Paying for HIV Care and Support
HIV care and support services are available for all people with HIV,
regardless of their ability to pay.
No one should go without care or
treatment because they can't afford it.
The information below is for your reference. Please talk to your case manager, benefits navigator, or call the
Health Information Helpline at (215)-985-2437
to learn about available resources.
To find other services or assistance you may be eligible for, contact
BenePhilly provides free, one-on-one help to Philadelphia residents with enrolling in public benefit programs.
Ryan White-Funded HIV Care
If you have HIV and live in Philadelphia or nearby counties (Bucks, Chester, Delaware, Montgomery, and Philadelphia in Pennsylvania, and Burlington, Camden, Gloucester, and Salem in New Jersey), and your household income is under 350% of the federal poverty level, you qualify for Ryan White-funded HIV care and support services. Use this table to check if your household income qualifies.
If you’re eligible for Ryan White services, you can get help paying for medications and lab tests through the Pennsylvania State Special Pharmaceutical Benefits Program (SPBP). SPBP may also help with certain Medicare Part C and D plans.
To learn more about SPBP and apply, visit the SPBP website.
To find local HIV care resources, visit the resource finder page or call the Health Information Helpline at 215-985-2437.
If you live outside the coverage area, use the HRSA medical provider finder tool.
If you’re eligible for health insurance, it’s important to apply and enroll. Ryan White funds can help with costs not covered by your insurance.
Learn More
about health
insurance options
below
Medicaid
Medicaid is a public health insurance program that covers adults with low income, pregnant people, children, elderly people, and people with children. Eligibility for Medicaid depends on the state you live in. In Pennsylvania, Medicaid was expanded under the Affordable Care Act (ACA) to include adults with lower incomes.
If you think you may be eligible for Medicaid, talk to your HIV medical case manager, benefits navigator, or visit BenePhilly for help with applying.
For more information on Medicaid:
- To check eligibility and how to apply, visit PA.gov
- For information on the waiting period for lawfully permanent residents, visit HealthCare.gov
- To learn about renewing Medicaid coverage, visit Medicaid.gov
- For help finding care with Medicaid Managed Care, visit PA.gov
Medicare
Medicare is a public health insurance program that covers people 65 and older and some people under 65 with disabilities or certain health conditions. Medicare has four parts: A, B, C, and D. Each part covers different healthcare services. You may have a combination of Parts A, B, and D, or choose a Medicare Part C plan, which sometimes includes prescription drug coverage.
If you’re eligible for the Special Pharmaceutical Benefits Program (SPBP) but not Medicaid, you can get help paying for certain Medicare Part C and D plans. To learn more, visit the PA Department of Health website or talk to a benefits navigator or medical case manager.
To find the best Medicare option for your needs, you can get help by:
- Talking to your benefits navigator or medical case manager
- Calling 800-MEDICARE (800-633-4227) (TTY: 877-486-2048)
- Calling the PA MEDI help-line (800-783-7067)
- Starting a live chat through Medicare.gov
For more information on Medicare:
- Eligibility and enrollment periods
- Visit CMS.gov for Parts A and B eligibility and enrollment
- Visit Medicare.gov for Parts C and D eligibility and enrollment
- Estimate eligibility and premium costs at Medicare.gov
- Enrollment
- See Medicare Parts C and D options at Medicare.gov
- Sign up for Medicare through SSA.gov
- Supplemental Coverage
- For help with Medicare Parts A and B premium costs: Medicare Savings Programs
- For help with out-of-pocket costs from Medicare Parts A and B:
Medigap/Medicare Supplement Insurance - For help with premiums and extra prescription costs from Medicare Part D: Extra Help
Employer-based Health Insurance
Most people in the United States get health insurance through their job. This is private insurance where your employer pays part of the premiums. Large employers must offer health insurance to full-time employees and their children. If you lose employer-sponsored healthcare coverage, you can keep it temporarily through COBRA.
