Assisters Succeed in Insurance Navigation for People Living with HIV and People at Increased Risk of HIV in a Complex Coverage Landscape

Abstract

Insurance enrollment is complex for people living with HIV (PLWH) and people at increased risk for HIV, in part, owing to needing to ensure access to adequate provider networks and appropriate formularies. Insurance for PLWH facilitates access to HIV care/treatment and, ultimately, viral suppression, which has the individual benefit of longevity and the public health benefit of decreased HIV transmission. For people at increased risk for HIV, access to insurance facilitates improved access to HIV biomedical prevention, which has the individual benefit of elimination of transmission risk and the public health benefit of decreased HIV transmission. The objective of this study was to explore perceptions of priorities related to plan navigation, barriers and facilitators for enrolling and maintaining insurance coverage, and questions related to regional, state, and federal policies impacting plans provided both on and off the Affordable Care Act (ACA) marketplace. We interviewed a national sample of assisters (n = 40), who specialize in insurance plan selection for these populations. We found that assisters tailor their approaches to HIV-specific and person-specific concerns by navigating challenges related to affordability, formularies, and provider networks. In a complex coverage landscape during a time of uncertainty about the long-term future of the ACA, assisters have mastered the ability to simplify the insurance selection process for a vulnerable population. Assisters have excelled at incorporating insurance literacy education and encouraging client engagement in the process. Assisters play an essential role in the current complicated and fragmented United States' health care delivery system for PLWH and people at increased risk for HIV and could be incorporated into the Ending the HIV Epidemic initiative.

Health insurance literacy among head and neck cancer patients and their caregivers: A cross‐sectional pilot study

“…Nonetheless, further work is needed to improve their health insurance literacy. Disease‐specific interventions have shown some improvements 73–78 . For instance, promising results have been documented from the use of financial navigators and related programs in oncology care 73–77 .…”

“…Disease‐specific interventions have shown some improvements. 73 , 74 , 75 , 76 , 77 , 78 For instance, promising results have been documented from the use of financial navigators and related programs in oncology care. 73 , 74 , 75 , 76 , 77 However, research has traditionally targeted only patients and did not include caregivers.…”

Patient Perspective of People with HIV Who Gained Medicaid Through Medicaid Expansion: A Cross-Sectional Qualitative Study

“…While an overlap might not seem like as big of an issue as a gap, we have heard from insurance assisters that both overlaps and gaps can result in lack of access to medications, including HIV medications. [16] We hypothesize that these overlap and gap issues described by this cohort may be the reason for the lower viral suppression among PWH who transitioned to Medicaid in 2019 that was observed in our clinic's quantitative study. [7] Overlaps/gaps may have only been an issue during the transition year (2019).…”

“…Previous work has demonstrated assisters tailor their approaches to HIV-specific and person-specific concerns by navigating challenges related to affordability, formularies, and provider networks. 16 Almost a quarter stressed the importance of having assistance by including it in their suggestions for Medicaid. The insurance enrollment process can be challenging, especially for patients with limited education or low health literacy.…”

Available but inaccessible: Patient experiences during the first two years of a primary care-based medical cannabis program at an academic medical center

“…Interestingly, patients with HIV were more likely to purchase medical cannabis. This could be because patients with HIV have more interaction with the healthcare system and have developed resources to understand complex healthcare system changes (23,24,25).…”