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Switch On Your HIV Smarts.

Help Choosing a Covered California Plan for HIV, HCV or PrEP Coverage

, by Emily Newman

CC picNovember 1 to January 31, 2016 is open enrollment season in California, so if you’re in need of health insurance, now’s the time to sign up. Before January 31, people in California can register for affordable health insurance through the Covered California state health insurance marketplace.

If you’re living with HIV or hepatitis C or are considering PrEP, there are some key things to keep in mind so you can choose a plan that best meets your needs.

San Francisco AIDS Foundation in collaboration with APLA Health & Wellness, Project Inform, Los Angeles LGBT Center, Access Support Network and San Francisco City Clinic released a Covered California plan guide for people living with HIV and/or hepatitis C and those seeking PrEP. The guide provides information about:

  • How to compare plans including the difference between HMOs, PPOs and EPOs and what the four “metal tiers” (e.g., Bronze, Silver, Gold and Platinum) cover;
  • How to take advantage of assistance, pharmaceutical company programs, and cost-sharing subsidies to reduce premiums and out of pocket costs;
  • How to enroll through a Certified Enrollment Counselor or Certified Insurance Agent and who to call with questions; and,
  • Your rights regarding health insurance coverage as a person with HIV or hepatitis C, and what to do if you’re denied coverage.

The guide also comes with a checklist of things to do and consider while you’re choosing a plan. Download the guide (PDF).

To help you anticipate how much you might pay for your prescription medications based on the plan you choose, the coalition has also released a formulary analysis. This analysis shows how hepatitis C,  hepatitis B and HIV medications, including Truvada for PrEP, are “tiered” on all 12 of the Covered California health plans so you can get an idea of how much you’ll have to pay each month for your medications. Download the formulary analysis (PDF).

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