Back HIV Policy & Advocacy New Guide Helps People with HIV and Hepatitis C Choose California Insurance Plans

New Guide Helps People with HIV and Hepatitis C Choose California Insurance Plans


Project Inform, the HIV and hepatitis C advocacy organization, has released a new guide to help people with HIV or hepatitis C navigate health coverage options under Covered California, the state's Affordable Care Act (ACA) insurance marketplace.

The ACA -- better known as Obamacare -- has given many people an opportunity to join Medicaid or to purchase insurance without pre-existing condition exclusions, often with government subsidies. But some states have refused to expand their Medicaid programs and some people with HIV, hepatitis C, and other chronic health conditions have found it difficult to find ACA insurance plans that include their specialist providers or cover the drugs they need.

Project Inform's new guide, available online, offers an analysis of the availability of HIV and hepatitis C drugs on each of the 11 Covered California plans’ medication formularies and the likely costs levels, or "tiers."

"It is critical for people with any chronic condition to make sure that their health care providers are included in the plan they choose and that the plan covers their medications at affordable prices," according to a Project Inform press release. "That process has proved to be especially challenging in the beginning phases of Covered California implementation."

Based on published formularies, Project Inform found that some plans place HIV and hepatitis C drugs in higher tiers, which end up costing more, particularly during the early months of the year before out-of-pocket caps are reached.

The guide explains issues to consider when choosing a plan, how to find necessary information, and advises people with HIV of additional benefits that may be available to them.

In addition to using the guide, Project Inform recommends that most people with HIV or hepatitis C should consult "a knowledgeable health insurance counselor who has experience dealing with HIV and HCV" before making their final plan choices.



Project Inform. How to Choose a Plan in Covered California. February 2014.