[Editor's note: As part of the Bay Area Reporter's efforts to keep the LGBT community informed about important policy changes, we invited Andy Scheer, MSW, medical social worker with San Francisco City Clinic and Andy Chu, Esq., legal director at Positive Resource Center, to offer their thoughts around the impact of the Affordable Care Act.]
Andy Chu: Mr. Scheer, this whole health care reform process has been very exciting for some and yet many, many folks find it to be tiring. For some reason, I always find you to be jazzed when you talk about the Affordable Care Act. Why is that? I mean ... health insurance! I've seen fetishes come and go in San Francisco, but a health insurance fetish ... really? What is it that gets you going about this topic?
Andy Scheer: I wonder which color hankie I should flag for my Obamacare fetish? (laughs) You're right, the constant spin and bickering about the ACA by politicos and talking heads can get exhausting. In the end, the monumental change that is happening to health care in the U.S. is something that people with HIV need to pay attention to. For the first time ever, HIVers �" heck, people with any pre-existing condition �" will likely be able to purchase health insurance on the general open market without the coverage denials or exorbitant premiums. That's huge.
Chu: It's really fantastic and yet, I think that this positive step forward for HIVers has been overshadowed a little by the clunky rollout of Healthcare.gov.
Scheer: That is an excellent point, Andy. Healthcare.gov got a lot of bad press and unfortunately, it overshadowed the successes that we here in California have been seeing with the CoveredCA website. Big take-away: http://www.Healthcare.gov �" the site for the state markets run by the feds �" is not http://www.CoveredCA.com. So the next time you hear an anti-Obamacare tirade about Healthcare.gov being a mess, please ignore it. CoveredCA.com is up, it's functioning, and people are getting insurance through it.
Chu: Being able to purchase health insurance is one thing, and paying for it is another. As we know, living with HIV brings along little expenses here and there that can add up. High rents in San Francisco have our budgets stretched thin already and adding on another monthly bill can really strap HIVers. Insurance through CoveredCA.com comes with a price tag. Is there any help out there to reduce costs?
Scheer: Look at you, giving me great lead-ins to my learning points. The answer is "yes." If you make below about $46,000 per year, the feds are going to give you help that they label a "premium tax credit." The less you make, the bigger the credit. In addition, if you make $50,000 or less per year and have HIV, it is likely that you are already enrolled in the state of California's AIDS Drug Assistance Program to pay for your HIV meds. People who qualify for ADAP who don't get insurance through their employer can get their monthly health insurance premiums paid for through a program called OA-HIPP (see below). You might have some out of pocket expenses for office visits or lab work, but you should not have to pay monthly premiums and you'll still have full, comprehensive health insurance coverage.
Chu: It sounds a little confusing, but definitely like a good way to go. I'm guessing that you'll tell me to speak with my social worker about navigating this process if I need help. (Both laugh.) Now, California is one of the 26 states that are doing Medicaid expansion, yes?
Scheer: Yes, and in California, we call the expansion "MAGI MediCal" (modified adjusted gross income). If you make below $15,856 a year you can sign up for this new type of MediCal. Traditional MediCal comes into play when someone is disabled or in their old age and it requires that they not have more than $2,000 in assets for a single person. The new MAGI MediCal, however, is based on income and does not require you to be disabled or without assets.
Chu: What if someone is disabled or retired and already has MediCal, and/or Medicare? What do they need to do?
Scheer: Generally, nothing. If you're already enrolled in one of these programs because you're disabled, on Calworks, or for another reason, you can stay on these programs. People who are already on Medicare due to age or disability are not eligible for MAGI MediCal or Covered California policies. Some people who are over the resource limit or can't afford the traditional MediCal programs can actually qualify for MAGI MediCal. And again, there is nothing that you need to do if you already get affordable insurance through your employer.
To learn more about HIV and Healthcare Reform, please visit the following:
http://www.CoveredCA.com or (800) 300-1506; SF Benefits Net, 1440 Harrison Street, M-F 8 a.m. to 5 p.m.; www.HIVHealthReform.org; www.PositiveInform.org; CA state Office of AIDS (for information and enrollment forms for OA-HIPP); http://www.Healthcare.gov/glossary, an excellent glossary of commonly-used, often confusing terms related to health insurance and health care reform.
Basic information
Everyone's situation is different. It is very important that people reach out to a social worker, inform him/herself with some research, turn to a community-based agency working with people with HIV, and/or attend a community forum to ask questions.
March 31 is the deadline for open enrollment for Covered California. If that date passes and you're not insured, it is likely that you're going to get hit with a fine when you pay your taxes in 2015.
If your employer does not provide health insurance, they may be contributing to a Health Reimbursement Account. You can use the money to pay for office visits and other out of pocket medical expenses. Don't let this money go to waste. It is yours to use.
Have a U Visa? Were you granted asylum? If you answer yes to these questions or have another form of legal immigration status, you may qualify for the ACA. Undocumented immigrants are not eligible for MAGI MediCal or Covered California policies, but are eligible for Healthy San Francisco, HIV care through Ryan White-funded clinics, and HIV meds through ADAP.
Before you purchase a plan on CoveredCA.com, be sure to find out which plan your doctor or clinic accepts. Call the doctor or clinic before you buy. Also, review the plan's drug formulary to ensure it includes the meds you need at a cost you can afford.
The OA-HIPP program can help with monthly premiums. If you earn between $15,856 and $22,980, enroll in an "Enhanced Silver Plan." Those with incomes between $23,095 and $50,000 should enroll in a "Platinum Plan."