Medicare Coverage

There are multiple ways that a client can become eligible for and enroll in Medicare. This graphic depicts six pathways to enrollment oriented along the lifespan. Click the image to expand the graphic.

The following tools and resources are intended to provide RWHAP managers, staff, and enrollment assisters with an overview of Medicare eligibility and coverage, including prescription drugs, for RWHAP clients and people with HIV.

Basics and Eligibility

  • The Basics of Medicare for RWHAP Clients
    Learn about the common Medicare eligibility pathways for people with HIV; the different parts of Medicare, including their coverage and costs; how you can support RWHAP clients to enroll in Medicare; and how the RWHAP helps clients with Medicare costs. This resource is also available in Spanish and Haitian Creole.
  • Medicare Prescription Drug Coverage for RWHAP Clients
    Learn about how clients get Medicare prescription drug coverage; requirements for Medicare prescription drug coverage; coverage for HIV medications; the “donut hole” period for prescription drug coverage; and how the RWHAP, including its AIDS Drug Assistance Program (ADAP), can help clients pay for Medicare prescription drug coverage.
  • Long-Acting Injectable Antiretroviral Therapy: Coverage and Cost-Sharing Considerations for RWHAP Clients
    This fact sheet will help RWHAP recipients navigate insurance coverage and cost sharing considerations for LA-ART. LAI ART is a form of HIV treatment that is available as an injection, received routinely by an individual (monthly or bi-monthly), and administered by a clinician or other health care professional.

Enrolling Clients in Medicare

  • How Medicare Enrollment Works
    Learn about the difference between the Initial Enrollment Period, Special Enrollment Period, and General Enrollment Period for Medicare; when clients need to enroll in Medicare to avoid late enrollment penalties; what clients enrolled in a Marketplace plan should do when they enroll in Medicare; and how clients can make changes to their Medicare coverage.
  • How to Enroll Clients in Medicare: Microlearning Module
    This microlearning module outlines the basic eligibility pathways for health coverage through Medicare, the Parts of Medicare, how to enroll in Medicare, and the relationship between Medicaid and the RWHAP ADAP. The module also suggests other ACE TA Center resources for RWAHP staff and people with HIV to learn more about Medicare coverage.
  • Transitioning from Marketplace to Medicare Health Coverage
    Learn how to help RWHAP clients navigate the transition from Marketplace to Medicare smoothly and efficiently using this helpful guide. The resource includes answers to frequently asked questions about this process.
  • One-on-One Medicare Enrollment Assistance for Ryan White HIV/AIDS Program Clients
    This resource provides an overview of State Health Insurance Assistance Programs (SHIP), which provide free, local, and unbiased health coverage counseling and information to people who are enrolled in Medicare or who are about to become eligible for Medicare.
  • The Fundamentals of Medicare-Medicaid Dual Eligibility for Ryan White HIV/AIDS Program (RWHAP) Clients
    This tool is intended to help case managers better understand the fundamental health coverage needs of their dually eligible clients, including how RWHAP and the ADAP work with Medicare and Medicaid coverage.
  • Dual Eligibility and Enrollment of Ryan White HIV/AIDS Program Clients: Microlearning Module
    This microlearning module provides an update on what Medicaid/Medicare dual eligibility is, types of dual eligibility, the basic pathways by which a person becomes dually eligible, how to enroll dually eligible clients, and the role of the RWHAP ADAP. The module also suggests other ACE TA Center resources for RWAHP staff and people with HIV to learn more about resources to support clients who are dually eligible.

Financial Help

  • Financial Help for Medicare
    This resource provides an overview of Medicare Savings Programs, the Extra Help program, and other sources of financial help for Medicare costs as well as eligibility criteria for these programs and how to support RWHAP clients to get help paying their Medicare premiums and out-of-pocket expenses.