

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How the ACA (Obamacare) Works

With health insurance, you and millions of other people pay a premium to an insurance company that will pay most of your medical care costs if you get sick. The premiums cost far less than you’d pay for medical treatment, so it can be a good deal if you can afford the premiums. If you can’t afford the premiums, you may be eligible for help through Ryan White’s OHDAP (Ohio HIV Drug Assistance Program) or other local programs. Just ask your social worker.

The ACA is a federal law that makes sure Americans are eligible for health insurance. Low-income people can get insurance under the ACA at affordable rates because the federal government pays for part of the premium.

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One great thing about the ACA is health insurance companies cannot deny coverage to you if you already have HIV. So if you find out you’re HIV-positive, you can relax: you can still get insurance to help pay for your treatments.


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ACA Requirements

ACA requires most Americans to have health insurance, either provided by their employers or purchased online at the ACA website at www.healthcare.gov. If you don’t get insured, you may have to pay a fine.

When you read up on ACA, you’ll notice lots of advice telling you to ask what the rules are for your state. Each state in the U.S. does ACA a little bit differently, so always make sure you’re going by the rules for the state you live in.  

For instance, to get signed up for ACA, you have to use an “exchange,” which is basically an online store to shop for options. Some states run their own exchanges. Other states use an exchange created by the federal government. Ohio, for example, uses the federal government healthcare exchange.

To qualify for ACA, you have to be a U.S. citizen or a legal immigrant who is not incarcerated. You also cannot be covered by another health insurance policy.

 

Open Enrollments for ACA

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There’s a special time to enroll in the ACA in the fall of every year. There are some exceptions that allow people to enroll at any time of the year. Ask your counselor if you might be one of the exceptions.

 

Subsidies, Tax Returns, etc.

A subsidy is a payment the government gives to people to encourage them to do things for the good of the country.  

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For instance, farmers get subsidies to encourage them to keep growing the food we all need to eat.

ACA offers subsidies that have the same idea: they encourage people to get signed up for health insurance because it makes health care cheaper for everybody. If your income’s low enough, ACA subsidies can make your premiums affordable.

To get subsidies, you have to be able to provide a tax return proving your income. Don’t worry if you’ve never filed a tax return. Just tell your counselor and they’ll tell you what to do.  

 

ACA Isn’t Your Only Coverage Option

The federal Medicaid program provides coverage for lots of low-income people who are HIV-positive. Again, you’ll have to ask your counselor if you qualify.

There’s also the Ryan White Program, which helps low-income people get access to health care.

All these programs mean you have somebody helping you deal with all the medical costs of treating your HIV infection. If you’re a U.S. citizen or eligible immigrant, you have a right to take advantage of these benefits. It’s the law.

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