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Ryan White Part B Insurance Continuation Program

What is the Ryan White Insurance Program?

Many of those living with HIV disease are able to continue employment at a business which offers healthcare and medication coverage while they manage their treatment. Others are able to maintain a COBRA policy through a former employer while they are transitioning to a new job or to disability. The Ryan White insurance program is intended to assist eligible participants to maintain access to these benefits. The insurance coverage must provide “creditable” pharmaceutical coverage, and be cost-neutral to the AIDS Drug Assistance Program (ADAP) to provide the same coverage. This program has the additional benefit of providing access to medical treatment for its participants.

How do you qualify for the Insurance Program?

• You must be a Colorado resident
• You must have proof of HIV positive diagnosis from a doctor or testing facility.  You may also access the program if a family member that is not HIV positive can acquire insurance from their employer on your behalf.
• You or your family must be at or below 400 percent of the Federal Poverty Level, (see below).
• You must be eligible for medical insurance or a COBRA policy through which you would be able to access medications in an affordable manner.
• If you are eligible for Medicaid, you must access your medications through that system. The Ryan White ADAP system must be the payer of last resort.
• If you are eligible for Medicare, you must receive assistance through the Medicare Part D assistance program (also through the Ryan White system).

Federal Poverty Level: Based on 2009 figures
400 percent of Federal Poverty:

*For each additional family member, add $14,960

Level I
For those eligible at 200 % of the Federal Poverty Level (FPL) or below. Participants can receive up to $10,000 for insurance premiums, as well as medical and pharmaceutical co-pays and deductibles annually. There may be a waitlist for participation in this program.

Level II
For those eligible at 400% of FPL or below. Participants may receive up to $8,400 annually in either insurance premiums, or pharmaceutical co-pays each month. The participant is allowed to choose which option he or she finds most beneficial only once annually, unless the participant’s carrier or policy terms change.

How Do I Find Out More About the Program?

You do not have to be case managed at a Ryan White funded agency to participate in the program, but enrollment in the program is managed by the contracted agency in your region. If you think that you qualify for the Ryan White Part B Insurance Program, inquire at one of the five agencies listed below. You may also call the Insurance Program Project Administrator at the Colorado Department of Public Health and Environment at (303) 692-2783. You will be asked to complete the AIDS Drug Assistance Program application located at:

http://www.cdphe.state.co.us/dc/HIVandSTD/ryanwhite/adap.html

Colorado AIDS Project
Adams, Arapahoe, Denver, Douglas, and Jefferson Counties
303-837-0166

Southern Colorado AIDS Project
Alamosa, Baca, Bent, Chaffee, Cheyenne, Conejos, Costilla, Crowley, Custer, El Paso, Elbert, Fremont, Huerfano, Kiowa, Kit Carson, Las Animas, Mineral, Otero, Park, Prowers, Pueblo, Rio Grande, Saguache, and Teller Counties
800-241-5468

Frequently Asked Questions:

What if I have Medicare?
The program cannot pay your Medicare Part A or Part B premiums. The "Bridging the Gap, Colorado" program does have assistance for Medicare Part D or Medicare Advantage Plan premiums, co-pays, and deductibles. Please see the Medicare Part D link above.

What if I am currently on COBRA continuation or the Colorado Uninsurable Health Insurance Program (CUHIP)?
The program may continue to pay your premiums, but contact a your case manager, even if the policy has recently expired.

My insurance premium is taken directly from my paycheck. Can you pay me back for it?
The program cannot pay clients directly or reimburse for insurance premiums or co-payments. Payments must go to the insurance provider/employer or to a pharmacy. Discuss options with your Case Manager.

How long can I stay on the program?
As long as you meet the eligibility requirements, the program continues to receive funding, and the insurance is “creditable”.