6 Ways Health Insurance Coverage for HIV Patients Has Improved with ACA

The Affordable Care Act was designed to ensure that all Americans have access to affordable health insurance coverage. The act passed in 2010 has helped millions of Americans get affordable insurance coverage, including HIV patients.

In addition to that, a majority of these people are vulnerable Americans who are either unemployed, working low-paid jobs and in some cases, with chronic diseases.

The act has also gone a long way in ensuring that HIV-positive patients have better and wider access to health insurance policies.

It does this through some ways;

1. Coverage For Pre-existing Conditions

Previously, insurers could deny Americans insurance cover if the individual to be insured had a pre-existing health condition. Asthma, Cancer, and HIV are good examples of pre-existing conditions.

Pre-existing Health Condition

The Act prohibits health insurers from canceling or rescinding coverage by clients making mistakes on their applications. There is also a prohibition on insurance companies from imposing lifetime caps on insurance benefits.

HIV patients benefit from these changes because they are now able to get health insurance coverage much more easily, without fear of being dropped from coverage and even without fear that their coverage will be rescinded/denied.

2. Affordable Coverage

HIV patients also get to benefit from the affordable coverage accorded by the Act. Affordability of coverage enhances through the Health Insurance Marketplaces that the act has created in every state.

These marketplaces help people compare the different health plans available and even identify the possible savings they are bound to benefit from.

HIV patients with low and middle incomes can get financial assistance from the act through tax credits that effectively lower their monthly premium costs and even their out-of-pocket costs. However, the tax credits are dependent on the size of a household and the income it gets.

HIV patients who also have children may apply for the Medicaid and Children Health Insurance Program (CHIP). These provide low-cost and sometimes even free healthcare coverage to successful applicants.

3. Prescription Drugs At A Lower Cost For Medicare Recipients

In the past, there were situations where HIV patients could not afford the prescription drugs they require.

The Affordable Care Act attempts to close the Medicare Prescription drug plan coverage gap (the gap is also known as the ‘donut hole’). This gap essentially means that the drug plan only covers drugs up to a certain limit after which the patient is required to pay higher prices for the prescription drugs.

HIV patients who are also Medicare recipients can now afford their medication much better. Based on the act’s provisions, once beneficiaries of Medicare get into the ‘donut hole’ they will receive 50% discount on all drugs provided they are covered brands.

The act now considers the AIDS Drug Assistance Program (ADAP) as a contribution towards Medicare Part D’s True Out of Pocket Spending Limit. Subsequently, HIV patients under the ADAP can now get out of the ‘donut hole’ much faster.

Prescription Drugs At A Lower Cost

4. Medicaid Eligibility Broadened

Previously, single adults without children were not eligible to receive Medicaid. With the Affordable Care Act, however, States, through an entirely federally funded program, can expand the eligibility criteria of Medicaid to include single adults as well as persons with incomes that are below 138% of the Federal poverty line.

Research has shown that Medicaid is one of the largest payers of HIV care in the United States. It is also a well-known fact that many gay, bisexual, single guys and men who have sex with men are affected more by HIV. The inclusion of childless single males, therefore, ensures that these high-risk groups are eligible for health insurance coverage.

HIV-positive patients that meet the income threshold and live in states that opt for Medicaid expansion do not have to wait for an AIDS diagnosis to qualify for Medicaid. They are therefore able to get life-extending care and treatment in real time

5. Providing Quality Coverage

Apart from making health care and health insurance affordable, the Affordable Care Act has also ensured that people get access to even better quality coverage and care. There are some ways through which it has done this;

  • The Act provides a list of essential health benefits that insurers in and out the Health Insurance Marketplace must offer. HIV patients benefit from hospital inpatient care, prescription drug services, lab tests as well as mental health; all of which are important to HIV patients.
  • Coordinated care through patient-centered medical homes is yet another benefit for those with HIV/AIDS. One such program is the Ryan White HIV/AIDS Program which is a pioneer of such care.
  • Health insurance providers are necessitated to offer preventive services such as HIV testing for everyone between 15 and 65 as well as other high-risk ages. Through these tests, more people will know their status and subsequently seek care and treatment.

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