Medication and Insurance Assistance (Including MIDAP and MDP)

Ryan White is the nation's safety net for people with HIV. It covers the cost of HIV medical care (doctor's visits and labs) and treatment (medication co-pays) for those without health insurance. It also can assist when insurance does not cover the full cost.

Many community organizations and doctor's offices around Michigan offer Ryan White services and can help you get medical care.

The Michigan Drug Assistance Program (MIDAP) provides prescription medication and vaccine copay/coinsurance coverage for qualifying Michigan residents with HIV. MIDAP helps cover the cost of certain U.S. Food and Drug Administration-approved prescription medications and vaccines for qualifying people with HIV. ALL other copays/coinsurance, such as medical visit copays and other medically related services, are the member's responsibility.

In order to be eligible for MIDAP, an individual must:

• Provide proof of HIV Status.
• Be a resident of the State of Michigan.
• Have a gross income between 138%-500% of the Federal Poverty Level (FPL).*
• Not be eligible for any other program. MIDAP is the payer of last resort.

*Your income will be evaluated based upon the Federal Poverty Guidelines in effect when MIDAP receives your completed application. Income is based includes earned income and/or unearned income (e.g., employment income, self-employment income, Supplemental Security Income). To find out how your income compares with the Federal Poverty Level, please use the Federal Poverty Level Calculator.

For more information about MIDAP including how to apply, please visit Michigan Drug Assistance Program.

The Premium Assistance Program (PA) helps Michigan Drug Assistance (MIDAP) clients cover costs associated with their health insurance policy including health insurance premiums to maintain their health insurance coverage. Premium Assistance gives clients the ability to have health care insurance coverage without the worry of affordability. Access to health care insurance enables clients to receive medical care, in addition to medication, to ensure whole body health. 

Three types of premium assistance are available:

• COBRA Premium Assistance.
• Medicare Part C (Advantage Plan) and Medicare Part D (Prescription Plan).
• Qualified Health Plan Assistance.

In order to be eligible for premium assistance, a client must first be eligible, approved and active with MIDAP.

For assistance with paying premiums, you can sign up for Premium Assistance within the MIDAP Online Application.

For more information about Premium Assistance and further resources, please visit Premium Assistance Program.

The Insurance Assistance Program (IAP) helps people with HIV maintain and continue their health insurance benefits while they are facing financial difficulty due to their specific illness. The IAP pays health insurance premiums for eligible individuals.

To qualify for MIDAP insurance assistance, you must have private health insurance. All medical services other than emergencies must be provided in Michigan.

You also:

• Must be living with HIV and meet at least one of the following criteria:
  • You currently are too ill to work in your current job, or
  • There is a substantial likelihood you will become too ill to work within the next three months (as verified by a physician or nurse practitioner), or
  • You currently are receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
• Must be a Michigan resident.
• Must have a gross monthly income that is less than, or equal to, 200 percent of the Federal Poverty Level.*
• Must not have more than $10,000 in cash/liquid assets and provide proof of assets.
• Must not be eligible for any employer-sponsored health insurance, other than your current policy.
• May be eligible and/or receiving Medicaid and/or Medicare.
• May be eligible if you have a Medicare Part D or Medigap policy.

For more information about the Insurance Assistance Program and further resources, please visit Insurance Assistance Program.

Health Insurance Premium Cost-Sharing Assistance (HIPCA) offers financial assistance for qualifying individuals to help pay for insurance premiums, co-pays, coinsurance, or laboratory bills.

• HIPCA Policy and Procedure Guidelines
• HIPCA Online Application

The Michigan Dental Program (MDP) is a comprehensive dental access program for Michigan residents with HIV. Covered dental services are based on pre-approved care plans and include both preventive and restorative care.

The Affordable Care Act Insurance Marketplace is for individuals age 18-64 years with an income of 133 percent to 400 percent of the Federal Poverty Level (FPL). With an income in this range, you may qualify for cheaper health care coverage.

The Michigan Drug Assistance Program (MIDAP) can also assist with health insurance premiums, coinsurances, copays and deductibles.

ACA Open Enrollment is a time when individuals can review, compare and update plans on the Marketplace. MIDAP currently covers Bronze, Silver, Gold and Platinum plans. However, Catastrophic Plans are not covered. To enroll in an ACA plan, visit HealthCare.gov.

