The Affordable Care Act and HIV/AIDS


As part of our ongoing effort to provide useful information to our visitors, we thought it would be helpful to provide you with some information about the Affordable Care Act an its impact on those living with HIV and AIDS. There are are many benefits that the ACA has provided, including improving access to coverage, ensuring quality coverage, ensuring preventative services, increasing coordinated care, and expanded medicaid services. In the upcoming election season, please keep these things in mind as you make your voting decisions.

Please read on…

MD Whitest Medical Institute ACA Graphic

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law and set into place a national effort to help ensure Americans have secure, stable, and affordable health insurance. The ACA is one of the most important pieces of legislation in the fight against HIV/AIDS in our history. Its implications for people at risk for and living with HIV/AIDS are described below.


The ACA provides Americans—including those at risk for and living with HIV/AIDS—better access to healthcare coverage and more health insurance options.

  • Coverage for people with pre-existing conditions.Thanks to the ACA, no American can ever again be dropped or denied coverage because of a pre-existing health condition, like asthma, cancer, or HIV. Insurers also are prohibited from cancelling or rescinding coverage because of mistakes made on an application, and can no longer impose lifetime caps on insurance benefits. These changes are significant because prior to the ACA, many people living with HIV or other chronic health conditions experienced obstacles in getting health coverage, were dropped from coverage, or avoided seeking coverage for fear of being denied. Now they can get covered and get the care they need.
  • Broader Medicaid eligibility. Under the ACA, states have the option, which is fully Federally funded for the first three years, to expand Medicaid to generally include those with incomes at or below 138% of the Federal poverty line ($16,105 for an individual and $32,913 for a family of 4), including single adults without children who were previously not generally eligible for Medicaid. (See this chart for more household sizes and incomes.) Medicaid is the largest payer for HIV care in the United States, and the expansion of Medicaid to low-income childless adults is particularly important for many gay, bisexual, and other men who have sex with men (MSM) who were previously ineligible for Medicaid, and yet remain the population most affected by the HIV epidemic.  Further, in states that opt for Medicaid expansion, people living with HIV who meet the income threshold will no longer have to wait for an AIDS diagnosis in order to become eligible for Medicaid. That means they can get into life-extending care and treatment before the disease has significantly damaged their immune system. (Find out if your state has expanded Medicaid coverage.)
  • More affordable coverage. The ACA requires most Americans to have qualifying health insurance. To help people access quality, affordable coverage, the ACA created Health Insurance Marketplaces (sometimes called “exchanges”) in every state that help consumers compare different health plans and determine what savings they may qualify for. The ACA also provides financial assistance for people with low and middle incomes in the form oftax credits that lower the cost of their monthly premiums and lower their out-of-pocket costs. These tax credits depend on a family’s household size and income. The 2015 open enrollment period to purchase affordable, quality healthcare coverage through the Health Insurance Marketplaces is over. However, you can still enroll if you have a life change that qualifies you for a Special Enrollment Period or if you qualify for Medicaid or CHIP. Learn more.
  • Lower prescription drug costs for Medicare recipients. In the past, as many as one in four seniors went without a prescription every year because they couldn’t afford it. The ACA closes, over time, the Medicare Part D prescription drug benefit “donut hole,” giving Medicare enrollees living with HIV and AIDS the peace of mind that they will be better able to afford their medications. Beneficiaries receive a 50% discount on covered brand-name drugs while they are in the “donut hole,” a considerable savings for people taking costly HIV/AIDS drugs. And in the years to come, they can expect additional savings on their prescription drugs while they are in the coverage gap until it is closed in 2020. In addition, as a result of the health care law, AIDS Drug Assistance Program (ADAP) benefits are now considered as contributions toward Medicare Part D’s True Out of Pocket Spending Limit (“TrOOP”). This is a huge relief for ADAP clients who are Medicare Part D enrollees, since they will now be able to move through the donut hole more quickly, which was difficult, if not impossible, for ADAP clients to do before this change. (To learn more about your Medicare coverage and choices, visit

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