What is the Affordable Care Act?
The ACA is a federal law that helps provide affordable health insurance by expanding Medicaid to more people and offering low cost health insurance options for purchase. In Nevada, this is done through Nevada Health Link (www.nevadahealthlink.com).
How does the ACA affect me?
Many clients of HOPES will become eligible to enroll in Medicaid or have the option to buy private insurance through Nevada Health Link. This depends on your income level, which will be assessed when you apply. A calculation called the Federal Poverty Level (FPL) is used. Those with an FPL between 0-138% will be eligible for Medicaid. Those between 139-400% of the FPL will be eligible to purchase insurance through Nevada Health Link. If you’re unsure whether or not you qualify, talk to a HOPES case manager.
What does insurance cover? What if I have a pre-existing condition?
Each insurance plan will have its own specific coverage benefits. However, all plans will be required to cover doctors visits, hospitalizations, maternity care, emergency room care, and prescriptions. There may be co-pays for these services. Additionally, new federal law prohibits an insurance company from denying someone health insurance due to a pre-existing condition.
When can I apply and enroll?
Open enrollment starts on October 1st, 2013 and ends on March 31st, 2014. There is one application process that will determine whether you qualify for Medicaid or insurance through Nevada Health Link. Anyone who signs up before December 15th, 2013 will have coverage effective January 1, 2014.
Should I apply and enroll?
Yes! If you don’t have any insurance or are currently on a subsidized program such as ADAP, you should plan to apply for insurance coverage. ADAP will no longer be an option if you qualify for health insurance. If you’re unsure whether or not you qualify, see a HOPES case manager to find out if you’re eligible.
Who will help me enroll?
HOPES case managers will schedule one-on-one enrollment appointments for clients, beginning in October. If you would like to enroll on your own, you can visit the Nevada Health Link website on October 1 to sign up for your new insurance plan. If you have questions about which plan is best for you and your family, please make an appointment with a HOPES case manager who will help you understand your options.
What if I am not a US citizen (undocumented)?
Undocumented individuals will not be covered under Medicaid or eligible to purchase insurance through Nevada Health Link. If you are undocumented, you may be eligible to get onto Access to Healthcare Network’s discount medical plan. To see if you qualify, contact Access to Healthcare Network at (775) 284-8989.
How will I pay for my insurance?
Individuals who earn no money will become eligible for Medicaid, which may not have a monthly cost depending on the plan. There will still be co-pays for doctor’s visits and prescription medication. If you purchase insurance from the exchange, you may be eligible for a tax credit that will help reduce your monthly insurance expense. A case manager at HOPES can help you apply for your tax credit.
What documents will I need to apply?
If you are applying for insurance through Nevada Health Link, you will need the following for each person who is applying for insurance: Full Name, DOB, SSN. You will also need to know the household income. Medicaid is reducing the amount of required documentation. All HOPES clients will be notified when the list is finalized.
How much will it cost for me to get insurance?
If you are eligible for Medicaid (0-138% FPL) then there may be no cost to you. If you are eligible for an insurance plan through Nevada Health Link (139%-400% FPL) then the cost will depend on the insurance plan you pick. Most people will be eligible for a tax credit that will help share the cost of buying health insurance. However, you MUST file taxes to be eligible for the tax credit.
I have never had insurance before and don’t know how to use it.
No problem! When the case managers at HOPES help you enroll in your new insurance plan, they will give you a brochure that tells you how to use your insurance. Also, HOPES will be holding a series of workshops to educate clients on how to use their new insurance.
What if I have Medicare, do I need to do anything?
No. There are no changes to Medicare and your coverage will continue as it has been. However, due to the ACA, Medicare now covers more preventative services.
What if I already have insurance, do I need to do anything?
If you already have insurance coverage through your job you, don’t need to do anything. If you currently pay out of pocket for your insurance or are on COBRA, you may be eligible for insurance through Nevada Health Link (www.nevadahealthlink.com). See a HOPES case manager for more information.
For Ryan White Clients
When I get insurance, should I keep Ryan White.
Yes. Ryan White may be able to assist you with help paying for monthly insurance costs and/or your medication co-pays. As well, the supportive services that Ryan White offers, such as housing assistance, and transportation assistance (bus passes, gas vouchers) will still be available and you will need to be on Ryan White to access those.
What services will Ryan White still offer?
The Ryan White program will still assist people with their insurance premiums and medication co-pays. As well, Ryan White will still continue to fund the housing and transportation programs. If you receive housing assistance, bus passes, gas vouchers, or rides form the HOPES transportation van these services will still be available to you as long as you stay on Ryan White. Ryan White dental funds will still be available for those whose new insurance plan does not have dental coverage.
What happens if I don’t apply for insurance? Can I stay on ADAP?
No. Ryan White is considered the “Payor of Last Resort”, which means, according to the federal government if you have other insurance options you must take them and cannot use Ryan White and ADAP to pay for your medication. Ryan White will be allowing a transition period to allow everyone time to get onto their new insurance plans, but after the transition period they will not allow people to continue to be on ADAP if they are eligible for Medicaid or an insurance plan on Nevada Health Link. What this means is if you do not enroll into an insurance plan you will not have coverage for your HIV medication. ADAP will not be eligible to you after the transition period.
What if I am HIV positive and undocumented?
Undocumented individuals with HIV/AIDS will still be eligible for Ryan White services. It is important that you do not let your Ryan White eligibility expire or you will not be able to have your medication paid for by the ADAP program.