Background
The health care coverage and financing landscape for people with and at risk for HIV in the U.S. is highly fragmented and made up of a patchwork of payers and programs. Each has its own eligibility requirements, services and benefits, cost sharing obligations, and financing structure. Further, program eligibility and benefits vary by state and in some cases, even more locally, leading to uneven access across the country and some people are left out of the system entirely. The Affordable Care Act (ACA), passed in 2010, expanded access to coverage and services for millions of people, including people with and at risk of HIV and as a result, the number of uninsured people has fallen significantly. Most people with HIV do have insurance coverage, particularly through Medicaid and private insurance, and many receive support from the Ryan White HIV/AIDS Program, the nation’s safety net program for people with HIV. This table provides an overview of the major payers and programs that provide coverage and services to people with and at risk of HIV. It builds on and updates earlier work published in the Lancet.
HIV Insurance Coverage and Care Landscape in the United States
Click on the buttons below to see data for the different payers and programs:
Medicaid
Medicare
Private Insurance
Veteran Affairs
Indian Health Service
Ryan White
Community Health Center
All Payers and Programs
ABP = alternative benefit plan. ACA = Affordable Care Act. AMP = average manufacturer price. ARVs = antiretrovirals. CPI-U = consumer price index for all urban consumers. EHB = Essential Health Benefits. FDA = Food and Drug Administration. FPL = federal poverty limit. HMO = health maintenance organization. PrEP = pre-exposure prophylaxis. Ryan White = Ryan White HIV/AIDS Program. SSI = Supplemental security income. STI = sexually transmitted infection. USPSTF = United States Preventive Services Task Force.
HIV Insurance Coverage and Care Landscape in the United States
Click on the buttons below to see data for the different payers and programs:
Medicaid
Medicare
Private Insurance
Veteran Affairs
Indian Health Service
Ryan White
Community Health Center
All Payers and Programs
Notes: ALS = amyotrophic lateral sclerosis. ARVs = antiretrovirals. FDA = Food and Drug Administration. HMO = health maintenance organization. NCD = national coverage determination. PPOS = preferred provider organization. PrEP = pre-exposure prophylaxis. Ryan White = Ryan White HIV/AIDS Program. STI = sexually transmitted infection. USPSTF = United States Preventive Services Task Force.
HIV Insurance Coverage and Care Landscape in the United States
Click on the buttons below to see data for the different payers and programs:
Medicaid
Medicare
Private Insurance
Veteran Affairs
Indian Health Service
Ryan White
Community Health Center
All Payers and Programs
ACA = Affordable Care Act. ARVs = antiretrovirals. EHB = Essential Health Benefits. FPL = federal poverty limit. PrEP = pre-exposure prophylaxis. Ryan White = Ryan White HIV/AIDS Program. STI = sexually transmitted infection. USPSTF = United States Preventive Services Task Force.
HIV Insurance Coverage and Care Landscape in the United States
Click on the buttons below to see data for the different payers and programs:
Medicaid
Medicare
Private Insurance
Veteran Affairs
Indian Health Service
Ryan White
Community Health Center
All Payers and Programs
AMP = average manufacturer price. ARVs = antiretrovirals. CPI-U = consumer price index for all urban consumers. FCP = federal ceiling price. Non-FAMP = average manufacturer price paid by non-federal purchasers. VA = Veteran Affairs.
HIV Insurance Coverage and Care Landscape in the United States
Click on the buttons below to see data for the different payers and programs:
Medicaid
Medicare
Private Insurance
Veteran Affairs
Indian Health Service
Ryan White
Community Health Center
All Payers and Programs
ARVs = antiretrovirals. FCP = federal ceiling price. IHS = Indian Health Service. NCF = National Core Formulary. PrEP = pre-exposure prophylaxis.
HIV Insurance Coverage and Care Landscape in the United States
Click on the buttons below to see data for the different payers and programs:
Medicaid
Medicare
Private Insurance
Veteran Affairs
Indian Health Service
Ryan White
Community Health Center
All Payers and Programs
AETC = AIDS Education and Technical Assistance Centers. AMP = average manufacturer price. ARVs = antiretrovirals. CHC = community health centers. CPI-U = consumer price index for all urban consumers. EHE = Ending the HIV Epidemic. MAI = Minority AIDS Initiative. PrEP = pre-exposure prophylaxis. Ryan White = Ryan White HIV/AIDS Program. SPNS = Special Programs of National Significance.
HIV Insurance Coverage and Care Landscape in the United States
Click on the buttons below to see data for the different payers and programs:
Medicaid
Medicare
Private Insurance
Veteran Affairs
Indian Health Service
Ryan White
Community Health Center
All Payers and Programs
CHC = community health centers. CPI-U = consumer price index for all urban consumers. EHE = Ending the HIV Epidemic. Ryan White = Ryan White HIV/AIDS Program. STI = sexually transmitted infection.
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