Under the Affordable Care Act, starting in 2014, any insurance plan that is certified by the Health Insurance Marketplace and provides essential health benefits, follows established limits on cost-sharing (like deductibles, co-payments, and out-of-pocket maximum amounts), and meets other requirements is considered a Qualified Health Plan.

Essential Health Benefits:

• Outpatient care
• Trips to the Emergency Room
• Inpatient hospital treatment
• Care before and after your baby is born
• Mental health and substance use disorder services such as behavioral health treatment, counseling, and psychotherapy
• Prescription drugs
• Services and devices to help you recover from injury, disability, or chronic condition including physical and occupational therapy, speech-language pathology, psychiatric rehabilitation and more
• Lab tests
• Preventative services including counseling, screenings, and vaccines to keep you healthy and manage a chronic disease
• Pediatric services such as dental and vision care

Under the Affordable Care Act, you can only apply for health insurance coverage during Open Enrollment, which is between November 15, 2014 and February 15, 2015.   However, if you had what is known as a “Qualifying Life Event” you are still eligible to enroll and even get financial help.  A Qualifying Life Event is simply a major life change – for example, you were recently married/divorced, had or adopted a child, lost a dependent/death in the family, graduated college, changed jobs, moved to a new state, etc. – then you can get coverage outside of the Open Enrollment period.  Remember this does not apply to Oregon Health Plan(OHP), you may apply for OHP at any time.

Individuals and families could qualify to receive help paying for a qualified health plan. Factors such as income and household size determine if a person or family are eligible for tax credits to help pay for monthly premiums. (An individual earning up to $45,900 a year or a family of four earning up to $94,200 a year could qualify for a tax credit.) Some people will also be eligible for cost-sharing reductions to help pay for copays, deductibles and other out-of-pocket costs.

If you have questions about how to apply for a qualified health plan and assistance with the costs, your care coordinator can help.

If you are uninsured and have not had a Qualifying Life Event and are unable to enroll for insurance, talk with your Care Coordinator about other options available to you until Open Enrollment begins.

The Oregon Health Plan (OHP) provides health care coverage to low-income Oregonians through programs administered by the Division of Medical Assistance Programs (DMAP). Currently, more than 600,000 people each month receive health care coverage through the Oregon Health Plan.

Qualification for OHP is based on residency, income, and/or those who are elderly, sight impaired, disabled, pregnant or receiving Temporary Assistance for Needy Families (TANF) benefits. Individuals who want to apply for OHP should always submit a completed application to see if they qualify. OHP is opening to more low-income adults in 2014. You may qualify for OHP, even if you’ve been denied in the past.

You can apply for the Oregon Health Plan at any time. Enrollment is always open.  All people enrolled in the Oregon Health Plan will become a member of a Coordinated Care Organization (CCO) that serves your county of residence.  Some counties have more than one CCO and you may be asked to choose.  For more information visit the Oregon Health Authority website.

Your Care Coordinator can help you apply for OHP or you can go to the Cover Oregon website at Cover Oregon

CAREAssist is Oregon’s version of the AIDS Drug Assistance Program (ADAP). CAREAssist helps people living with HIV/AIDS pay for medication and other medical care expenses. CAREAssist is not health insurance, but they help individuals maintain and utilize health insurance by paying for insurance premiums, doctor visit co-pays and medication co-pays. To become a member of CAREAssist, you must:

• Have a confirmed HIV status
• Reside in Oregon
• Currently have medical insurance or be in the process of applying for medical insurance. We can help you with this.
• Have income below 400% of the Federal Poverty Level (FPL) (http://aspe.hhs.gov/poverty/15poverty.cfm).

Individuals who are uninsured and need coverage for prescription medications related to their HIV care may be eligible for up to a 30-day supply through the Bridge Program. This program can also assist with a limited number of medical services to confirm HIV diagnosis and determine appropriate HIV treatment regimens.  Payments for specialty care referrals are not available at this time, although exceptions will be considered with prior authorization. The Bridge Program application must be completed by a physician. All prescriptions covered by the Bridge Program must be obtained through a CAREAssist Network Pharmacy.

For persons who are unable to secure health insurance outside of an open enrollment period, CAREAssist can assist with payments for a limited number of medical services and medications necessary for HIV treatment, through the Uninsured Persons Program (UPP).

Your Care Coordinator at HIV Alliance can help you apply for CAREAssist and can answer any questions you might have.

For more information visit the Oregon Health Authority website.