Public and Private Benefits: Income Replacement and Health Care

More than a 25 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.  As HIV has become for many people, a chronic, manageable condition, the key is access to health care and medications. The AIDS Law Project guides uninsured people living with HIV enroll in Medicaid, Medicare, Social Security disability benefits and private insurance. 

Public Benefits

Public assistance programs can be a lifeline for people living 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 who 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, see the federal poverty guidelines income limits chart below.

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 who buy insurance have certain rights.

Insurance companies can legally deny you insurance if you are living with HIV, but your insurance cannot be canceled if you are diagnosed with HIV after your policy is in effect. An insurer cannot test you without your consent, but they may deny coverage if you refuse to be tested.

Resources

2020 FPIG INCOME LIMITS

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.

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Social Security Disability Benefits

The Social Security Administration (SSA) has two programs that provide disability benefits to people, who are unable to work because of their health, including people living with HIV. Supplemental Security Income (SSI), provides cash assistance and Medicaid to people who are low income, disabled and have limited resources. Social Security Disability Insurance (SSDI), provides cash assistance and Medicare to people who are disabled. worked and paid taxes for a required number of years. Clients with a limited work history or earnings record may be eligible for both SSI and SSDI.

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Disability Evaluation Under Social Security 14.00 Immune System Disorders - Adult

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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.

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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

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Compass

Pennsylvania’s online resource to apply for a broad range of social programs which includes an application for Cash Assistance, Supplemental Nutrition Assistance Program (SNAP) and Medical Assistance.

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Special Pharmaceutical Benefits Program Application

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 or with the on-line application.

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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.

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Pennsylvania “Mini-COBRA” law

Pennsylvania 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

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Health Insurance Premium Payment Program

The Health Insurance Premium Payment (HIPP) Program helps pay the health insurance premium for Medicaid recipients who are also eligible for employer-provider health insurance. For Medicaid recipients registered in the HIPP program, in addition to paying the premium, Medicaid 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 A

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