Public and Private Benefits: Access to Health Care

The AIDS Law Project’s Access to Healthcare is an exceptionally effective program that makes a real difference in the lives of people with HIV/AIDS. Fully 27 percent of the clients who come to the AIDS Law Project are looking for some form of public or private health insurance as the road to health care because with treatment this disease — once a short-term death sentence — can be treated as another chronic, manageable condition. The key is access to health care and medications. Through this program, uninsured people with HIV/AIDS enroll in Medicaid, Medicare, Social Security disability benefits and private insurance.  Accessing health care makes a real difference not just in the lives of clients who continue working and raising their children but also in the impact of the disease on the larger community. People with HIV/AIDS whose conditions are stabilized through health care contribute more than they cost society.

PUBLIC BENEFITS:

Public assistance programs can be a lifeline for people with HIV by providing a monthly income, access to medical care, and help with some special needs. The rules for these programs are complicated. Before applying we recommend that you find a case manager can help you. To find an AIDS service organization in the Philadelphia area, call the Health Information Hotline at 1-800-985-AIDS (2437) if you live. In other parts of Pennsylvania, call the State AIDS Fact Line at 1-800-662-6080. National and state officials often make changes in the public benefits system, and many benefit levels (as in money amounts) change from year to year. For up-to-date benefit levels, ask your case manager.

Remember to look before you leap; MARRIAGE affects public benefits. Click here for more information.

Updates/Resources:

Updates:

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Check out the 2017 numbers for public benefits eligibility here.

                 (posted 3/15/17)

update stickerHealthy Pennsylvania and People with HIV and AIDS:  On August 28, the federal Department of Health and Human Services (HHS) approved Pennsylvania’s proposal for Medicaid expansion, known as Healthy Pennsylvania.                                     Click here for more information.

                  (posted 9/15/14)

Enrollment for PA Fair care, the health insurance plan for uninsured Pennsylvanians with pre-existing conditions has been suspended effective           March 2, 2013.  For more click here.

                 (posted 3/10/13) 

The Social Security Administration is moving from paper checks to electronic benefits. For more info, click here                 

                 (posted 3/13/13)

SPBP Income Levels Raised, effective 1/24/13.

                 (posted 3/8/13)

Effective August 15, 2011, the Philadelphia Social Security offices will be open to the public Monday through Friday from 9:00 am to 3:30 pm. SSA district offices will no longer issue replacement SSA cards.  

                 (posted 8/1/11)

Medicaid Resources:

  • FPIG Comparison Chart (2015): Poverty Income Guidelines, or FPIGs, are figures issued by the U.S. Department of Health and Human Services and are used to establish eligibility for a variety of, but not all, public assistance programs.

Medicare Resources:


Pennsylvania Department of Labor Resources:


Pennsylvania Department of Public Welfare Resources:

  • Compass: Pennsylvania’s online resource to apply for a broad range of social programs which includes an application for Cash Assistance, Food Stamps (now called SNAP) and Medical Assistance.
  • Health Insurance Premium Payment Program: The Health Insurance Premium Payment (HIPP) Program helps pay the health insurance premium for Medical Assistance (MA) recipients who are also eligible for employer-provider health insurance.  For MA recipients registered in the HIPP program, in addition to paying the premium, MA will continue to pay all costs that the employer-related insurance will NOT cover.  The program helps the Department of Public Welfare, which runs the program, to save dollars ‘by purchasing cost effective employment related health insurance available to a Medical Assistance recipient’.
  • Special Pharmaceutical Benefits Program:The Special Pharmaceutical Benefits Program covers prescriptions and some lab services for people who have been prescribed HIV medications. SPBP applications and re-enrollment forms may now be submitted by email to spbp@magellanhealth.com. Click here to download a copy of the application.

Social Security Administration Resources:

  • Social Security’s Program Operations Manual System (POMS) This section of the SSA Program Policy Information site contains the public version of the Program Operations Manual System (POMS). The POMS is a primary source of information used by Social Security employees to process claims for Social Security benefits. The public version of POMS is identical to the version used by Social Security employees except that it does not include internal data entry and sensitive content instructions.
  • The Red Book A Social Security Administration resource concerning the employment-related provisions of Social Security Disability Insurance (SSDI) and the Supplemental Security Income (SSI) Programs for educators, advocates, rehabilitation professionals, and counselors who serve people with disabilities.

PRIVATE BENEFITS:

Private benefits primarily cover three kinds of insurance: health insurance, life insurance and disability insurance.  Insurance policies are legal contracts. Just like any contract, it is important that you read your policy and understand its terms. People living with HIV and AIDS who buy insurance have certain rights. For example, your insurance cannot be canceled because you have HIV or AIDS. You cannot be tested for HIV unless you agree to the test. However, in many cases, insurance companies can legally deny you insurance because you have HIV or AIDS. This means that in some cases, if you do not agree to be tested for HIV, the insurance company can deny you for this reason as well.

Resources:

  • Consolidated Omnibus Budget Reconciliation Act (COBRA).  A federal law that permits qualifying employees to maintain group health insurance after leaving employment. The qualified employee may be required to pay the full cost for the coverage. COBRA coverage has limited duration, but in most cases the maximum COBRA period is 18 or 36 months. Pennsylvania also has a “Mini-COBRA” law that gives employees of small businesses (2-19 employees) who receive health insurance from their employers the right to purchase continuation health insurance after they leave employment. It allows eligible employees and dependents to purchase health insurance for nine months after their employment ends. An employee or dependent eligible for Mini-COBRA coverage may not be discriminated against on the basis of any evidence of inability to be insured. For more information about Mini-COBRA, call the Pennsylvania Department of Insurance at 1-877-881-6388 or click here.

  • HIPAA Creditable Coverage. HIPAA requires that most health plans provide coverage for pre-existing medical conditions and protects the portability and continuity of health insurance coverage.

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