Purpose and focus
The AIDS/HIV Insurance Assistance Program helps people with HIV get access to health insurance. The program covers all or part of the cost of insurance premiums. To be eligible, a person must:
- Live in Wisconsin.
- Have family income that does not exceed 300% of the federal poverty level (FPL).
- Have a doctor state that the individual has HIV.
- Have or be eligible for health insurance under a group health plan or an individual health plan.
The program subsidizes premiums for:
- Group health insurance continuation coverage.
- Medicare supplement policies.
- Medicare Part D prescription drug plans.
- Individual policies.
Group health continuation coverage
Under federal law, people who have employer group health insurance may continue that insurance at their own expense for 18 months after leaving work. This is known as the Consolidated Omnibus Budget Reconciliation Act, or COBRA. There are requirements, such as enrolling within a certain time period after leaving a job. In some circumstances, COBRA benefits can extend to 29 months for those who are eligible for Social Security disability.
Medicare supplement policies
Many people who leave work due to illness may be eligible for federal Social Security disability income (SSDI) benefits. SSDI recipients usually receive Medicare 24 months after they are determined to be disabled. Because Medicare has a 20% copay for medical services, many people want additional (supplemental) insurance through private Medicare policies. The Insurance Assistance Program covers the cost of basic Medicare supplemental plans plus additional coverage (riders) for Part A deductible and Part B excess charges.
Medicare Part D Prescription Drug Plans (PDPs)
Medicare Part D covers costs of prescription drugs provided through private insurance plans. The Insurance Assistance Program pays the cost of Part D PDPs for eligible individuals with HIV who are covered by Medicare. There is a wide variety of PDPs and individuals with HIV should make sure the plan they choose provides coverage for their HIV medications.
Purchasing an individual health insurance policy is an option for people without group health insurance (through an employer or other association). People with incomes greater than 100% of the federal poverty level may be eligible to purchase insurance through the Health Insurance Marketplace. The Insurance Assistance Program will cover the cost of Silver level 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 at community-based organizations. Case managers assist clients in completing an application and forwarding it to the Insurance Assistance Program. If the client is eligible, the program contacts the client's employer and/or insurance company to set up payment of the monthly insurance premium.
The program can provide comprehensive health insurance coverage at little or no cost to clients through coordination with other state and federal programs, including the AIDS Drug Assistance Program, Medicaid, and Medicare.
Application materials for the Wisconsin AIDS/HIV Insurance Assistance Program
Fact Sheet, P-42115 (PDF)
Client Disclosure Authorization, F-01829 (MS Word)
Part B (Physician Portion) of Application Form F-44614B (PDF)
Instructions for Completing Application Form F-44614I (PDF)
Six-Month Verification Form (SMRF) F-00851 (PDF)
Wisconsin AIDS Drug Assistance Program Policy Manual P-01771 (PDF)