What is Health Care Reform?
President Obama signed the Patient Protection and Affordable Care Act – sometimes called ACA, “Obamacare,” or health care reform
– in March 2010. This law is designed to make it easier for everyone to access health care, including people with HIV. The law became effective January 1, 2014. It is important for you to know that even though your insurance may change, there is an abundance of assistance to pay for your care. In general, you can expect to have better coverage than you have had in the past.
|If you as an individual annually…||Earn less than $15,801 you qualify for Medicaid.||Earn between $16,394 and $47,520 you qualify for an Advanced Premium Tax Credit or Cost Share Reductions. Earn more than $47,521 you qualify for a State Marketplace Qualified Health Plan.|
|You may be eligible for…||Colorado Medicaid Program
Health First Colorado is a public health insurance for low-income Coloradans.
Connect for Health Colorado
is the only place to apply for financial assistance to help reduce your costs and get access to a statewide network of insurance providers.
|What will it cost?||You might have to pay a small co-payment to receive some services.||Many variables will contribute to cost.|
|To get started:||Call: 800-221-3943||Contact the AIDS Service Organization in your area for help enrolling.
Denver Metro: (303) 837-1501
Frequently Asked Questions for PLWHA who may need Supplemental Assistance
|What criteria is needed for eligibility?||How can this further complement care?|
|Colorado Indigent Care Program
|If not eligible for Colorado’s Medicaid Program or Child Health Plan Plus (CHP+) and do not have insurance||Discounted health care services at specific hospitals and clinics|
|Health Insurance Assistance Program
|Enrolled in insurance||Assistance paying for the cost of the premiums, co-pays and other out-of-pocket costs on qualifying health insurance plans|
|Supplemental Wrap-Around Assistance Program
|Enrolled in Medicaid||Pays the Medicaid co-pays for prescription drugs on the State Drug Assistance Program (SDAP) formulary|
|HIV Medication Assistance Program
|Uninsured||Provides SDAP formulary medications only that can be filled only at Denver Health ID pharmacy, University Hospital IDGP pharmacy, and Scales Pharmacy|
|State Pharmacy Assistance Programs (SPAP)**||On Medicare Part D Plan||Medicare assistance program called Bridging the Gap that pays for premiums, limited medical expenses and co-pays for SDAP formulary medications|
**Indicates program has income and residency criteria. Only those who are residents of Colorado and make less than 500% of the federal poverty level qualify for assistance through these programs.
Will I be able to still see my same medical provider?
This depends on the insurance you have:
- If you are eligible for Medicaid, it is likely that you will be able to continue to see your medical provider at a Ryan White clinic, such as Beacon Clinic, CHIP, Denver Health, MCPN, Peak Vista, Pueblo Community Health Center, St. Mary’s, and University Hospital. If you wish to change clinics, there may be more providers that accept Medicaid, and you would be free to use one of them. Check with your clinic to get more information.
- If you are not eligible for Medicaid, and instead enroll in a private health insurance plan through Connect for Health Colorado, you will need to make sure that the plan you choose is going to be accepted by your medical clinic and specialty providers, as well as whether or not it covers your medications. An insurance navigator at your local AIDS Service Organization will work with you to review the plans and determine which one may be right for you. Your local Colorado AIDS Project office will be able to enroll you in the Health Insurance Assistance Program and go over the rules you need to follow in order to get assistance.
What if I like things the way they are?
- Under the Ryan White law, if you are eligible for insurance (Medicaid, Medicare, Connect for Health, or through your employer), you must enroll in If you are already accessing your care through one of these insurers, the way you pay for your care will probably not change. You will have access to better and more comprehensive options than you have had in the past. Work with your Ryan White Case Manager to explore which supplemental assistance programs may still be able to offer support.