• Health Insurance Marketplace FAQ
• 2025 Marketplace Open Enrollment FAQ
• You are Enrolled - How to Make the Most of Your Coverage
• ACA Plans: How to Stay Covered All Year Long
• Enrolling in a Plan: What You Need to Know

Special Enrollment Period (SEP)

You may qualify for a special enrollment period if you have a major life event during the year. Major life events include things like losing your job, marriage, divorce, birth of a child, etc. For more information of qualifying life events, visit Information on Special Enrollment Period.

Medicaid is made up of various insurance plans that can cover low-income adults plus children and pregnant women.

The Healthy Michigan Plan is for people age 19-64 years, with an income at or below 133 percent of the Federal Poverty Level (FPL).

You can apply for Medicaid online at MI Bridges or by calling the MI Bridges Help Desk at 844-464-3447.

Medicare is a health insurance program for individuals age 65 or older, individuals under 65 with certain disabilities, and individuals of all ages with End-Stage Renal Disease (ESRD - permanent kidney failure requiring dialysis or a kidney transplant).

The Michigan Drug Assistance Program (MIDAP) can assist with Medicare Part C (Advantage Plans) and Medicare Part D (Prescription Plans) premiums, coinsurances, copays, and deductibles.

Medicare Open Enrollment is a time when individuals can review and compare benefits between plans on the market and choose the coverage that best fits their needs. MIDAP currently pays premiums for Medicare Part C (Advantage Plans) and Medicare Part D (Prescription Plans).

To enroll in a Medicare Part C (Advantage Plans) or Medicare Part D (Prescription Plans) plan, visit Medicare.gov.

• MIDAP, PA and IAP Chart
  The Michigan Department of Health and Human Services (MDHHS) Bureau of HIV and STI Programs (BHSP) offers programs to help eligible residents access and maintain treatment. The Michigan Drug Assistance Program (MIDAP) is federally funded and covers the cost of HIV-related medications and copays for uninsured and underinsured clients between 138% and 500% of the Federal Poverty Level (FPL). The Premium Assistance Program (PA), also federally funded, helps pay insurance premiums – including Medicare Part C or D, COBRA or Qualified Health Plans for individuals already enrolled in MIDAP. The Insurance Assistance Program (IAP) is state-funded and supports clients with disabilities who have incomes below 200% of the FPL and less than $10,000 in assets (excluding a home or car). It may also assist with Medicare Part D premiums for Medicaid recipients. Together, these programs ensure that individuals living with HIV in Michigan can access care and medication support.
• Michigan 2-1-1
  Michigan 2-1-1 is a free service available 24/7/365 to help connect Michigan residents with the information and resources they need. For assistance with locating resources available in Michigan to help prevent, diagnose and treat HIV and STIs, visit: Michigan 2-1-1 HIV/STI Services.

• Extra Help with Medicare Prescription Drug Plan Costs (Social Security Administration)
  

  Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $5,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

  Clients who have a Medicare Part D plan and have a FPL of 150% or lower are required to apply for a Low Income Subsidy/Extra Help and submit the determination in the MIDAP Online System.

• Ryan White HIV/AIDS Program (RWHAP) Policy Clarification Notices of Interest (Health Resources & Services Administration [HRSA] HIV/AIDS Bureau)
  • Policy Clarification Notice (PCN) #13-02: Clarifications on Ryan White Program Client Eligibility Determinations and Recertifications Requirements
    This policy clarification outlines the RWHAP expectations for client eligibility assessment and clarifies the recertification requirements. (Relates to Policy Notice #10-02 and 2011 National Monitoring Standards)
  • Policy Clarification Notice (PCN) #13-05: Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Private Health Insurance
    This policy clarification notice reiterates HRSA policy regarding the use of RWHAP funds for premium and cost-sharing assistance for the purchase and maintenance of private health insurance coverage. It also provides RWHAP grantees and subgrantees with additional guidance on using RWHAP funds for premium and cost-sharing assistance. (Relates to HAB Policies #10-02 and #7-05) 

• MDHHS HIPCA, DMR, MIDAP, PA, Medicaid, Gap Insurance Education Training
  This recording includes updates from the Continuum of Care Unit (CoC), MIDAP, IAP and Script Guide Rx. We take a deeper dive into the policy and procedures for HIPCA and MIDAP along with updates to the Direct Member Reimbursement Process.
• Special Enrollment Periods (SEP) Reference Chart (Beyond the Basics)
• Employer Coverage & Premium Tax Credit Eligibility Guide (Beyond the Basics)