Like millions of other Medicare recipients, Jeff Taylor, 43, had to devise his own complicated combo to pay for HIV meds. Taylor’s financial regimen included AIDS drug assistance programs, his own cash and driving from his native Palm Springs, California, to Tijuana to snag cheaper pills. Imagine his relief, then, when he heard about Congress’ new, supposedly simpler Medicare prescription plan, which kicked in January 1, 2006. But relief turned to horror when he tried to understand it. The plan, called Medicare Part D, pays for meds through hundreds of private drug plans. Plans vary by state, have different premiums and cover different drugs, requiring nightmarish research to find one that fits your needs. For months, Taylor has spent up to three hours a day on the phone or Internet—and has yet to pinpoint his out-of-pocket costs. Even benefits counselors remain baffled. “This plan is so confusing some think that it might have been better if Congress hadn’t passed a bill at all,” says Jeffrey Crowley, an HIV expert at Georgetown University’s Health Policy Institute. “But for some people with HIV, it is an opportunity to get better coverage.” Here’s a primer.

Two-thirds of HIVers on Medicare are also eligible for Medicaid—and before January 1, Medicaid covered their prescriptions. Now Medicare covers them instead. Those eligible for both who didn’t pick one of Medicare’s many new private plans by January 1 were randomly assigned one. “Dual eligibles are the sickest and poorest people with HIV who can’t afford to pay extra if they are randomly assigned the wrong plan,” says Crowley. “People will fall through the cracks. Even if it’s a statistically small percentage, that is thousands of people.” Peter Ashkenaz, a spokesperson for the Center for Medicare and Medicaid (CMS), says the government has taken precautions to prevent this, but that any dual-eligible person unhappy with the new regimen can find help at his or her pharmacy. For the one-third of HIVers on Medicare who, like Taylor, aren’t dual-eligible,enrollment in the new prescription plan is optional. Their enrollment deadline is May 15—after which they’ll pay a penalty premium.

No plan is permanent. Dual-eligibles can switch monthly and single-eligibles at least once a year. What’s more, all plans cover every antiretroviral (though not necessarily meds for side effects). Can’t find a plan right for you? Crowley recommends dropping by Look at overall cost, including copays and drug coverage. Or visit an AIDS service organization or benefits counselor.Remember: Pick your plan—don’t let your plan pick you.  

Find more info at the following:

Centers for Medicare & Medicaid Services


Gay Men’s Health Crisis Public Policy Department

Treatment Access Expansion Project