Enrollment assisters — also known as navigators and certified application counselors — play an essential role in helping people living with HIV find an affordable health plan that best covers their needs. During 2016 Open Enrollment for the Health Insurance Marketplace (which runs through January 31, 2016), assisters will walk people through the detailed application and enrollment process to help them determine their eligibility for coverage and subsidies, compare health plans, and complete and submit the application. But some assisters may be new to supporting people living with HIV, and in turn, clients may feel less comfortable talking with them.
It’s critical that all enrollment assisters understand the enrollment needs of people living with HIV, including the importance of avoiding gaps in medication coverage and ensuring that medications and HIV care services are affordable.
To address this need, the HRSA-supported Affordable Care Enrollment (ACE) TA Center has created a short animated video and one-page fact sheet to help assisters better understand the enrollment and insurance needs of people living with HIV.
The ACE TA Center encourages HIV programs to provide one-on-one enrollment assistance to clients, either by training their staff as enrollment assisters or partnering with an outside organization to provide this support. One-on-one enrollment assistance is associated with increased enrollment rates, particularly in communities of color (read other Best and Promising Practices for Engagement and Enrollment ).
What enrollment assisters need to know to support people living with HIV to enroll in coverage:
- Many consumers, particularly people of color, have experienced stigma and discrimination in the past. Some may fear negative attitudes and prejudice. People living with HIV are particularly concerned about maintaining continued access to affordable medications and current providers.
- Taking HIV medication every day helps lower the level of HIV in your blood. People with less HIV in their blood are much less likely to get sick or pass HIV to others.
- Without affordable coverage, HIV medications can cost hundreds of dollars per month.
- Some health plans may only cover certain HIV drugs, place them on higher tiers, or require increased cost-sharing.
- People work closely with their doctor to find the HIV treatment plan that works best for them, and it’s important to help consumers find an affordable plan that includes their current medications.
- People living with HIV may not want to disclose their HIV status to an assister.
Things to consider when assisting people living with HIV to find a health plan:
- Help consumers find an affordable plan that covers their medications and includes their current doctor, if available.
- Let consumers know that your conversations are judgement-free and confidential.
- Know how to contact your state’s Ryan White HIV/AIDS Program and its AIDS Drug Assistance Program. In many cases, Ryan White Program funds can be used to buy health insurance, pay for premiums and out-of-pocket expenses.
Visit targethiv.org/ace for more helpful enrollment resources for people living with HIV from the ACE TA Center. The goal of the ACE TA Center is to help Ryan White HIV/AIDS Program grant recipients and subrecipients enroll diverse clients, especially people of color, in health insurance.