For more information:
- Enrollment
- Visit KFF.org
- COBRA
- Visit the U.S. Department of Labor website
- General Questions
- Visit KFF.org
- Alternative Employer-Sponsored Coverage (Small Employers)
- Individual Coverage Health Reimbursement Arrangements (ICHRAs)
- Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs)
Marketplace Health Insurance Plans
You can buy private health insurance plans through the Health Insurance Marketplace, also called the Exchange. All Marketplace plans cover the same basic health benefits, and eligible people can apply for subsidies to help lower costs. In Pennsylvania, the health insurance Marketplace is called Pennie.
For more information:
- Eligibility
- Visit HealthCare.gov
- Pennie (PA’s official health insurance marketplace)
- Shop for Marketplace health insurance plans and check your subsidy eligibility through Pennie
- Cost
- Marketplace plans are divided into metal tiers with higher or lower premiums and deductibles
- Apply/Enroll
- Visit Pennie for information on enrollment periods and how to apply for Marketplace health insurance
- Off-Exchange Qualified Health Plans
- You can also buy a plan directly through a broker or health plan (this is called an off-Exchange qualified health plan). You can only get subsidies for plans purchased on the Exchange.
Children's Health Insurance Program (CHIP)
CHIP is a public health insurance program for children who are not covered by Medicaid or other health insurance. Depending on your household size and income, you may be eligible for free, low-cost, or full-cost coverage through CHIP. If you think your child may be eligible, talk to your HIV medical case manager, benefits navigator, or visit BenePhilly for help with applying.
For more information:
- Eligibility and how to apply Visit PA.gov for eligibility information
For information on the waiting period for lawfully permanent residents, visit HealthCare.gov - For eligibility and how to apply visit PA.gov
- To renew CHIP Coverage visit Medicaid.gov
Veterans Administration Benefits
The U.S. Department of Veterans Affairs provides healthcare benefits for veterans of the U.S. military, army, navy, or air force who were not dishonorably discharged. VA healthcare benefits can be used with other healthcare coverage. If you think you may be eligible for VA benefits, talk to your medical case manager, benefits navigator, or visit BenePhilly for help with applying.
Visit VA.gov for eligibility information and to apply.
TRICARE
TRICARE provides healthcare coverage for active-duty members of the United States Uniformed Service and their families. TRICARE can be used with other healthcare coverage. If you think you may be eligible for TRICARE, talk to your medical HIV medical case manager, benefits navigator, or visit BenePhilly for help with applying.
For more information:
- Eligibility
- Visit TRICARE.mil
- Use the TRICARE Plan Finder to find a plan that matches your eligibility status
- Enrollment
- Once you know which plan you qualify for, click on it at TRICARE.mil to see enrollment instructions
Additional Help Paying for Medications
You can get help finding out which resources are available to you by contacting your HIV medical case manager, benefits navigator, or calling the Health Information Helpline at 215-985-2437.
PHMC Emergency Financial Assistance Services
In Philadelphia and surrounding counties, Public Health Management Corporation (PHMC) offers emergency financial assistance for HIV medications that aren’t covered by insurance or other programs. A HIV medical case manager can help you access this service and plan your medical care and costs. If you don’t have a medical case manager, call the Health Information Helpline at 215-985-2437.
HIV Medication Assistance Programs
There are several programs available to help cover the cost of HIV medication. A HIV medical case manager, can connect you to these services, assist with planning your medical care, and help manage any related costs. If you don’t already have a HIV medical case manager, you can call the Health Information Helpline at 215-985-2437 for assistance. You can also explore available options by visiting the Medication Assistance Programs website.
Please talk with your HIV medical case manager, benefits navigator, or call the Health Information Helpline at 215-985-2437 to find out which resources are available to you. Nobody should go without HIV care and treatment because they can’t afford it.
Want to Learn More about HIV?
Check out these other pages:
Learning you’re HIV positive can be scary but you’re not alone. We can walk you through what to do next. Learn more
With treatment you can reduce the amount of HIV in your blood to levels so low it can’t even be detected. Learn more
Learn about HIV stigma and how to challenge it. Learn more
If you’re HIV positive you have the right to live a life free of discrimination. Find out how you’re protected. Learn more
Know what to expect when you start care. Learn more
HIV Resource Finder Tool
HIV Resource Finder Tool
For additional HIV care and support services, including food delivery, legal assistance, mental health support, housing, and more, try our resource tool.