Back HIV Policy & Advocacy Obamacare Deadline Coming Up, Guide Offers Covered California Advice for HIV, HCV, PrEP

Obamacare Deadline Coming Up, Guide Offers Covered California Advice for HIV, HCV, PrEP


December 15 is the deadline to enroll in Affordable Care Act (ACA or "Obamacare") health plans for insurance coverage starting on January 1, 2015. Finding the right plan can be tricky for people with HIV or hepatitis C, and for those who want coverage for Truvada for pre-exposure prophylaxis (PrEP), but there are resources to help.

ACA insurance plans are arranged in tiers -- bronze, silver, gold, and platinum -- that provide different levels of coverage. Lower-tier plans have less expensive monthly premiums, but members must pay higher co-pays for doctor visits and other services. Basic prevention services, however, are free on all plans.

Plans also vary in terms of providers and drug formularies. Some plans have more specialists dealing with HIV and hepatitis C in their provider networks. Many plans put HIV and hepatitis C drugs in a "specialty" tier that requires higher co-pays or prior authorization. It is important to check whether a specific plan includes your providers and covers the drugs you need.

The website for the national ACA exchange is at Some states have also set up their own marketplaces, which can be found at Many people are eligible for federal subsidies to help pay their premiums. 

About half of the states have expanded their Medicaid programs under the ACA to include more people, with a higher income threshold (usually up to 138% of the federal poverty level). Young people can now stay on their parents' insurance plans until age 26, and Medicare eligibility typically starts at age 65. has put together some helpful ACA advice and resources for people with HIV and hepatitis C. Some states, AIDS service organizations, and other non-profits have counselors or "navigators" who can provide individualized assistance in choosing a suitable plan.

Several organizations including the San Francisco AIDS Foundation (SFAF), APLA Health & Wellness,and Project Inform have prepared a guide to help California residents find appropriate plans through Covered California that include coverage for HIV, HCV, or PrEP.

The guide, available free online at, explains important considerations for choosing a plan and describes resources that may be available to help pay for health insurance. An accompanying guide to Covered California's 2015 drug formularies, available at,details the cost of specific drugs on each of the 10 plans and whether prior authorization is required.

Among the guide's recommendations, according to a recent press release:

  • 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.
  • HIV negative people with an annual income between $11,670 and $29,175 may qualify for cost-sharing subsidies and can reduce their out-of-pocket costs by choosing a Silver plan.
  • People 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 SFAF's director of state and local affairs Courtney Mulhern-Pearson. "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."

While open enrollment will continue through February 15, 2015, people who want coverage starting on January 1 will need to enroll by December 15 and pay their first premium payment by the due date. Outside of open enrollment, people can only sign up after a "qualifying life event" such as loss of a job, marriage (including same-sex partners), divorce, or birth of a child.



B Ryan. Obamacare's Open Enrollment Period Starts November 15. and November 1, 2015.

San Francisco AIDS Foundation. New Guide Helps Californians Navigate Health Insurance Coverage for PrEP, HIV, and HCV Drugs. Press release. December 8, 2014.

Project Inform. New Guide for choosing a health plan through Covered California is now available.