IN THE LOOP

See below for more information about each of these programs. If you have any questions or need help enrolling, call APLA Health’s benefits specialists at 213-201-1615.

Taking PrEP? Thinking about it? California just launched a new program to make PrEP more affordable! PrEP, or pre-exposure prophylaxis, is a daily medication that HIV-negative individuals can take to reduce their chance of contracting HIV. PrEP reduces the risk of contracting HIV by up to 99 percent.

If you need help paying for PrEP, you can now enroll in California’s statewide PrEP Assistance Program (PrEP-AP). The program is run by the California Office of AIDS and provides financial assistance with PrEP medication and related medical expenses.

• If you have insurance (including Medicare and private insurance), the PrEP-AP will pay for all PrEP-related medical out-of-pocket costs including deductibles, copays, and coinsurance. The program will also cover any medication costs not covered by the drug manufacturer’s copay assistance program. Gilead, the manufacturer of PrEP, has a copay assistance program that will cover up to $4,800 toward the cost of your prescription.
• If you don’t have insurance, the PrEP-AP will pay for all PrEP-related medical costs including doctor visits, HIV testing, and labs. You will be able to get the medication for free through Gilead’s patient assistance program. Uninsured individuals must go to a provider within the state’s “PrEP-AP Provider Network” to have their medical costs covered. However, if you are low-income and live in Los Angeles, you can still visit one of 15 “Centers of Excellence” to get PrEP for free.

In order to be eligible for the PrEP-AP, you must:

• Have a modified adjusted gross income less than 500 percent of the federal poverty level (about $60,700);
• Be at least 18 years old, although individuals under 18 will become eligible in the near future;
• Be a resident of California—regardless of immigration status;
• Not be fully covered by Medi-Cal or other third party payers.

If you would like to enroll in the PrEP-AP, start by visiting an enrollment site in your area. An experienced enrollment worker will assist you with enrolling into both the PrEP-AP and Gilead’s assistance program. A map with enrollment sites authorized to perform PrEP-AP enrollment can be found here.

California’s Office of AIDS now offers two programs to help people living with HIV pay their Medigap and employer-based health insurance premiums. These programs also provide coverage for medical out-of-pocket costs, including copays and deductibles.

The Employer-based Health Insurance Premium Payment Program (EB-HIPP) will pay a portion of your employer-based health insurance premium as well as medical out-of-pocket costs like copays and deductibles that count towards your annual out-of-pocket maximum.

In order to qualify for EB-HIPP, you must:

• Be enrolled in the AIDS Drug Assistance Program;
• Be enrolled in employer-based insurance;
• Have you employer agree to participate in the program;
• Be employed by the employer in order to participate in the program (i.e. you cannot be on your spouse’s employer-based health insurance plan).

You can enroll in the program by submitting the required documentation to your ADAP enrollment worker or the Office of AIDS. You DO NOT need to disclose your HIV status to your employer in order to enroll in the program. You can read a memo from Office of AIDS about this new program here.

Although the Office of AIDS has covered Medicare Part D premiums for several years, the program will now also cover Medigap insurance premiums. Medigap policies are private insurance plans that cover Medicare copays, coinsurance, and deductibles. If you are enrolled in Medicare Part D, the Office of AIDS will also cover medical out-of-pocket costs that count towards your annual out-of-pocket maximum whether or not you have a Medigap policy.

If you are already enrolled in the Medicare Part D premium payment program, you are automatically eligible to receive assistance with medical out-of-pocket costs. If you would like to receive assistance with your Medigap insurance premium, make an appointment with an ADAP enrollment worker so they can submit the required documentation to the Office of AIDS. You can read a memo from the Office of AIDS about these changes here.

A broad range of Medigap policies are offered in California. They are numbered as Part A through Part N. Some plans are more comprehensive than others (N and F provide the fullest coverage), and prices and availability vary. For a good comparison of plans, click here.

Medicare beneficiaries in California are guaranteed access to Medigap policies during the first six months after they become eligible for Medicare or when they turn 65 if they were on Medicare previously (for instance, people who receive Medicare under age 65 because they are disabled).

Other life events also kick off a six-month open enrollment period for Medigap—like leaving a job or losing access to military health benefits. If you do not enroll in a Medigap policy during open enrollment, insurers do not have to offer you a plan, may offer a narrower range of plans, or may charge more. Californians with active Medigap policies should also be aware of the state’s birthday rule, which allows you to change or upgrade your Medigap plan for 30 days following your birthday. You can find more information about Medigap here.

Low-income Medicare beneficiaries should also qualify for health coverage through the state’s Medi-Cal program. Medi-Cal then serves as Medigap coverage for nearly all Medicare out-of-pocket costs.

Last year, the Los Angeles County Department of Public Health (LADPH) launched its newCenter for Health Equity to address infant mortality, skyrocketing STD rates, cultural and linguistic competency in healthcare services, environmental justice, and health outcomes in LA’s neighborhoods. As part of the initiative, LADPH recently released a series of health profiles that provide an overview of health characteristics for each city in Los Angeles County, as well as each council district in the City of Los Angeles.

The profiles include data on life expectancy, physical activity, tobacco use, community safety, environmental justice, housing, mental health, reproductive justice, HIV and STD rates, and access to healthcare. These topics are known as social determinants of health, which are the “conditions in the environment in which people live, learn, work, play, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” according to the US Department of Health and Human Services. In other words, where you live, your income and education level, and what you do affect how healthy you are.

The health profiles offer an informative look at the variation in health outcomes for Angelenos living in different parts of the County, and highlights where LADPH needs to focus its efforts in order to achieve the goals of the Center for Health Equity. Los Angeles City Council Districts 4 (Ryu), 8 (Harris-Dawson), 10 (Wesson), 13 (O’Farrell), and 14 (Huizar), and the cities of Beverly Hills, Long Beach, Inglewood, Santa Monica, and West Hollywood have some of the highest rates of HIV and STDs in the county. By comparison, HIV and STD rates in Arcadia, Cerritos, Diamond Bar, Glendora, Hacienda Heights, La Mirada, Manhattan Beach, Torrance, Temple City, Santa Clarita, Rosemead, and Rancho Palos Verdes are some of the lowest in the county. For example, in West Hollywood, the number of people living with HIV per 100,000 individuals (the rate of HIV) is 6,992, while in Arcadia it is 56. The rate of gonorrhea in West Hollywood is 2,192 per 100,000 people while in Arcadia it is 7.5.

Take a look at your city or council district here. If you don’t like what you see, call or send an email to your representative and ask them to support legislation, policies, and programs that will help improve health outcomes in your community.