Guide Aims To Help Californians With HIV Select Exchange Plans
Five California organizations have released a guide for individuals with HIV and other diseases to help them select health plans through Covered California, Frontiers Magazine reports (Ocamb, Frontiers Magazine, 11/30).
In November, state public health officials announced that California has the second-highest rate of HIV infections in the U.S., despite a significant drop in new diagnoses each year.
Gil Chavez, state epidemiologist and deputy director for infectious diseases, said that a total of 137,000 Californians are living with HIV, while "at least 400 people are newly diagnosed every month."
Further, the state Department of Public Health said at least 15,000 Californians likely have HIV but have not yet been diagnosed (California Healthline, 11/20).
Meanwhile, a recent Avalere analysis found that some individuals with HIV/AIDS who purchased 2015 silver-level plans through Covered California and other exchanges under Affordable Care Act faced limited coverage for prescription drug treatments, as well as large out-of-pocket costs (California Healthline, 11/16).
Details of Coverage Guide
The guide was developed by the:
- Access Support Network;
- AIDS Project Los Angeles;
- Los Angeles LGBT Center;
- Project Inform; and
- San Francisco AIDS Foundation.
It provides recommendations that Californians with HIV, hepatitis C, hepatitis B and those considering pre-exposure prophylaxis should take into account before selecting a health plan during Covered California's current open enrollment period, which ends Jan. 31, 2016.
The guide is divided into two parts:
- A list of things to consider when choosing a health plan and information about financial assistance; and
- An analysis of 12 plans' drug formularies.
Among other things, the guide recommends that:
- Individuals avoid bronze-level and minimum coverage plans because of high deductibles that could limit access to medications; and
- Individuals with incomes between 138% and 250% of the federal poverty level consider silver-level plans, through which they would be eligible for help with out-of-pocket costs.
The guide also notes that:
- Some Californians with HIV can receive financial support through the AIDS Drug Assistance Program;
- Costs for a 30-day supply of prescription drugs are capped at $250 for silver, gold and platinum plans and limited to no more than $500 for bronze plans; and
- Plans sold through Covered California are required to host a customer service line dedicated to prescription drug issues, such as assistance and cost estimates (Frontiers Magazine, 11/30).