Purpose and focus
The AIDS/HIV Insurance Assistance Program helps persons with HIV maintain access to health insurance. The program does this by subsidizing (covering all or part of the cost of) policy premiums. To be eligible, an individual must:
- Live in Wisconsin.
- Have family income that does not exceed 300% of the federal poverty level (FPL).
- Have a doctor certify that the individual has HIV infection.
- Have or be eligible for health insurance coverage under a group health plan or an individual health plan.
The program subsidizes premiums for the following types of policies: group health plan continuation coverage, Medicare supplement policies, Medicare Part D prescription drug plans, and individual policies.
Group Health Continuation Coverage
Under a federal law passed as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, individuals who are covered by employer provided group health plans may continue to participate in the plan at their own expense for 18 months after leaving work. Certain conditions apply, such as enrolling within a specified time period after leaving a job. In certain circumstances, COBRA benefits can be extended to 29 months for people who become eligible for Social Security disability.
Medicare Supplement Policies
Many people who leave work due to illness become eligible for federal Social Security disability income (SSDI) benefits. SSDI recipients usually receive Medicare 24 months after the date of their disability determination. Because Medicare coverage involves a 20% co-pay for medical services, many individuals seek additional coverage through private Medicare supplement policies. The Insurance Assistance Program will cover the cost of basic Medicare supplemental plans plus the Part A deductible rider and the Part B excess charges rider.
Medicare Part D Prescription Drug Plans (PDPs)
Medicare Part D is coverage for prescription drugs that is provided through private insurance plans. The Insurance Assistance Program will pay the cost of Part D PDPs for eligible individuals with HIV who are Medicare beneficiaries. There is a wide variety of PDPs available and individuals with HIV should make sure that the plan they choose provides coverage for their HIV related medications.
For people who do not have health insurance (through a group plan provided by an employer or other association); purchasing an individual policy may be another option for coverage. People with income that is greater than 100% FPL may be eligible to purchase coverage through the Health Insurance Marketplace. The Insurance Assistance Program will cover the cost of Silver plans available through the Marketplace. Visit HealthCare.gov to learn more about health insurance plans that are available in your area.
Client access and benefits
To apply for the Program, clients typically work with case managers who are located at AIDS service organizations throughout Wisconsin. The case managers assist clients in completing the program application and then forward the application on to the Insurance Assistance Program staff. If the client meets the program eligibility requirements, their employer and/or insurance company is contacted to set up payment of the client’s monthly insurance premium.
In coordination with other state and federal programs, including the AIDS Drug Assistance Program, Medicaid, and Medicare, the Program can provide comprehensive health insurance coverage at little or no cost to clients. Program expansion which occurred in April 1998 resulted in more persons being eligible for the benefits of comprehensive health insurance.
Growth and trends
After initial startup of the program in SFY 1991, client enrollment remained steady between SFY 1992 and SFY 1997. The program had an increase in enrollment in SFY 1998 with the expansion of eligible insurance coverage. In April 1998, the AIDS/HIV Insurance Assistance program offered additional options to a wider number of individuals. Program expansion included:
- Coverage of both individual and group health insurance
- Higher income eligibility limits
- Elimination of limits on length of coverage
For additional information on the Wisconsin AIDS/HIV Insurance Assistance Program, call 1-800-991-5532.
Wisconsin AIDS Drug Assistance Program Policy Manual P-01771 (PDF)
Application Materials for the Wisconsin AIDS/HIV Insurance Assistance Program
Fact Sheet P-42115 (PDF)
Spanish Fact Sheet (Boletin) P-42115S (PDF)
Application Form F-44614A (PDF)
Part B (Physician Portion) of Application Form F-44614B (PDF)
Instructions for Completing Application Form F-44614I (PDF)
Spanish Application Form (Solicitud Inicial) F-44614AS (PDF)
Part B (Physician Portion) of Spanish Application Form F-44614BS (PDF)