ADAP Insurance

ADAP clients with income of at least 50% of the Federal Poverty Level may qualify for assistance with insurance through the Federal Marketplace.

In addition to meeting the program qualifications, an individual must meet the following criteria to receive ADAP Insurance:

• Be enrolled in an ADAP supported insurance plan.
• Use a pharmacy in the network of the ADAP contracted Pharmacy Benefits Manager (PBM) to receive medication co-payments and/or deductible assistance.
• Use the ADAP contracted Insurance Benefits Manager to enroll in and receive premium assistance with insurance.
• Request determination of available subsidies from the Marketplace when submitting a Marketplace application.
• Provide all supporting documentation required by the federally facilitated Marketplace at the time the Marketplace application is submitted and the enrollment is processed.

ADAP Insurance offers help with the following types of insurance:

• Medicaid Share-of-Cost (if the cost of medications is not enough to activate share-of-cost Medicaid each month).
• Medicare Part C or Part D (co-pays only).
• Employer-sponsored insurance.
• COBRA policies.
• The annually approved ADAP supported plans in the federally facilitated Marketplace.

ADAP cannot pay for a stand-alone dental or vision insurance policy. ADAP cannot pay out-of-pocket costs for any service except pharmacy costs. However, other programs of the HIV Section may be able to help with those costs.

If you have insurance but cannot afford your medication, there are several insurance exceptions that will allow a person to receive assistance.

• No Brand Name Coverage
• No Prescription Coverage
• Open Enrollment
• Pharmaceutical Benefits Cap
• Unaffordable Co-payment

For more information on health care insurance coverage through ADAP, please contact your local ADAP Office.