Affordable Care Act Open Enrollment Deadline Coming Up February 15

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Sunday, February 15, is the final deadline to enroll in Affordable Care Act ("Obamacare") health plans during the annual open enrollment period. Finding the right plan can be a challenge for people with HIV or hepatitis C and those who want coverage for pre-exposure prophylaxis (PrEP). It is important to balance monthly premium costs, copays, and deductibles to best meet individual needs.

ACA insurance plans are arranged in tiers -- bronze, silver, gold, and platinum -- that provide different levels of coverage. Lower-tier plans have less expensive monthly premiums, but members must pay larger annual deductibles before coverage kicks in or higher co-pays for doctor visits and other services. Many people are eligible for federal subsidies to help pay their premiums. Basic prevention services are free on all plans.

Plans also vary in terms of providers and drug formularies. Some plans have more HIV and hepatitis C specialists in their provider networks. Many plans put HIV and hepatitis C drugs in a specialty tier that requires higher co-pays or prior authorization. Some plans make Truvada (tenofovir/emtricitabine) for PrEP more affordable. It is important to check whether a specific plan includes the desired providers and medications.

The website for the national ACA exchange is at https://www.healthcare.gov. Some states have also set up their own marketplaces, which can be found at https://localhelp.healthcare.gov. About half of the states have expanded their Medicaid programsunder the ACA to include more people with a higher income threshold. Young people can now stay on their parents' insurance plans until age 26, and Medicare eligibility typically starts at age 65.

The Kaiser Family Foundation web portal, Health Coverage, HIV & YOU, presented by Greater Than AIDS, can help people living with HIV research their health insurance options. The website features a guide to the essential health benefits provided under the ACA, state-specific information for all 50 states, FAQs, and checklists of information needed to enroll.

The San Francisco AIDS Foundation, Project Inform, and other organizations have put together a guide to help California residents find appropriate plans through Covered California that include coverage for HIV, hepatitis C, or PrEP.

The guide, available online at http://www.projectinform.org/pdf/CCguide.pdf, explains important considerations for choosing a plan and describes resources that may be available to help pay for health insurance. An accompanying guide to Covered California's 2015 drug formularies, available at http://www.projectinform.org/pdf/CCformularies.pdf,details the cost of specific HIV and hepatitis C drugs on each of the plans and whether prior authorization is required.

Participants can sign up for the first time or switch to a different plan during the annual open enrollment period. After February 15, people will only be able to sign up after a "qualifying life event" such as loss of a job, marriage (including same-sex partners), divorce, or birth of a child.

2/11/15