No insurance, no doctor?

Worried that you can’t get care because you don’t have health insurance? Have insurance but not sure if it will cover STD or HIV treatment or care? Below are some answers to these questions.

What are insurance options for people with STDs or HIV?

Many clinics in Santa Clara County offer STD and HIV services to people with a variety of financial backgrounds – from people with no insurance, to people with private insurance, and everyone in between. It can be very expensive to treat HIV, so it’s important to know what your health insurance options are if you have HIV. Some of the options include:

Group Health Insurance Plans

Group health insurance is private insurance that 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, 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.

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.
  • Veterans Administration (VA)– All veterans of the United States military are eligible to receive medical services through veteran’s healthcare facilities across the country. In fact, the VA is the largest medical provider for people living with HIV in the U.S.
  • 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.

If you have private insurance, can you access services like Medicare, Medicaid, and ADAP to help pay for your HIV care?

In general, if you have private insurance and/or health insurance provided by your employer, you will not be eligible for state or federal benefits. There may be exceptions, however. Check with your local provider for more information.

Sources: AIDS.gov, HRSA.gov