ADAP clients with income of at least 75% of the Federal Poverty Level may qualify for assistance with insurance through the Federal Marketplace. Open Enrollment for the closed January 15, 2022, but if you have a qualifying life event, you may qualify for a special enrollment period. Visit https://enroll.brhpc.org or call 844-441-4422 for assistance. Select 1 for English, 2 for Spanish or 3 for Creole THEN select option #1 for insurance enrollment assistance. Clients must enroll in a plan from the list of ADAP Marketplace plans.

In addition to meeting the program qualifications, an individual must meet the following criteria to receive ADAP Insurance:

• Be enrolled in an ADAP supported insurance plan.
• Use a pharmacy in the network of the ADAP contracted Pharmacy Benefits Manager (PBM) to receive medication co-payments, and/or deductible assistance.
• Use the ADAP contracted Insurance Benefits Manager to enroll in and receive premium assistance with insurance.
• Request determination of available subsidies from the Marketplace when submitting a Marketplace application.
• Provide all supporting documentation required by the federally facilitated Marketplace at the time the Marketplace application is submitted, and the enrollment is processed.

• Medicaid Share-of-Cost (if the cost of medications is not enough to activate share of cost Medicaid each month).
• Medicare Part C or Part D (co-pays only).
• Employer-sponsored insurance.
• COBRA policies.
• The annually approved ADAP supported plans in the federally-facilitated Marketplace.

If you have insurance but cannot afford your medication, there are several insurance exceptions that will allow a person to receive assistance.

• No Brand Name Coverage
• No Prescription Coverage
• Open Enrollment
• Pharmaceutical Benefits Cap
• Unaffordable Co-payment