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HIV & the A.C.A.
Oct 2, 2013

I get my medical bills paid for by Charity Care for the Hospital I go to (St. Mary's, Passaic, NJ) and my meds by P.A.A.D. How will the A.C.A. affect the coverage I have. I grow less than 16k per year, and am 58 years old. Will I have to join or buy into insurance exchanges? Will my prescriptions still be covered without a deductible by me?

Response from Mr. Chambers

Your question is perfectly timed as the enrollment into ACA (Affordable Care Act aka Obamacare) just opened. There has been a lot of concern about how Ryan White funded plans are going to coordinate with the new law.

To answer your questions, I am assuming that the Charity Care you receive is for basic HIV care. You should ask them to be sure, but I doubt if that counts as a qualified health insurance plan that you will need to have to avoid a tax penalty next year. If that is the case you will need to enroll in a health plan.

Based on your income, you will either be eligible for Medicaid or, more likely, you will need to purchase a health plan from the Health Exchange.

At your income level, the federal government will pay a large portion of your premiums. Also New Jersey has a Health Insurance Continuation Program (HICP) through their state office of AIDS, which will probably pay your portion of any premiums.

Your health exchange is located here. Just enter your state and it will show you plans, what your costs would be based on your income.

I'm sorry I can't be more definite about this, but since federal Ryan White funds for HIV care is administered by the states, there may be slight differences in the programs by state. I encourage you to contact a local AIDS Service Organization in your area. Someone there should be able to give you more specific information.

Regarding medications, when you say P.A.A.D. I wonder if you mean the AIDS Drug Distribution Program (A.D.D.P.) That is the program in New Jersey that pays for HIV medications. That program will continue.

When you purchase a health insurance plan under ACA, the ADDP program will pay what the insurance does not pay for medications that are on the ADDP formulary, so, no, you will not have a deductible for the medications you get through ADDP. If I am mistaken about the program, please write back.

To summarize, check your health exchange and see what you are eligible for based on your income. Contact a local AIDS Service Organization to see how the programs that are unique to PLWHA in New Jersey will help you with ACA coverage.

This is a whole new era for health insurance in this country so please be patient. There will be glitches and bumps in the initial process, but millions more are going to have access to quality health care with this health insurance. Good luck, Jacques located here.

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