New health insurance plans created since 2010 cannot refuse to cover you or charge you more just because you have a pre-existing health condition, including HIV/AIDS. Once you have insurance, these plans cannot refuse to cover treatment for pre-existing conditions. The only exception is for an older plan that you bought yourself before 2010 – these plans, which are called "grandfathered" plans – do not have to cover pre-existing conditions. If you have a grandfathered plan, you can switch to a marketplace plan during open enrollment (November 1, 2016 to January 1, 2017) and get coverage that includes any pre-existing condition.
A note on limits: Under the ACA, insurance companies cannot set a lifetime or annual limit on what they spend on essential health benefits for your care during the entire time you are enrolled in that plan.
For a list of providers who specialize in care for individuals with HIV or AIDS, contact your local Ryan White HIV/AIDS program. The Ryan White HIV/AIDS program can help you get medical care and other services. And, depending on your state, you may qualify for additional financial help to pay your premiums or other out-of-pocket medical costs.
- Does the plan cover PrEP (Pre-Exposure Prophylaxis) drugs for HIV-negative individuals?
- Does the plan cover PEP (Post Exposure Prophylaxis) drugs for newly HIV infected individuals?
- What are the costs (such as co-insurance and co-pays) associated with PrEP? What drug "tier" is PrEP covered under?
- HIV/AIDS medication coverage: Coverage of specific medications is regulated state by state, and you should ask about the specific drugs covered in your state by brand name to assess if there will be a co-pay.
- Which HIV/AIDS drugs are/are not covered? How do I access my prescription drug formulary? What drug "tier" are my HIV/AIDS drugs covered under?
- What are the costs (such as coinsurance and copays) associated with the HIV/AIDS drugs that I need?
- What kind of testing is covered?
- Is blood testing, oral rapid testing, or an in-home rapid testing kit covered?
- What's the confidentiality of testing for young people on their parent's plan?
- What kind of long-term care coverage is part of the plan for people living with HIV or AIDS?