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.
- The ABCDs of Medicare Coverage - Resource for People with HIV
This resource helps clients understand the different parts of Medicare (Parts A, B, C, and D) and the difference between Original Medicare and Medicare Advantage plans as they consider enrolling in Medicare. This resource is also available in Spanish and Haitian Creole. - Best and Promising Practices for Engaging, Enrolling, and Retaining People with HIV in Health Coverage
The ACE TA Center has identified best and promising practices for engaging, enrolling, and retaining people with HIV in health coverage. Though the current list is most relevant to enrollment in Marketplace health insurance, many of the best practices can also apply to Medicare and Medicaid enrollment work. - Frequently Asked Questions about Medicare
This searchable page features questions commonly asked during ACE TA Center webinars on Medicare. Questions and answers are arranged into six categories. - FAQ: Medicare Prescription Payment Plan
This searchable FAQ explains two key Medicare reforms going into effect on January 1, 2025: the new Medicare Prescription Payment Plan (MPPP) and the Medicare Part D $2,000 out-of-pocket (OOP) cap.
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.
