Healthcare Reform

Welcome to APLA’s page for information regarding health care reform in California. We will update this page as new information becomes available, so please bookmark this page and keep checking back.

The Affordable Care Act, also known as Obamacare, provides better access to health care coverage for millions of people in the United States. Under the new law, you can no longer be dropped or denied health insurance due to a pre-existing condition, including HIV/AIDS and hepatitis C (HCV).

Covered California is the state’s marketplace, where qualified legal residents of California can purchase affordable health insurance. Covered California open enrollment for 2015 began November 15, 2014, and ends February 15, 2015. After open enrollment, you can only enroll through a special enrollment period, which occurs if you have a “qualifying life event” such as loss of a job, birth of a child, divorce, or loss of insurance. If you choose not to enroll and don’t have other comprehensive health insurance, you may be required to pay a tax penalty. Fortunately, you may qualify for assistance to help pay for your health insurance premiums and out-of-pocket costs, such as medications, routine tests, and co-pays for doctor visits.

Some Californians living with HIV/AIDS can get their medications covered and/or additional help with the cost of their medications through the AIDS Drug Assistance Program (ADAP) and may be eligible to have their insurance premiums paid by the Office of AIDS Health Insurance Premium Payment (OA-HIPP) program. If you are currently on ADAP and you are also eligible for private insurance through Covered California, you may be required to pay a tax penalty if you do not buy health insurance. However, it may make sense for you to remain on ADAP and not enroll in private insurance, depending on your individual circumstances. If this applies to you, APLA encourages you to contact your ADAP benefits counselor to consider all of your health care enrollment options.

Californians with limited income may qualify for Medi-Cal, which is a public health insurance program that provides coverage at very low or no cost. If your annual income is below 138% of the federal poverty level ($16,105 for individuals), you are likely eligible for Medi-Cal. For more information about Medi-Cal eligibility, visit www.dhcs.ca.gov or your local county social services office.

If you are living with HIV and/or HCV or are HIV-negative and considering taking PrEP, it is extremely important to understand all of your options before enrolling in a new health insurance plan through Covered California. APLA Health & Wellness, together with other community partners, developed a guide to help you choose a plan that best meets your individual health needs and budget. The guide explains important things to consider when choosing a plan and includes information about additional benefits that might be available to help pay for the cost of health insurance. The guide also includes an analysis of the availability of HIV, HCV, and PrEP drugs on each of the 10 plans’ drug formularies and the likely amount you will have to pay, also known as “tiers.”

Read APLA Health & Wellness’ Covered CA Guide

Read APLA Health & Wellness’ Covered CA Formulary Analysis

Whenever possible, you should talk with a Covered California certified enrollment counselor or Insurance Agent who understands your individual health care needs before enrolling in a new health insurance plan. If you would like to meet with one of APLA or APLA Health & Wellness’ Certified Enrollment Counselors, please contact Jaqueline Perez: 213.201.1454, jperez@apla.org or Alba Escobar: 323.329.9926, aescobar@apla.org.