Insurance Options for People with HIV
Because it can be very expensive to treat HIV, it's important to know what your health insurance options are if you are living with HIV disease. Some of the options include:
Group Health Insurance Plans
Group health insurance is private insurance often comes with employment. Many of these programs cover comprehensive medical care, including hospital visits, outpatient care (clinic settings) prescription coverage and specialist visits. In some cases, however, you may still have to pay for some of your healthcare costs, even if you have private insurance. Some of these costs might include co-pays or premiums.
Individual Health Insurance Policies
You may be able to buy an individual health insurance policy, but they tend to be more expensive and require a pre-screening application that may exclude coverage for pre-existing conditions, like HIV disease.
Public Healthcare Programs
If you don’t have health insurance—or you need help because your insurance doesn’t pay for the care you need—the programs listed below can help by paying for care that is delivered by local and state agencies.
- Ryan White HIV/AIDS Program – Funds outpatient primary care, HIV/AIDS drugs, and supportive services only when other public or private sources are not available.
- Medicaid – Supports healthcare for low-income individuals who meet eligibility requirements. Medicaid is administered by states, and each state sets its own guidelines for eligibility and services.
- Medicare – Federal health insurance program that supports medical care for those who qualify based on work history, age, and disability status.
- Other programs that pay for HIV/AIDS medications – These include: the Ryan White AIDS Drug Assistance Program (ADAP); Medicare Part D; patient assistance programs; and clinical trials.
For more information, see HRSA’s Learn More about Health Care.
See also HRSA’s State HIV/AIDS Hotlines.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is not a type of insurance—but it was designed to make it easier for people to get and keep health insurance.
HIPAA has three main functions:
- It protects people with group insurance coverage from discriminatory treatment.
- It enables small groups (such as businesses with a small number of employees) to get, and keep, health insurance coverage more easily.
- It gives people new options for getting individual coverage when they lose or leave their group insurance (because of a job change or being fired/laid off, etc.)
This law provides several protections important to people with HIV/AIDS:
- It limits (but doesn’t eliminate) the ability of insurance companies to exclude you from coverage if you have a pre-existing condition.
- If you have a family member who has had health problems in the past, or is having them now, HIPAA keeps group health plans from denying you coverage or charging additional fees for coverage because of your family member’s health.
- It guarantees certain small business employers (and certain individuals who lose job-related coverage) the right to purchase individual health insurance.
- HIPAA guarantees, in most cases, that employers or individuals who purchase health insurance can renew the coverage, regardless of any health conditions of individuals covered under the insurance policy.
For more information, see CDC’s HIV and the Law: HIPAA.
Fact Sheets & Print Materials
- The Kaiser Family Foundation - HIV/AIDS Policy Fact Sheet: Medicaid and HIV/AIDS : This fact sheet provides data and information on HIV/AIDS and Medicaid eligibility, benefits, spending, caseloads, and future outlook.
Related Topics on AIDS.gov
Frequently Asked Questions
Will my HIV test results be given to my insurance company?
In general, testing laboratories are not required to share your test results with insurance companies and can only share them with the “authorized person,” which usually means you (the patient) and/or your healthcare provider who ordered the test and is responsible for using the results. This may vary from state to state and between insurance plans, however. If you file insurance claims for treatment for HIV or AIDS, then your insurance company will know you have HIV disease.
Will my insurance company drop me if I’ve been tested for HIV?
Your insurance company should not drop you for being tested for HIV—or for being HIV-positive. Certain insurance plans have restrictions on what they will pay for, including pre-existing conditions, but they should not drop you for taking an HIV test.
- HHS - Medicare.gov
- HRSA - The Ryan White HIV/AIDS Program
- The National Women's Health Information Center (NWHIC) offers a comprehensive listing of all the public healthcare programs available for people living with HIV/AIDS.
- Office on Women’s Health - Office on Women's Health - Insurance, Information from Other Trustworthy Sources
- Centers for Medicaid and Medicare Services - Regulations and Guidance
Last revised: 06/01/2012