One Last Push: What you must know before March 31 if you are HIV+

Time is ticking. You and your loved ones only have until March 31st to apply for health insurance. Don’t delay.

Under the Affordable Care Act (or ACA), the Health Insurance Marketplace ensures that no application for health insurance is rejected due to preexisting medical conditions, such as HIV, which disproportionately affects communities of color and older people. Did You Know? Research projects that within the next few years, one in two people with HIV in this country will be age 50 or older. One in Two!

The Diverse Elders Coalition (DEC) knows that understanding the Health Insurance Marketplace can feel a lot like piecing together a puzzle.  With only days left to apply for insurance, it can be especially overwhelming—and there is no time to waste.

This is why we are bringing all the necessary information to you, centralized in one place. If you are (or someone you know is) an older adult, living with HIV/AIDS, needs insurance or just have some last minute questions about the health insurance marketplace, let us help you.

Take a look below and open up the section that is most relevant to you.

I don’t have insurance
If you are an older person living with HIV, The ACA is a big help. Because of the ACA, health insurance is easier to get and can be more affordable.

All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These benefits include areas of significant importance to HIV+ people such as prescription drugs, lab services and chronic disease management. Without the ACA, private insurance options have varied widely from limited or no coverage in some states to very expensive comprehensive coverage in other states. For example, prior to this year’s implementation of the Health Insurance Marketplace, New York had no exclusions for pre-existing conditions such as cancer, diabetes, heart disease or being HIV+, however individual HMO coverage with a major insurer cost $1,409 per month in 2013. This price point was extremely unaffordable for many HIV+ older adults. When the ACA was implemented in January 2014, “gold” level coverage from the same insurer cost $688 per month. That’s $721 less a month or $8,652 more a year in an HIV+ older person’s pocket. Based on income levels, there is also the opportunity to qualify for an Advanced Premium Tax Credit to further decrease the cost of health insurance. For HIV+ older people, the Health Insurance Marketplace is yet another major benefit of the Affordable Care Act.

Learn more on why the ACA is a big help to HIV+ older adults

Apply for health insurance. Download our flyer, Why the ACA Matters to Our Communities, which offers step-by-step instructions for enrolling in the Marketplace (also available in Chinese ∣ Vietnamese ∣ Korean ∣ Spanish)

I have Medicaid
If you are currently covered under Medicaid, there is nothing you need to do. If you are unsure if you are eligible for Medicaid, click this link to see if you qualify.

Medicaid serves as the single largest payer of long-term care in the United States, which is often necessary for older adults and people with disabilities who rely on institutional or in-home health services. Medicaid is also the largest source of funding for medical and health-related services for people with low income in the country, including many older adults with HIV. Additionally, many people with HIV qualify as disabled if their condition has progressed and they have been diagnosed with AIDS.

If you don’t qualify, visit www.healthcare.gov and check your options for buying health insurance.

Need help applying? Download our flyer, Why the ACA Matters to Our Communities, which offers step-by-step instructions for enrolling in the Marketplace (also available in Chinese ∣ Vietnamese ∣ Korean ∣ Spanish)

My job gives me insurance
If you currently have insurance through your employer or that of your spouse or a family member, there is nothing you need to do.

However, if you feel that you can find a cheaper plan through the Health Insurance Marketplace or know that circumstances at work will change, visit www.healthcare.gov and check your options for buying health insurance.

Need help applying? Download our flyer, Why the ACA Matters to Our Communities, which offers step-by-step instructions for enrolling in the Marketplace (also available in Chinese ∣ Vietnamese ∣ Korean ∣ Spanish)

I’m 65 or older and have Medicare
Medicare is critically important to the health and economic well-being of diverse older adults. Among those over age 55, 46 percent of Latinos are covered by Medicare, 43 percent of Asians, and 52 percent of African Americans.

If you are already on Medicare, the Marketplace does not affect you. However, the ACA has provisions that have improved the benefits older people 65+ get through Medicare, including lower-cost prescription drugs and free preventive services.

Unfortunately, you’ll have to wait a while for the next Medicare open enrollment. It will run from October 15-December 7, 2014.

I get support from the Ryan White HIV/AIDS Program
If you don’t currently have insurance (such as through an employer, Medicare or Medicaid), but currently receive support from the Ryan White HIV/AIDS Program and the AIDS Drug Assistance Program (ADAP) for your HIV care and treatment needs, you’ll need to buy health insurance.

It’s important to note that some states have expanded Medicaid, meaning if you weren’t eligible before, you may now be. Click this link to see if you qualify.

If you don’t qualify for Medicaid, visit www.healthcare.gov and check your options for buying health insurance.

Need help applying? Download our flyer, Why the ACA Matters to Our Communities, which offers step-by-step instructions for enrolling in the Marketplace (also available in Chinese ∣ Vietnamese ∣ Korean ∣ Spanish)

I am an immigrant living with HIV
If you are an immigrant living with HIV, how the Marketplace will impact you depends on your immigration status.

For the 10 million non-citizens living in the United States legally, they are expected to gain health insurance through the Health Insurance Marketplace. This means that even for an older person 65+ who has not met the work requirements to qualify for Medicare, they will be able to shop for insurance in the Marketplace.

Unfortunately, the estimated 11 million undocumented immigrants living in the United States are not eligible to buy health insurance in the Marketplace.  For this reason, undocumented immigrants are not subject to the mandate that nearly all residents carry insurance or pay a financial penalty. Those undocumented immigrants who need health care have the option of using the nation’s 8,500 community health centers (they do not ask about immigration status) or visit a hospital’s emergency room.

It’s important to note that Ryan White services and medications are free for those with an income under $44,680, regardless of immigration status.

I need more time. Can I apply for health insurance after March 31?
An important note from the Centers for Medicare and Medicaid (CMS):

The deadline for open enrollment is March 31st.    As the Administration said previously, those consumers who are in line by the March 31st deadline to complete enrollment, we will make sure you get covered.  Just like Election Day, if you are in line when the polls close, you get to vote.  We won’t close the door on those who tried to get covered and were unable to do so through no fault of their own.  So, those who were in line or had technical problems with the website can quickly come back and sign up as soon as possible.

Additionally, CMS also is clarifying that under limited circumstances, people with complex cases may qualify for a special enrollment period.  These include, for example, victims of domestic abuse and consumers who were found ineligible for Medicaid, but whose accounts were not transferred to the Marketplace in a timely way before March 31.  These special cases are for specific situations where a consumer was not able to successfully complete enrollment during the open enrollment period despite their efforts to do so and through no fault of their own.

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