Navigating the Healthcare System: A Practical Guide

1) Start with the basics: your health information and your rights

• Know your health information. Keep a list of your medicines, allergies, past surgeries, and diagnoses. Bring it to every visit. Health literacy means having the information and services you need to make good health decisions. It also means being able to find, understand, and use health information during appointments.
• Use plain language with your care team. Ask your doctor to explain tests, treatments, and next steps in simple words. Ask “What is my main problem, what do I need to do, and why is it important for me to do this.” These are teach-back questions that help you check understanding.
• Know your preventive care benefits. Health plans must cover many preventive services at no cost, including routine screenings. Recent court decisions preserved the Affordable Care Act requirement that plans cover preventive services such as HIV screening and PrEP without cost sharing, and federal guidance confirms coverage for long-acting injectable PrEP as a preventive service.

2) Choose and use health coverage

• Compare plans by total cost, not only the monthly premium. Look at the deductible, copays, coinsurance, and the medicine list. If you see doctors often or take daily medicines, a lower deductible can save money over the year.
• Check that your doctors and clinics are in network. In-network care usually costs less. If your current doctor is not in network, you may be able to keep seeing the doctor for a short time under “continuity of care,” but you must contact your insurer to request this.
• Know what every Marketplace plan must cover. All plans must cover essential health benefits such as doctor visits, hospital care, prescriptions, lab tests, mental health, substance use services, preventive care, and chronic disease management.
• Where to get help. You can meet with trained navigators or a licensed broker for free help picking a plan.

3) Make the most of a clinic visit

• Before your visit. Write your top three questions. Bring a list of medicines and doses. Bring your insurance card and a photo ID.
• During your visit. Ask about benefits and risks, costs, and next steps. Ask how to reach the clinic after hours. Ask when you should come back. Use teach-back to repeat instructions in your own words.
• After your visit. Read your visit summary. Set reminders for medicines and follow-up tests. Call the clinic if side effects or new symptoms appear.

4) Everyday health habits that support care

• Be active each week. Adults need at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week, plus muscle-strengthening on 2 days. You can break this into short sessions.
• Eat well, sleep well, and manage stress. These basics help medicines work better and help your body recover after illness.

Navigating Care for People Living with HIV

This section explains practical steps for finding coverage, staying in care, and using local help if you live with HIV.

1) Your key rights and protections

• No one can deny you coverage because of HIV. The Affordable Care Act ends pre-existing condition denials and increases access to HIV treatment and preventive services.
• Preventive HIV services are covered. Most plans must cover HIV screening and specified formulations of PrEP without cost sharing. Federal guidance clarifies that this includes long-acting injectable PrEP.

2) Picking a health plan when you take HIV medicines

• Look closely at the drug coverage. Check that your antiretroviral therapy and any other medicines are on the plan’s formulary. Compare copays or coinsurance for brand and generic options.
• Review total costs. Plans with lower premiums can have high deductibles. If you see your HIV clinician often or need lab monitoring, a plan with better cost sharing may save money overall.
• Ask about financial help. Many people qualify for help with premiums or out-of-pocket costs in Marketplace plans. Some programs can also help pay for premiums and medicines if you qualify.

3) Coverage pathways if you live with HIV

• Marketplace coverage. You can buy a plan and may qualify for premium tax credits and cost-sharing reductions based on income.
• Medicaid. Eligibility rules vary by state. Medicaid may cover doctor visits, hospital care, medicines, labs, and more for eligible adults. Your state Medicaid office or a navigator can explain local rules.
• Medicare. You may qualify for Medicare before age 65 if you receive Social Security Disability Insurance and meet time requirements.
• Ryan White HIV/AIDS Program and ADAP. Ryan White is the largest HIV-specific program in the U.S. It helps people with HIV who are uninsured or under-insured. Part B funds the AIDS Drug Assistance Program, which provides FDA-approved HIV medicines and can pay premiums for eligible clients.

4) Staying healthy after diagnosis

• Stay in regular care and take ART every day. People who start and stay on treatment can live long, healthy lives and protect their partners by keeping the virus undetectable.
• Use reliable federal resources. HIVinfo from NIH offers easy-to-read information on diet, exercise, mental health, legal topics such as disclosure, immunizations, and travel.
• Build strong health literacy. Better health literacy is linked with better adherence and health outcomes for people with HIV. Ask your care team to explain lab results and treatment plans in simple terms, and use teach-back to confirm understanding.

Prince George’s County, Maryland: Where to Get Help

These local programs can help you enroll in coverage, stay in care, and afford your medicines if you live in Prince George’s County.

• Prince George’s County Health Department, HIV/AIDS Program (HAP). HAP provides comprehensive medical care for uninsured and under-insured residents living with HIV. HAP also offers confidential counseling, testing, and referrals. Contact the Health Department to ask about eligibility, appointments, and community testing events.
• HIV Services in Prince George’s County portal. The county’s services page highlights local organizations that provide support services, mental health care, outreach, education, and HIV testing. Heart to Hand in Largo is one of the listed community partners for support services and testing.
• Maryland AIDS Drug Assistance Program (MADAP). MADAP helps Maryland residents living with HIV get free or low-cost medicines. It can also help with insurance premiums for eligible clients. Ask a case manager for help applying.
• Enrollment help for health coverage. Free in-person help is available when you shop for plans. Navigators and brokers can help you compare costs, check formularies, and enroll.
• For complex coverage questions. CMS provides a current guide to Marketplace, Medicaid, and Medicare options for people with HIV, including details on disability and special enrollment rules.

Step-by-step checklist for Prince George’s County residents

1. Get tested or confirm your status at county sites or community partners. Ask about same-day linkage to care.
2. If newly diagnosed, ask the clinic to schedule an intake visit within a few days and to connect you with a case manager and MADAP if you are eligible.
3. Pick a health plan that covers your HIV medicines and preferred clinics. Review deductibles, copays, and drug tiers before you enroll.
4. Enroll in support programs such as Ryan White Part B services and MADAP if you qualify. These can reduce out-of-pocket costs and help keep you in care.
5. Schedule routine follow-ups and lab monitoring. Use reminders to take your medicines daily. Ask your provider to explain every result and next step.
6. Keep up with preventive care and healthy habits. Use your plan’s no-cost preventive services and be active each week.

Frequently asked questions

What if I cannot afford my HIV medicines right now
Ask a case manager about MADAP and Ryan White options. These programs can provide medicines and may pay premiums if you qualify.

Can I get PrEP covered
Most health coverage must cover specified PrEP options without cost sharing, including long-acting injectable PrEP, based on current federal guidance.

How do I find local mental health or support groups
Start with the County Health Department’s HIV services page and community partners. Many offer individual and group support, mental health care, and linkage to other services.

Where can I learn more about living well with HIV
HIVinfo at NIH has up-to-date pages on treatment, diet and nutrition, exercise, mental health, immunizations, travel, and legal topics.

Short glossary

• Deductible. The amount you pay each year before the plan starts to pay for covered services.
• Formulary. The plan’s list of covered medicines. Copays and rules differ by tier.
• In network. Doctors and hospitals that have a contract with your plan. Care costs are usually lower in network.
• Continuity of care. A limited right to keep your current doctor for a short period when switching plans, if requested.