Sonoma County Home | Site Map | Contact Us | Search

HIV/AIDS Resource Guide for Sonoma County

Esta página en Español

HIV/AIDS Services: Benefits Information

HIV/AIDS Benefits and Benefits Counseling

The benefits available to people living with HIV/AIDS generally fall into one of two categories: Income replacement and Health coverage. In this guide we cover the basic benefits available to many (but not all) people living with HIV/AIDS. To learn more about the support you can receive in paying for health care or replacing lost income schedule an appointment with your benefits counselor. A benefits counselor is available to meet with you at Face To Face (707)544-1581, or you can schedule time with a case manager at your doctor's office if you would like to learn more.

Income Replacement

There are many types of publicly and privately administered benefits programs available to assist you monetarily.

Privately administered programs (such as long-term and short-term disability insurance) can be provided automatically by an employer, offered to an employee at their expense, or purchased individually. There is a significant amount of variation in the benefits and requirements of each of the different policies. Consequently, it is best to contact your plan administrator or benefits counselor with questions about your specific policy.

The Social Security Administration (SSA) pays disability benefits under two programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To be eligible for either program you will need to be determined disabled by Social Security standards. This means that SSA will decide, based primarily on your medical records, whether you are so severely impaired that you will be unable to do any substantial amount of work for at least a year. The take-home message: See your doctor regularly and report all of your symptoms. Your doctor's records may someday play a vital role in determining your income.

To apply for either SSDI or SSI you can: 1) call the Social Security Santa Rosa Field Office at (707) 544- 4302 to schedule an appointment, 2) call Social Security's toll-free number at 1-(800) 772 -1213 to schedule an appointment, or 3) Apply online at www.socialsecurity.gov. Be aware that the online application is only for SSDI benefits.

Social Security Disability Insurance (SSDI): To be eligible for SSDI you need to have been determined disabled and you need to have worked and paid Social Security taxes for approximately five out of the last ten years. The exact number of years of work needed depends on how old you are when you become disabled. The exact amount of your SSDI benefit depends on how much you earned while you were working. There is a five-month waiting period between the date you first become disabled and your first SSDI benefits check. If you are eligible for SSDI but your monthly benefit is low, you may be eligible for both SSDI and SSI.

Supplemental Security Income (SSI): To be eligible for SSI you need to have been determined disabled and you need to meet certain income and resource limitations. You must have an extremely low monthly income and your resources (excluding your residence and one vehicle) must be less than $2000 for a single individual. For 2008, the maximum SSI payment is $870.

State Disability Insurance (SDI): To be eligible for SDI you need to have been working and paying taxes up until the date that your medical provider certifies that you are unable to work for at least eight days. You must apply for benefits within 49 days of becoming disabled. Benefit amounts are approximately 55% of your previous earnings and can be paid for up to 52 weeks. There is a seven day waiting period before benefits are payable. Applications are available from your medical provider, your benefits counselor, or the Santa Rosa EDD Office at 606 Healdsburg Avenue.

Return to Work: Most benefits programs offer incentives to assist you in transitioning from disability to work. For example, SSDI offers the Ticket to Work program, as well as a nine month Trial Work Period where you can continue to receive your full benefit check despite any earned income. Please do not believe the rumors - you can earn money and keep some of your benefits! However, negotiating each program's different regulations can get tricky. If you are considering work, contact your benefits counselor for individualized assistance.

Health Coverage

Employer-Sponsored Health Coverage: Many people with HIV are covered by private insurance through their employer. This kind of coverage is often considered the "gold standard" because of the ease in using it for primary and specialty care. However, private insurance is difficult - if not downright impossible - to get for those who are not employed (and for many who are!). Insurance companies are allowed by law to deny coverage to people with HIV who apply for an individual policy, unless continuous coverage under a previous plan can be documented. For more information about your own private insurance policy, or to find out how you may qualify for private insurance please see a benefits counselor.

Continuation of Employer-Sponsored Coverage: When you leave an employer, you have several options for continuing your health coverage. You can elect to purchase COBRA coverage that will allow you to remain a member in your previous group plan. You will be required to pay whatever your employer was paying for the coverage plus 2% administrative charges. You must elect COBRA coverage within sixty days of receiving your Notice of COBRA Rights from your employer. Coverage under COBRA can continue for 18-29 months. Some health plans will also allow a conversion from an employer-sponsored group health plan to an individual plan. Conversion plans are typically much more expensive and offer less coverage. However, with a conversion you will not be required to prove your insurability to qualify for the individual plan. Under HIPPA laws, when your coverage ends your health plan will automatically provide you with a certificate of creditable coverage, showing the amount of time that you were covered under the plan. If used within 63 days, this certificate can allow you to apply your previous health coverage to the pre-existing conditions exclusion period on a new policy.

CareHIPP: a health continuation program administered by the California State Office of AIDS that pays COBRA, conversion, or private health insurance premiums for up to three years for qualified individuals. There are eligibility guidelines. See your benefits counselor to enroll.

Medi-Cal: health coverage for California's low-income residents who are aged or disabled. To be eligible an individual must meet financial eligibility criteria, and be disabled (by Social Security's standards) or be over 65 years old. Those receiving SSI benefits are automatically enrolled in no share-of-cost Medi-Cal. There are also Medi-Cal programs for pregnant women, children under the age of 21, and emergency medical needs.

Medi-Cal Working Disabled Program: a program that allows a Medi-Cal recipient to earn up to approximately $50,000 per year (in 2008) and retain Medi-Cal benefits with no share-of-cost. A monthly premium is assessed on a sliding scale based on income.

CMSP : health coverage that is similar to Medi-Cal in terms of financial eligibility and coverage, but does not require a person to be disabled to receive benefits. Recipients must re-apply for CMSP every three or six months (depending on income).

To apply for Medi-Cal, Medi-Cal Working Disabled Program, or CMSP schedule an appointment with your benefits counselor to complete a mail-in application. For expedited processing you can also apply in-person at the Sonoma County Human Services Department at 2550 Paulin Drive, Santa Rosa.

Medicare: health insurance for individuals on SSDI benefits or those entitled to Social Security retirement insurance who are 65 years old. Those on SSDI benefits will be automatically enrolled after receiving 24 months of benefits. There are four "parts" to Medicare:

• Part A pays for hospitalization, skilled nursing, home health & hospice care.
• Part B pays 80% of allowable outpatient medical services (like doctor visits) with a 20% cost to the patient after a $100 deductible.
• Part C is an option that allows you to assign your Medicare coverage to a Medicare Advantage Plan. Medicare Advantage Plans are private health plans, HMOs, or PPOs that provide all of your Part A & B, and sometimes D coverage. For example, Kaiser Northern California offers the Senior Advantage Program to Medicare Recipients.
• Medicare Part D pays for prescription drugs. Part D is very complicated in the way it pays for medications throughout the year. Coverage varies depending on the annual cumulative drug costs a patient has reached. A program for low-income individuals, called Extra Help or the Low Income Subsidy, eliminates that variation and reduces co-pays.

ADAP: this program is a supplement intended to carry all or some of the cost associated with HIV medications. It helps pay for FDA-approved medications for HIV/AIDS, HIV-related illnesses, and Hepatitis C treatment. Individuals may be uninsured, on Medicare, or have insurance with insufficient prescription drug coverage. Financial eligibility rules apply. Contact the local ADAP Coordinator at 707-565-7402.

---

Disclaimer: The Sonoma County Department of Health Services makes no assumption of quality and makes no warranties regarding providers appearing in this resource guide. This resource guide simply a public listing provided for consumer convenience, and is not a recommendation or endorsement by the Department.