More than 1.2 million people in the U.S. are living with HIV. If left untreated, HIV can lead to AIDS. But with consistent medical treatment, the risk of sexual transmission is effectively zero.
Antiretroviral therapy, or ART, is the best treatment for HIV, along with regular visits to your doctor or clinic to monitor your health. ART extends your life span and helps stop the spread of disease. For the best outcome, you should begin treatment as soon as possible after you are diagnosed.
Since the passing of the Affordable Care Act, most people with HIV who have health insurance have access to appropriate HIV medical care, including ART. But only two-thirds of people with HIV are under the care of a medical professional.
If you’re concerned about paying for treatment and other related costs, many programs can help provide financial assistance, medication, and support services to people with HIV.
Federal and State Programs
Ryan White HIV/AIDS Program
This federal program helps more than 50% of people with HIV every year. It sends funds to states, U.S. territories, and local communities. The program is named for Ryan White, who got HIV/AIDS at age 13 in 1984 after a blood transfusion. He overcame AIDS-related discrimination and won the right to attend school.
What’s included:
One part of the Ryan White program allows U.S. cities most affected by HIV to pay for HIV-related medical and support services. Medical services may include help paying for medication, home health care, case management, mental health services, substance abuse care, and more. Support services may include child care, emergency financial help, food bank or delivery meals, housing, medical transportation, and more.
Another part of the Ryan White HIV/AIDS program is the AIDS Drug Assistance Program or ADAP. It allows states, as well as local and community organizations, to provide FDA-approved medication and health insurance to low-income people with HIV.
Eligibility and how to apply:
People who are diagnosed with HIV or AIDS who cannot pay for the care they need can get help. Each state has its own requirements and list of covered HIV-related drugs. States also differ in how they look at income to decide whether you qualify for ADAP.
Use these online tools to find information about Ryan White HIV/AIDS and ADAP programs in your area and then apply to those programs:
https://www.greaterthan.org/find-services/
Medicaid
This federal program allows states to pay for health and long-term care services for low-income people. It provides coverage for about 42% of adults with HIV in the U.S.
What’s included:
Medicaid covers services that are important to people with HIV and people who are at risk. That includes prescription drugs, inpatient and outpatient care, and preventive services. Specific benefits vary from state to state.
Eligibility and how to apply:
Eligibility for Medicaid also varies from state to state. The Affordable Care Act gives states the option to expand eligibility to include low-income adults who don’t have children. So those with HIV don’t have to wait until they get AIDS to qualify. States also must cover other groups, such as people with disabilities who receive Supplemental Security Income (SSI). They also may cover people who are “medically needy,” are pregnant, and other specific groups.
To find out if you are eligible for Medicaid in your state and learn how to apply, visit https://www.healthcare.gov/lower-costs/
Medicare
This major federal health insurance program, which covers people over age 65 or under 65 with permanent disabilities, is an important provider of coverage for people with HIV. Around one-quarter of people being treated for HIV receive health insurance through Medicare.
What’s included:
Medicare provides basic health care services, including doctor visits, hospitalization, and prescription drugs for HIV.
Eligibility and how to apply:
Almost 80% of those people with HIV on Medicare qualify because they are disabled and get Social Security Disability Insurance (SSDI) payments, which qualifies them for Medicare after 2 years. To learn more about SSDI, visit https://www.webmd.com/hiv-aids/guide/disability-aids-qualifying-social-security-disability-insurance. For information about Medicare eligibility and how to apply, visit https://www.medicare.gov/basics/get-started-with-medicare.
The U.S. Department of Veterans Affairs (VA)
The VA is the largest health care network in the country and provides health care to 9 million veterans every year. It’s also the largest provider of health care services in the U.S.
What’s included:
The VA provides HIV testing, treatment, and preventive services.
Eligibility and how to apply:
You may be eligible if you served in the active military, naval, or air service and didn’t receive a dishonorable discharge. Learn more about eligibility here https://www.va.gov/health-care/eligibility/ and apply for VA health care benefits here https://www.va.gov/health-care/apply/application/introduction. To find a VA location near you, visit: https://www.va.gov/find-locations/.
Children’s Health Insurance Program (CHIP)
In 2018, 21% of new cases of HIV diagnosed were in youth between the ages of 13 and 24. The CHIP program sends money to the states to cover the costs of health care services provided to low-income children and teens.
What’s included:
Children and teens up to age 19 from low-income families may be eligible for health care services.
Eligibility and how to apply:
Each state has its own rules about who qualifies for CHIP. You can apply for and enroll a child in CHIP at any time. To learn more and see if you’re eligible, visit www.insurekidsnow.gov or call 877-KIDS-NOW (877-543-7669).
Pharmaceutical Manufacturers
Patient Assistance Programs
HIV drug manufacturers operate patient assistance programs (PAPs) that provide free or reduced-cost ART medications to low-income people living with HIV who don’t qualify for programs such as Medicaid, Medicare, or ADAP.
What’s included:
Pharmaceutical PAPs provide medicine at little to no cost to eligible people with HIV.
Eligibility and how to apply:
Drug companies have different qualification criteria, but you only have to fill out one application and then submit it to each PAP to request help. You can fill out the Common Patient Assistance Program Application (HIV), located here. Next, visit the AETC National Coordinating Resource Center list of “HIV Treatment Manufacturers” to learn how to apply to each program: https://aidsetc.org/resource/medication-assistance-programs.
The Pharmaceutical Research and Manufacturers of America (PhRMA) also provides a Medicine Assistance Tool that helps you locate manufacturers’ patient assistance programs: https://mat.org/.
HIV-Prevention Medication Assistance
Ready, Set, PrEP (HIV-prevention medication and treatment)
If you’re the sexual partner of someone with HIV, you may be interested in the Ready, Set, PrEP program, which provides free HIV-prevention treatment to those who qualify. Pre-exposure prophylaxis (PrEP) drugs can reduce the risk of sexually transmitted and injection drug use-related HIV in people who are at high risk of exposure. Before your doctor prescribes the drugs, you’ll need a negative HIV test and maybe a kidney function test. Both tests may be repeated regularly while you’re on the medication.
What’s included:
The program provides free PrEP medications. Lab tests and clinic visits may be covered or reduced, depending on your income.
Eligibility and how to apply:
If you don’t have health insurance, have received a negative HIV test and a prescription for PrEP, and live in the U.S. (or U.S. territories), you can apply. If you don’t have a doctor or prescription yet, you can find one using the HIV.gov Care Services Locator here: https://locator.hiv.gov/.
For more information, visit https://readysetprep.hiv.gov/. To enroll, visit: https://getyourpreppatient.iassist.com/. Call 855-447-8410 for more information or for help enrolling.
Other Support Services
Housing Opportunities for Persons with AIDS (HOPWA)
HOPWA is a federal program that provides funds to states, local communities, and nonprofits that provide housing assistance to low-income people with HIV.
What’s included:
HOPWA provides housing assistance and, in some instances, chemical dependency treatment, mental health treatment, nutritional services, job training, placement assistance, and assistance with daily living.
Eligibility and how to apply:
To qualify for assistance, you must have HIV/AIDS and meet your state or local agency’s income standards. To see which agencies in your area provide assistance through HOPWA, visit https://www.hud.gov/program_offices/public_indian_housing/ pha/contacts. To see if you qualify for HOPWA, visit https://www.benefits.gov/benefit/5888#Eligibility_Checker.
