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How does the Affordable Care Act impact persons with HIV/AIDS?

Q: How does the Affordable Care Act impact persons with HIV/AIDS?

A: Persons with HIV/AIDS have long been unable to purchase health insurance on the individual market due to their chronic condition. The Affordable Care Act creates many new opportunities for persons afflicted with HIV/AIDS. No longer having to worry about their pre-existing condition is but one example.

As of November 2011, fewer than one in seven (13 percent) people living with HIV had private insurance and nearly 24 percent had no coverage at all. The remainder of persons dealing with HIV/AIDS were covered by government programs including Medicaid, Medicare, or the Ryan White HIV/AIDS Program, which provides HIV-related services.

For those who have been locked out of the insurance market because of their health status, including those living with HIV/AIDS, the ACA created the Pre-Existing Condition Insurance Plan. More than 90,000 people – some of whom live with HIV or AIDS – enrolled in this program as a bridge to 2014 when insurers can no longer underwrite based on pre-existing conditions.

Prescription drug coverage

The Affordable Care Act also closes, over time, the Medicare Part D prescription drug benefit “donut hole,” giving Medicare enrollees living with HIV and AIDS the peace of mind that they will be better able to afford their medications. Beneficiaries receive a 50 percent discount on covered brand-name drugs while they are in the “donut hole,” a considerable savings for people taking costly HIV/AIDS drugs. And, in future years, they can expect more savings on prescription drugs while in the coverage gap until it is closed in 2020.

Also as a result of the ACA, AIDS Drug Assistance Program (ADAP) benefits are now considered as contributions toward Medicare Part D’s True-Out-of-Pocket Spending Limit (“TrOOP”).

Also very importantly, in November 2012, the Obama administration announced that HIV/AIDS will be one of the chronic conditions eligible for enhanced federal reimbursements through Medicaid. The announcement means people living with HIV/AIDS can continue to rely on expert care from HIV specialists who, in turn, will receive enhanced reimbursements for providing chronic condition care.

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