New Guide Helps Californians Navigate Health Insurance Coverage for PrEP, HIV, and HCV Drugs


Coverage Varies Under Ten Covered California Plans

SAN FRANCISCO, December 8, 2014—A new guide to health insurance plans available through the Covered California marketplace helps individuals considering pre-exposure prophylaxis (PrEP) and people living with HIV and/or hepatitis C (HCV) select the plan that best suits their needs. San Francisco AIDS Foundation (SFAF) developed the guide in collaboration with AIDS Services Foundation Orange County, APLA Health & Wellness, CNE Media, Los Angeles LGBT Center, Project Inform, Public Law Center, San Luis Obispo County AIDS Support Network, and The Thrive Tribe Foundation.

“If you are living with HIV or HCV, or considering PrEP, it is extremely important to understand all the options before choosing a health insurance plan through Covered California,” said Neil Giuliano, San Francisco AIDS Foundation CEO. “We’re excited about this guide, which will help people find a plan that best meets their individual health needs and budget.” 

The guide contains two parts. The first part explains important considerations for choosing a plan and describes resources that may be available to help pay for the cost of health insurance. The second part details the relative cost of specific drugs on each of the ten plans and whether or not prior authorization is required.

Among the guide’s recommendations:

  • Low-premium plans might end up costing more in out-of-pocket costs than plans with higher premiums. People with chronic conditions and with routine medication needs, including PrEP, should avoid Bronze and Minimum Coverage plans.
  • Individuals not living with HIV with an annual income between $11,607 and $29,175 may qualify for cost-sharing subsidies and can reduce their out-of-pocket costs by choosing a Silver plan.
  • Individuals living with HIV may qualify for additional financial assistance through the OA-HIPP Program and can reduce their out-of-pocket costs by choosing a Platinum plan.

“Health care reform has helped thousands of people in the Bay Area and across California access care, but the multitude of options and complexity of costs can make it challenging to select a program with a specific budget in mind,” said Courtney Mulhern-Pearson, the foundation’s director of state and local affairs. “This tool makes it easier for people to compare Covered California plans  based on their own care needs, during the most critical time of year—open enrollment.”

The release of the guide coincides with the open enrollment period for Covered California, which began November 15, 2014 and ends February 15, 2015. Individuals who want coverage starting January 1, 2015 need to enroll by December 15, 2014 and pay their first premium payment by the due date. After open enrollment, individuals can only enroll following a "qualifying life event" such as loss of a job, birth of a child, divorce, or loss of insurance. Individuals who choose not to enroll and who aren’t otherwise covered may be required to pay a tax penalty.

Because plans can change at any time, the foundation recommends individuals looking for a plan consult a Covered California certified enrollment counselor or certified insurance agent who understands their individual health care needs before enrolling in a plan.

The guide is available at http://bit.ly/CoveredCaliforniaGuide and http://bit.ly/CoveredCaliforniaFormularies.

About San Francisco AIDS Foundation
No city experienced epidemic levels of HIV faster than San Francisco. At San Francisco AIDS Foundation, we work to end the epidemic where it first took hold, and eventually everywhere. Established in 1982, our mission is the radical reduction of new infections in San Francisco. Through education, advocacy, and direct services for prevention and care, we are confronting HIV in communities most vulnerable to the disease. We refuse to accept that HIV transmission is inevitable. More information about the foundation is available at http://www.sfaf.org.

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