ADAP to the Rescue!

If you have private health insurance or Medicare, there are important changes in the Illinois AIDS Drug Assistance Program (ADAP) that may help you with some of your drug costs. Additionally, ADAP may make it possible for some people to afford comprehensive health insurance coverage under the new Illinois Pre-Existing Condition Insurance Plan (IPXP).

First and foremost: The income eligibility limit for Illinois ADAP is 500% of federal poverty. That means for 2011, your annual income must be less $54, 450 in order for you to enroll in any of ADAP’s programs.

So let’s dig in and explain.

For folks with private insurance:
ADAP used to pay drug copays for people with private health insurance, but only if the copays were more than 20% of the drug costs or if a drug’s individual copay was more than $100. But now ADAP will enroll you no matter what your deductibles and copays are. Keep in mind that like always, your insurance plan must be able to coordinate with ADAP’s pharmacy, CVS/Caremark. Additionally, ADAP can’t fill a prescription for more than a one-month supply of drugs. So if your insurance plan requires you to use prescriptions for three-months supplies (for example), ADAP can’t help you.

For folks on Medicare Part D:
Most people on Medicare with annual income under $26,917 can already get help with their drug costs either through Extra Help or Illinois Cares Rx. Usually that leaves people with very low drug copays — about $6 per prescription. Now ADAP can pay these small copays for you.

Most people on Medicare but with annual incomes over $26,917 can’t get Extra Help or Illinois Cares Rx, so they often have had to rely entirely on ADAP to provide them with their HIV medications. Beginning this year, the money that ADAP spends on your medications counts toward your Part D out-of-pocket costs. This means that ADAP money will help fill your Part D “donut hole” (the phase of the Part D program where you pay 100% of your drug costs) to get you to the phase of the Part D program where you pay only 5% of your drug costs.

As with all ADAP programs, your Part D plan must be able to coordinate with ADAP’s pharmacy, CVS/Caremark, in order for you to enroll in these programs.

For folks who want to enroll in the Illinois Pre-Existing Condition Insurance Plan: The Illinois Pre-Existing Condition Insurance Plan (IPXP) is the newly-created program that can provide health insurance to people who have been uninsured for at least six months and whose pre-existing health conditions prevent them from getting individual insurance coverage. ADAP can pay up to $500 toward your monthly IPXP premiums and help with your copays and deductible for HIV medications.

Talk about a landslide of good news.

If you want to talk more about any of these programs, give us a ring at 312-427-8990.

You can get ADAP’s info here.

You can get IPXP’s info here.

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