Cost of HIV Treatment

Understanding your health insurance options is key to maintaining good health.

Will My Health Insurance Cover My HIV Treatments?

There is no simple answer to this question. Getting health insurance to help pay for HIV care and treatment can be a challenge for some people living with HIV.

If you are already covered by a private group health insurance plan, such as insurance you have through your employer or a private individual plan, it will typically cover your HIV care, just as it covers care for other medical conditions. Most group health plans require that you pay a portion of your medical costs through:

• Regular payments (sometimes called “premiums”), which are usually subtracted from your paychecks, and/or
• Co-pays, payments made at the time you receive health care services or medications.

If you are covered by a private health insurance policy, review your policy to find out what HIV care and treatment your insurance provider covers. If your policy does not cover portions of your HIV care, some government and private programs may be able to help pay for or provide these services.

What If I Don’t Have Health Insurance?

A number of programs may help pay for your care and treatment if you do not have health insurance or if your health insurance doesn’t cover the care you need. A social worker or your case manager can help you determine if you are eligible and apply for these programs.

These programs include:

• Ryan White HIV/AIDS Program: The Ryan White HIV/AIDS Program provides HIV-related services (like medical care and medications) in the United States for people who do not have enough health care coverage or financial resources to pay for care. The program fills gaps in care not met by other payers. Persons need to meet certain eligibility requirements to access this program. You can call your State HIV/AIDS Hotline and ask them to refer you to the nearest Ryan White provider, or talk to your social worker or case manager to find out more.
• Medicaid: The federal-state health insurance program pays for medical care for people with low incomes, older people, and people with disabilities. States manage the Medicaid program, and each state decides who is eligible and what the program covers. Medicaid is currently the biggest source of insurance coverage for people living with HIV. The Affordable Care Act (ACA) expands Medicaid so that, in participating states, more people with HIV who did not qualify in the past can get coverage.
• Medicare: The federal health insurance program is for people who are 65 and older or are disabled. All Medicare drug plans cover all HIV medications.

Ask for help. Working with your social worker, case manager, or patient navigator will help you get the care, treatment, and support you need.

How Will The Affordable Care Act Help Me Get Coverage For Or Pay For HIV Care And Treatment?

The Affordable Care Act (ACA) is a law that was passed to help ensure that Americans have secure, stable, and affordable health insurance. The ACA created several changes that expand access to coverage for people living with HIV. Because coverage varies by state, talk to your health care provider or social worker to get information about the coverage available where you live. CDC has information about the ACA and living with HIV. You can find additional information about the ACA and living with HIV from the Henry J. Kaiser Family Foundation. You can also contact the ACA helpline at 1-800-318-2596 for more information.

Can I Get Care And Treatment From A Government Community Health Center?

More than 8,000 Community Health Centers are operated by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA). They help more than 20 million people with limited access to health care. HRSA Community Health Centers provide HIV testing and some offer other services to people with HIV, including medical care. Fees are based on a person’s ability to pay. Some patients receive care services at the center itself, while others are referred to an HIV specialist if the Community Health Center does not provide HIV care. Talk to your case manager or social worker for more information on Community Health Centers and whether you are eligible to receive HIV care and treatment from a center near you.

Use the HRSA Health Center Locator to find a Community Health Center near you.

Paying for your HIV medication can be a challenge. Fortunately, there are government and private programs that can help pay for medication if you are eligible. Some of these programs include:

• Ryan White AIDS Drug Assistance Program: The Ryan White AIDS Drug Assistance Program (ADAP) provides HIV- and AIDS-related prescription drugs to uninsured and underinsured individuals living with HIV and AIDS. ADAP funds are used by states to provide medications to treat HIV, or to prevent the serious deterioration of health, including measures for the prevention and treatment of opportunistic infections. As a payer of last resort, ADAP only helps individuals who have neither public nor private insurance or cannot get all of their medication needs met through their insurance payer. The medication provided by this drug program varies by state. Call your state’s HIV and AIDS hotline to ask about the ADAP program in your state or speak to your case manager or social worker.
• Medicare Prescription Drug Coverage Plans: Medicare Prescription Drug Coverage Plans are required to provide coverage for common medications that people living with HIV use. Talk to your case manager or social worker to learn more about these plans.
• Private Prescription Assistance Programs: Some major drug companies offer patient co-pay savings programs to people living with HIV. In addition, other assistance is available to help qualifying patients with no prescription coverage to obtain free medication. These programs can help you get the medicines you need at low or no cost. Ask your medical provider, case manager, or social worker for more information.

Your case manager, social worker, or patient navigator can help you determine your eligibility and help you apply for these types of assistance. They can also help identify other assistance programs available in your community.