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Common Questions

Find answers to commonly asked questions about the Affordable Care Act, the state and federal marketplaces, Medicaid, Medicare and the Ryan White HIV/AIDS Program below. We have made every effort to provide accurate information, but you should contact the health insurance marketplace or Medicaid agency in your state for guidance on your specific situation.

Categories

What Do I Need to Do During Open Enrollment Season?

The Basics about Health Insurance

How Do I Use My Insurance?

What Does the Affordable Care Act Mean to Me?

The Ryan White HIV/AIDS Program and AIDS Drug Assistance Program (ADAP)

Expanded Coverage through Medicaid

Insurance Coverage through an Employer

Insurance Coverage through State Marketplaces:

Problems and Troubleshooting Insurance Coverage

What is...

What Do I Need to Do During Open Enrollment Season?

What does open enrollment mean?

When is the next open enrollment period?

What is a special enrollment period?

By when do I need to enroll to have healthcare coverage in 2015?

If I already have coverage, do I need to do anything?

If I have a plan now, will I automatically stay enrolled for 2015?

Why does my plan cost more this year, or why have my benefits changed and what can I do?

What do I do if my current plan is not offered next year?

What if I do not like my current plan and want to consider other options?

How do I decide if I should switch plans?

What should I know about the AIDS Drug Assistance Program (ADAP) when selecting a health plan?

Do I have to wait for open enrollment to enroll in Medicaid?

The Basics about Health Insurance

What is health insurance and how do I know if I have it?

Am I required to have health insurance?

How do I sign up to get health insurance?

How much does health insurance cost?

What if I can’t afford insurance?

How do I determine my income?

Will my HIV medications be covered if I sign up for health coverage under the Affordable Care Act?

What happens if I lose my coverage or experience other major changes in my life after the open enrollment period has closed?

How Do I Use My Insurance?

Why do I need insurance?

How does health insurance work?

How can insurance help me to stay healthy?

What should I look for when selecting a plan?

What services will I get if I buy insurance?

Will all of my doctors take my insurance?

How will I find doctors who take my insurance?

Will my HIV medications be covered by my insurance?

Why are the drugs I need not covered?

I can’t find a drug on the formulary of my health plan. Does that mean I can’t get it?

For people who are HIV negative, will my insurance pay for Truvada as pre-exposure prophylaxis (PrEP)?

Will ADAP help me pay my prescription drug copays?

Can the Ryan White HIV/AIDS Program assist me with copays for doctor visits??

How do I communicate with an insurance company?

What kinds of information does an insurance company need about me?

If something changes in my life, like my job, death, marital status, or family size, do I need to notify my insurance company?

When can I sign up for health coverage under the Affordable Care Act (or ACA)?

By when do I have to sign up?

Why is it important to find doctors who are “in network” for my health plan?

Once I have enrolled, when does my new coverage begin?

What Does the Affordable Care Act Mean to Me?

If I don’t currently have insurance, what are my options through the Affordable Care Act?

If I already have insurance (including through Medicaid or Medicare), do I need to do anything or will anything change for me?

Are my insurance options different because I am a person living with HIV?

If I have Medicare, does the Affordable Care Act provide any support for prescription medications?

Can my wife/husband/partner/children get the same insurance as me?

What if I am lesbian, gay, bisexual, or transgender (LGBT)? Will that affect my health insurance coverage and options?

Can I be denied health insurance because I have HIV (or another pre-existing health condition)?

Will I be charged more for insurance because I have HIV (or another health condition)?

Is dental coverage available when I sign up for health coverage under the Affordable Care Act?

If I sign up for health insurance coverage will my HIV status be kept confidential?

The Ryan White HIV/AIDS Program and AIDS Drug Assistance Program (ADAP)

If I receive services from Ryan White or AIDS Drug Assistance Program (ADAP), do I still need insurance?

If I currently receive financial support from the Ryan White Program or AIDS Drug Assistance Program (ADAP), will that support still be available?

Can I still see my Ryan White/ADAP services provider under the Affordable Care Act?

Expanded Coverage through Medicaid

Who is eligible to get insurance through Medicaid?

What benefits are offered under Medicaid in a state that is expanding Medicaid?

What benefits are offered under Medicaid in a state that is not expanding Medicaid?

If my state is not expanding Medicaid and I can’t afford to buy insurance on my own what are my options?

Insurance Coverage through an Employer

Is my employer required to provide insurance?

If I don’t want to get insurance through my employer, do I have other options?

Does insurance coverage through an employer differ from coverage provided through other sources (such as purchased from a marketplace/exchange)?

If I lose my job, what are my insurance coverage options?

Insurance Coverage through State Marketplaces:

Who is eligible to buy insurance through the state marketplaces

How does health insurance purchased from a marketplace compare with that provided through other sources, like an employer?

What is the difference between the bronze, silver, gold and platinum plans offered in the marketplace?

Is there a limit on out-of-pocket expenses for insurance through the marketplace?

How do the different plans in the marketplace compare in terms of coverage of benefits for someone with HIV?

How do I know if I am eligible for additional financial support to help pay for a plan in the marketplace/ exchange?

If I live in a state that does not operate its own marketplace, can I get financial help to make my coverage affordable?

If I move to another city/state do I need to change coverage in the marketplace?

Can I keep my own doctor when I buy insurance in the marketplace?

Will my prescription drugs be covered by my plan in the marketplace?

Problems and Troubleshooting Insurance Coverage

Where can I get help enrolling?

What if I am denied insurance coverage?

What if I am denied a medication or a service I believe I need?

What if I believe my health plan does not understand my needs or is treating me unfairly?

I still can’t afford insurance, even with a subsidy. What can I do?

What is...

What is health insurance?

What is a state marketplace/exchange?

What is Medicaid?

What is Medicare?

What is the Ryan White HIV/AIDS Program?

What is the AIDS Drug Assistance Program (ADAP)?

What is the Federal Poverty Level (FPL)?

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What you need to know

We have made every effort to provide accurate information on this portal, but you should contact the marketplace or Medicaid agency in your state for guidance on your specific situation. Click here to find contacts in your state. All data on the site were updated November 2014 and are subject to change.

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