Shopping around: Marketplace and Medicare Open Enrollment considerations for people with HIV

Open enrollment for health insurance plans takes place just once a year for most people. Marketplace and Medicare plans can change each year, and a person’s health needs can change too, so it is important to take this opportunity to compare plan options. It is particularly important that people with complex medication and treatment needs, including people with HIV, review plans and ensure that the cost, coverage, and in-network providers and pharmacies meet their health needs and budgets. 

Our Access, Care, and Engagement Technical Assistance (ACE TA) Center builds the capacity of the Ryan White HIV/AIDS Program (RWHAP) community to navigate the changing health care landscape and help people with HIV access and use their health coverage to improve health outcomes.

Marketplace Open Enrollment for 2021 coverage is November 1–December 15 in HealthCare.gov states. All eligible clients, including new enrollees, can enroll and change plans during this period.

• Some states with their own state-based exchanges have later end dates. 
• People can preview Marketplace plans now on HealthCare.gov.

Medicare Open Enrollment is October 15–December 7 in all states. During this time, individuals who are already enrolled in Medicare coverage can change their health plan and/or prescription drug (Part D) coverage. People can compare plan options now.

JSI’s ACE TA Center recognizes the growing number of people living long and full lives with HIV in the U.S., many of whom are starting to qualify for age-based Medicare coverage. To help people with HIV and their providers with this transition, we are facilitating an orientation process for the RWHAP community of health departments, service providers, and people with HIV. To date, we have developed a series of easy-to-understand resources and webinars that provide an orientation to Medicare enrollment, prescription drug coverage, financial assistance, and navigating the transition from Marketplace to Medicare.

For example, How Medicare Enrollment Works explains the differences between the Initial Enrollment Period, Special Enrollment Period, and General Enrollment Period for Medicare; how to avoid late enrollment penalties; and how clients can make Medicare coverage changes.

Financial help is available. Many individuals are eligible for financial assistance for Marketplace or Medicare coverage. In addition, RWHAP clients can often get help paying monthly premiums and out-of pocket costs. Also, the RWHAP remains available to clients who are not eligible for other health coverage, and can provide access to medication and outpatient HIV medical services. To learn about the types of financial assistance available to Marketplace and Medicare enrollees, access these helpful ACE resources: 

• Understanding Premium Tax Credits and Cost-Sharing Reductions is an interactive eLearning module for consumers who get coverage through the Health Insurance Marketplace.
• Financial Help for Medicare provides an overview of Medicare Savings Programs, the Extra Help program, and other sources of financial help, as well as eligibility criteria. It also explains how RWHAP can help with premiums and out-of-pocket expenses.

The value of one-on-one enrollment assistance

We encourage all individuals to receive one-on-one enrollment assistance, especially if this is their first time enrolling in health coverage. For people with HIV, it is generally better to start by locating an HIV service provider in your community, rather than starting with an enrollment assister who is unfamiliar with the HIV system of care. In many cases, HIV service providers have enrollment assisters or benefit specialists on staff who can answer questions about and who understand the unique health coverage needs of people with HIV. The ACE TA Center also helps HIV programs to train their external enrollment partners.

For individuals enrolling in Medicare, there is also the State Health Insurance Assistance Program, which provides free, one-on-one insurance counseling to Medicare-eligible individuals, families, and caregivers. Learn more at www.shiptacenter.org.