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A Guide to Health Coverage in New York

Winter 2006/2007

New York State offers a number of ways for people with HIV to get coverage for their medical expenses. You don't need private health insurance to get expert medical care and access to medications. If you don't know where to begin, find someone who does: talk to a local AIDS service organization, ask your case manager, or call the numbers below.

The following is a quick reference guide to available health care coverage options in New York State. It is not a comprehensive guide to all the eligibility requirements for all programs. For example, some programs calculate your income after subtracting your payments for health-related services and basic living expenses. If you think you might be eligible for one of these programs, contact the program directly for additional eligibility and coverage information.


Symbol Key
Primary Care Services
Primary Care Services
Prescription Drug Coverage
Prescription Drug Coverage
Inpatient Care
Inpatient Care
Home Health Care
Home Health Care
Medical Transportation
Medical Transportation
$$$$Over $200 per month
$$$$100 - $200 per month
$$Less than $100 per month
$Less than $50/month, co-payments of $1-$3

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Medicaid, 800-541-2831

Comprehensive health care coverage for people with limited assets and income who are U.S. citizens or qualified aliens. Can be working but must have a medical need. For a single person, income less than $8,304 per year and assets under $4,150.

Primary Care ServicesPrescription Drug CoverageInpatient CareHome Health CareMedical Transportation $


SNPs (Medicaid HIV Special Needs Plans), 800-541-2831

Special managed care health coverage for people with HIV/AIDS, providing enhanced coordination of quality health care through HIV specialty providers. Eligibility is the same as Medicaid. SNP's are available in the five boroughs of New York City. Some services like pharmacy benefits are covered with a regular Medicaid card when you are enrolled in a SNP.

Primary Care ServicesPrescription Drug CoverageInpatient CareHome Health CareMedical Transportation $


Medicare, 800-772-1213

Health care coverage for people over 65 or people who have been receiving Social Security disability payments for 24 months, need dialysis or have had a kidney transplant. U.S. citizens and documented immigrants only. Can work, no income or asset restrictions. (Limited home care benefit available for acute post-hospital health-related care)

Primary Care ServicesPrescription Drug CoverageInpatient CareHome Health Care $ - $$


Family Health Plus, 877-934-7587

Managed care health coverage for U.S. Citizens or documented aliens ages 19-64, There are no medical requirements. Individuals can be working, with income up to $9,800 for a single person, $13,200 for a married couple, $19,800 for a single parent and families of 3 or more up to $45,300, assets (depending on family size) less than $22,950.

Primary Care ServicesPrescription Drug CoverageInpatient Care $ - $$


Child Health Plus, 800-698-4543

Comprehensive managed care health coverage for children under 19. Must be a U.S. Citizen or qualified alien. There are no medical criteria. Household income dictates the family share of the premium cost. There are no asset limits.

Primary Care ServicesPrescription Drug CoverageInpatient Care $ - $$


Healthy New York, 866-432-5849

Streamlined managed care health coverage for people 18-65 who do not have Medicare. Must be a U.S. citizen or qualified alien and working at least part time or episodically. Income for a single person is up to $25,125 (add $8,250 for each additional family member), no asset limit. (Limited prescription benefit available: $3,000 per person per year)

Primary Care ServicesPrescription Drug CoverageInpatient Care $ - $$$


ADAP/ADAP Plus (HIV Uninsured Care Programs), 800-542-2437

Limited drug, primary care and home care coverage for New York State residents with HIV who are not eligible for Medicaid or have limited insurance coverage. Income eligibility: less than $44,000 for a single person, $59,200 for a family of two and $74,400 for a family of three or more. Assets must be less than $25,000. (Limited home care benefit -- $30,000 per person per lifetime)

Primary Care ServicesPrescription Drug CoverageInpatient CareHome Health Care FREE


AHIP (AIDS Health Insurance Program), 518-474-9193

Medicaid administered insurance premium payment assistance for people with AIDS or symptomatic HIV Illness. Must be U.S. citizen and can work at most part time. Income up to $18,130 for a single person. There are no asset restrictions.

Primary Care ServicesPrescription Drug CoverageInpatient CareHome Health Care FREE


APIC (ADAP Insurance Continuation Program), 800-542-2437

Insurance continuation program for people with HIV who need help paying for their insurance premiums. Eligibility criteria are the same as the ADAP / ADAP Plus HIV Uninsured Care Programs.

Primary Care ServicesPrescription Drug CoverageInpatient CareHome Health Care FREE


EPIC (Elderly Pharmaceutical Insurance Coverage), 800-332-3742

Prescription drug coverage for people over 65. Undocumented individuals are eligible. No medical eligibility criteria, income under $35,000 if single and $50,000 if married, there are no asset restrictions. Cost of coverage depends on income.

Prescription Drug Coverage $ - $$$


Prenatal Care Assistance Program, 800-522-5006

Comprehensive Health Care for pregnant women during their pregnancy and for two months after giving birth. Undocumented women are eligible; women can be working, net income up to $26,400 per year, no asset limit.

Primary Care ServicesPrescription Drug CoverageInpatient Care $


Private Insurance, State Insurance Department, 800-342-3736

Comprehensive private insurance coverage can be purchased by anyone with HIV (or any other medical condition) living in New York, regardless of their disease status (how sick they are) at the same price as anyone else. For people who have not had other insurance coverage in the 12 months before they buy the policy, the company can impose a "pre-existing condition" clause for up to twelve months -- this means that if you have HIV and buy a policy the insurance company does not have to cover any of your HIV care for up to 12 months. After that, the company must pay for all of your health care needs. If you are eligible and decide to buy a policy, APIC may be able to help pay the premiums.

Primary Care ServicesPrescription Drug CoverageInpatient CareHome Health Care $$$$




  
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This article was provided by AIDS Community Research Initiative of America. It is a part of the publication ACRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.
 
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