EDITOR'S NOTE: Open enrollment for Covered California closes on Tuesday, January 31, 2017. Click here to check out a guide to choosing a health plan for people with HIV and/or viral hepatitis and those seeking PrEP.
Covered California is our state’s health insurance marketplace created by the Affordable Care Act. Although some people have expressed concerns about the future of the Affordable Care Act under the new President elect, Covered California has issued a statement to reassure customers that plans purchased for 2017 are not in jeopardy.
“We understand there may be a lot of chatter in the media about the election, but here are three things you need to know: Your coverage will remain intact for 2017 and the foreseeable future; your financial assistance are protected under the law; and, the rates for 2017 will not change,” the statement read.
What it is: Covered California is the place where Californians can get health insurance under the Patient Protection and Affordable Care Act. Covered California health insurance plans cover services like prescription drugs, doctors’ visits, hospitalizations, labs, and mental health and substance use services.
Who it’s for: Covered California health insurance is for people who live in California who don’t already have insurance from their job, or aren’t eligible for Medicare or Medi-Cal. Many times, people who sign up for Covered California plans are people who work independently—maybe they’re a musician or are involved in theater. Or they work different part-time jobs at many different places—none of which are a steady employer who provides health insurance.
Why you might want to sign up for a plan: If you don’t have affordable insurance provided by your employer, and don’t have Medicare, signing up for a Covered California plan will give you the minimum essential coverage to avoid the tax penalty (which is 2.5% of your adjusted gross income).
When you can sign up for a plan: Open enrollment is from November 1, 2016 to January 31, 2017. During this period, you can sign up for a new plan or make changes to an existing plan. If you miss the open enrollment period, you’ll have to wait until next year’s enrollment period to sign up for coverage or make changes to your plan. Only a very limited of “qualifying” life events—like a marriage or divorce, or the birth of a child—will allow you to make changes mid-cycle.
How to know what level of coverage to choose: The Covered California coverage tiers range from bronze (lowest level of coverage) to platinum (highest level of coverage). You can compare different types of plans on the Covered California website. Generally, people living with HIV or people at risk for HIV who access PrEP are going to use the health system more, and will benefit from higher-tiers plans (i.e., not bronze-level plans).
For more information on Covered California and PrEP, click here (PDF).
Other things you need to know: This is the time to sign up! Don’t wait if you need health insurance to find out more. We’re not salespeople and we don’t make a commission from signing people up for plans. We just want our clients to be able to access the kinds of care they need, with the best insurance coverage they can get.
You might have heard that Covered California premium prices are going up this year. That’s true, but because the financial aid tax credit is based on a percentage of your income, you’ll also receive more of the tax credit.
Who you can ask for help: If you live in San Francisco, and are living with HIV, you may contact HIV Insurance and Benefits Navigator Star Morris at email@example.com or by calling 415.487.3047. Star can help you pick and sign up for a plan. The organization Out2Enroll also connects LGBT people and allies to health insurance under the Affordable Care Act. You can find additional information on the Covered California website.
ADAP (AIDS Drug Assistance Program)
What it is: ADAP is a program that helps low-income people living with HIV. People who qualify for Medi-Cal are not eligible for ADAP. People who make more than 500% of the Federal Poverty Level ($59,400 per year for a household of one) are not eligible.
Who it’s for: ADAP is for people who are living with HIV and on a limited income. To qualify for ADAP, you must be a resident of California, living with HIV, and 18 years of age or older.
When to sign up for coverage: Anytime—there is no open enrollment period. However, if you also are on OA-HIPP (see next section), you must sign up for ADAP within 48 hours of picking a Covered California plan, add “ for payment by January 1. You can enroll in OA-HIPP at any time. We recommend seeing an ADAP enrollment worker who is also a Covered California certified enrollment counselor.
How to sign up for coverage: You must apply for ADAP at an authorized enrollment site. To find an enrollment site, call A. J. Boggs client service at 844.550.3944. If you live in the San Francisco Bay Area, you can contact Star Morris, the HIV Insurance and Benefits Navigator, at firstname.lastname@example.org or 415.487.304 for an appointment. Star can help eligible people sign up for ADAP, OA-HIPP, and/or Covered California plans. You can also contact our Benefits Counselor Ellen Novogrodsky at 415.487.8023, email@example.com for benefits counseling, ADAP and OA-HIPP enrollment and to answer any questions regarding eligibility for benefits programs.
At your enrollment visit, you’ll need to bring the following types of documents:
Proof of identity
Proof of residence
Proof of HIV status with viral load and CD4 count
Proof of income with recent pay stubs
Proof of health coverage
Who you can ask for help: Call A.J. Boggs client service at 844.550.3944 for further information.
Other things to know: If you qualify for ADAP coverage, you’ll need to pick up your HIV medications at a participating ADAP pharmacy. (There are more than 6,000 ADAP pharmacies in California.)
You ADAP plan will renew every year on your birthday. Make sure to pay attention to your mail about a month before your birthday each year—you’ll be sent a form that will ask you to renew your plan. When you renew, you’ll need to answer some questions about your life, and you’ll also need to have your labs done that show your viral load. This is because they keep track of everyone in ADAP to make sure their medications are working.
Between birthdays, mid-year, you’ll be asked to fill out what’s called a self-verification form. This form will ask you if anything—like your address or your income—has changed. You can fill it out yourself, or you can take it to your ADAP enrollment worker who can help you fill it out.
OA-HIPP (Health Insurance Premium Payment) Program
What it is: OA-HIPP, like ADAP, is a program of the California Department of Public Health. This program helps people pay for monthly health insurance premiums—including those for COBRA, Covered California, and private insurance plans. In order to be eligible for OA-HIPP you must meet the requirements of and be enrolled in the ADAP Program.
Who it’s for: OA-HIPP is for people in the ADAP program. People on Medicare or full-scope Medi-Cal or Medi-Cal expansion are not eligible for OA-HIPP.
When to sign up for coverage: Sign up at the same time that you sign up for ADAP.
How to sign up for coverage: Sign up with your ADAP enrollment counselor (see section above). You can sign up at the same time that you sign up for ADAP. If you’re also signing up for a Covered California plan, sign up for ADAP and OA-HIPP within 48 hours of picking a Covered California plan add for faster processing. You can sign up for OA-HIPP at any time.
Other things to know: OA-HIPP clients will need to re-certify and re-enroll in OA-HIPP at the same time that they re-certify and re-enroll in ADAP. This will be before your birthday month every year, and then six months later. If you are enrolling in Covered California the State of California requires that you request the full tax subsidy that you are eligible for. Find additional information about OA-HIPP at the Office of AIDS website.
If you have any questions about enrolling in a program, or would like to know more about what you may be eligible for, please contact our Benefits Counselor Ellen Novogrodsky at 415.487.8023 or firstname.lastname@example.org.
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