From Coverage to Care to an AIDS-Free Generation

Content From: Dr. Cara James, Ph.D., Director, Office of Minority Health at the Centers for Medicare and Medicaid ServicesPublished: December 05, 20144 min read



Editors Note: Open Enrollment for coverage through the Marketplace is NOW until February 15th, 2015. Today, we share a guest post from Dr. Cara James, Director, Office of Minority Health, Centers for Medicare and Medicaid Services (CMS), on the importance of coverage and things to know about the Marketplace for those living with HIV/AIDS.If you live with HIV or AIDS or you know someone who does, you know how important it is to stay healthy. As we work together toward a healthy, AIDS-free generation, World AIDS Day is a great time to highlight some recent changes to health insurance and new opportunities for persons living with HIV/AIDS to get covered, get care, and stay healthy. Coverage is more affordable and complete because of benefits such as:

  • You cannot be denied coverage or discriminated against based on your HIV status in most plans, and all plans sold through the Marketplace;
  • You have coverage for a basic set of health services under most plans in the individual and small group market;
  • States expanding Medicaid can improve your coverage options; and
  • New financial assistance through the Marketplace can make coverage affordable.

Open Enrollment for coverage through the Marketplace is from NOW until February 15th, 2015, so now is the time to enroll in coverage. Work with someone you trust, or explore’s plan-finder tool on your own to find coverage that’s right for you. You can use the resources including Step 2 of the From Coverage to Care Roadmap at the end of this post to help you learn about your options and pick the plan that’s right for you.

Here are five things to think about when shopping for coverage that are specific to consumers with HIV and AIDS. We’ve also linked to resources below to help you and others living with HIV/AIDS understand and use your coverage to live longer, healthier lives.

5 Things to Know About the Marketplace for People Living with HIV/AIDS
  1. You may be eligible for financial assistance. Most people who are currently uninsured qualify for financial assistance to make coverage affordable. You may be able to get financial help even if you’re earning as much as $46,680 a year as an individual or $95,400 as a family of 4 (income levels are slightly higher in Alaska and Hawaii). Fill out a Marketplace application by starting at to determine your eligibility.
  2. Find a plan that works with your ADAP. Talk with an enrollment assister or outreach worker about which Marketplace plans work with your AIDS Drug Assistance Program (ADAP) or Ryan White HIV/AIDS Program if you have one. ADAPs may only work with certain plans, so you will want to pick one of those plans to get any additional premium tax credits and cost-sharing reductions you may be eligible for.
  3. Choose the right provider. If you have a provider you trust and want to keep working with, talk with your provider or outreach worker about how check if your provider is in a plan’s network. If you need a new provider and have a plan in mind, ask for help finding a provider in that plan’s provider network who you will be comfortable working with.
  4. Getting covered is the first step. Read and use the From Coverage to Care materials including the “Roadmap to Better Care and a Healthier You” booklet for a step-by-step guide on how to use your coverage.
  5. The individual shared responsibility payment may affect you. Even if you get assistance from a Ryan White HIV/AIDS program or ADAP, you still should enroll in coverage. The Ryan White HIV/AIDS Program and ADAP assistance do not meet the requirement to maintain minimum essential coverage, so you still need to enroll in a plan or other minimum essential coverage (like Medicare or Medicaid, if you’re eligible), apply for an exemption (, or make an individual responsibility payment.

This World AIDS Day, get covered and know how to use your coverage. Check out the resources below and partner with the CMS Office of Minority Health in our commitment to an AIDS-free generation ahead.

Resources for PLWHA – Enrolling and Using Your Coverage

Find Local Help ( lets you enter your ZIP Code to find in-person help in your area for applying for and enrolling in coverage through the Marketplace.Compare Marketplace Plans ( lets you enter your ZIP Code and answer a few simple questions to browse your coverage options for Marketplace plans.

From Coverage to Care Resources . Print, order, download and share resources including videos to help you understand and use your coverage to get the care you need.

Target Center Consumer Tools ( Disclaimer). The Target Center also hosts enrollment assister tools, provider tools, community tools, and more, for different audiences working with Ryan White Programs and ADAPs.