How to Pay for HIV Care in California

Prefer to watch? Below is the full interview with special guest Ernesto Ayala that served as the original inspiration for this article.

Access and adherence to medication also known as antiretroviral therapy (ART) for HIV/AIDS has allowed for people diagnosed to obtain undetectable viral loads, stay healthy, and live long fulfilling lives. Sadly, there are still many who are unable to access life-saving medical care and medication due to potential cost, fear, and potential lack of education or awareness around access.

In the United States, Health Care Providers can be very expensive. When contemplating the cost of a treatment plan and treatment services, most individuals will turn to their insurance provider. If you have insurance, it’s a great option for staying current with your health care provider. But sometimes insurance doesn’t cover all types of medical interventions.

It’s for this reason that we’ve compiled a list of important resources you can use to pay for the various types of care you might need if you are living with HIV/AIDS.

Medical care (Medical Appts)

If you have insurance through an employer or purchase insurance on your own:

Health Insurance Premium Payment

Obtaining insurance on your own– If you’re eligible for insurance and make above the federal poverty level you can apply for Obama Care/Covered California and obtain an HMO or PPO insurance. If you make under $64,400 as a single you qualify for OA-HIPP through ADAP (AIDS Drug Assistance Program) which can assist with monthly premiums.
Obtaining insurance through your employer- If you make under $64,400 as a single you qualify for EB-HIPP through ADAP which can assist with monthly premiums.
- Your employer is not required to know your status. Your portion of the insurance premium payments are sent directly to the employer on a monthly basis.

To find an agency that helps with ADAP enrollment Visit Arcgis.com.
To obtain additional information about ADAP visit the California Department of Health here.

State and federally funded medical insurance programs:

Medi-Cal (California)

Making under the federal poverty level- you qualify for Medi-Cal insurance and all medical appts, specialists, and medications are at zero cost. As well, Medi-Cal is free. Medi-cal enrollment can be done online or through a benefits specialist.

Medicare

If you are over the age of 65 or have certain disabilities before the age of 65 you qualify for medicare. To find out more about Medicare go to medicare.gov or go to your local Social Security Office.

Ineligible for Medi-Cal, undocumented, or Underinsured

If you are undocumented or do not have access to medical insurance but are HIV positive, you qualify for Ryan White (AOM), which pays for all medical appts related to HIV and specialists if related to HIV. Assistance with applying for Ryan White can be found on FindHivCare.
If you are uninsured or underinsured and need a specialty referral, you may qualify for Los Angeles County CHAIN, Medical Subspecialty Services Referral Program, which covers certain outpatient specialty consultations and outpatient surgeries and procedures for patients with HIV/AIDS-related health conditions. For more information, visit CHAIN.

Financial assistance with Medication to keep your viral load undetectable

ADAP: If you are only eligible for Ryan White services, you may sign up for ADAP to help cover the cost of medication. HIV medications are covered through ADAP as well as other classes of medications not necessarily related to HIV.
- Medications by Class
- Medications by Name
Patient Access Programs – These are programs for people that do not qualify for ADAP that assist with medication financial assistance. Ask at your pharmacy. Most pharmaceutical manufacturers have co-pay cards to assist with high co-pays to medication, or patient support programs for those who are ineligible for ADAP or may be lapsing medication assistance for whatever reason.

Additional information about HIV medication coverage can be found at Poz.com.

Mental Health Support for HIV/AIDs Patients

Clearly, having access to the medications you need is a major priority, but your medications alone don’t constitute the complete care many individuals might need. HIV can also take a toll on your emotional well-being. The National Institute of Mental Health states that people living with HIV/AIDS are at higher risk for mental health conditions such as depression, anxiety, and cognitive disorders. It’s important to remember when looking for a therapist to make sure they are HIV/AIDS affirming in how they work with clients.

I have compiled a list of agencies in the Los Angeles area that are well educated and HIV/AIDS affirming and offer no charge or sliding scale therapy. Many of these agencies have been working with people diagnosed with HIV for over twenty years. It’s imperative that you work with a clinician or agency that has inclusive health care services. Many of these agencies assist with applying for ADAP and Medi-Cal.

Agencies

As with any disease, getting the care you need is paramount. The financial challenges can be significant, but as you can see there are a plethora of resources that can help reduce out-of-pocket costs. Being diagnosed with HIV is understandably overwhelming. With the diagnosis come a lot of new responsibilities, conversations, treatments, and decisions. At times like these, it’s important to remember that you are not alone. There are many organizations in this article brimming with people who have answers and are happy to help. In the end, you’ll see that though it might seem initially overwhelming, you’re not alone, you will get through this, and likely meet new and amazing people along the way. If you have any other questions about the services, resources, and organizations listed here, don’t hesitate to contact me. I’d be happy to help you any way I can.

How to Pay for HIV Care in California

Medical care (Medical Appts)

If you have insurance through an employer or purchase insurance on your own: