Approaching and Important Deadlines for People Eligible for Medicare

Advocates and those eligible to enroll in Medicare Part A and/or Part B, or beneficiaries who want to change their Medicare Advantage plan enrollment need to be aware that both the Medicare General Enrollment Period (GEP) and Medicare Advantage Open Enrollment Period (MA-OEP) is currently open and ends on Wednesday, March 31, 2021.

Medicare General Enrollment Period (GEP)

Beneficiaries who are eligible and wish to enroll in either Medicare Part A or Part B, but are not in their Initial Enrollment Period or a Special Enrollment Period, can only enroll between January 1, 2021 and Marchi 31, 2021, also known as the GEP. During the GEP individuals must apply through the Social Security Administration (SSA) with coverage starting July 1, 2021.

It is essential to apply during the GEP, particularly for individuals in California who do not have premium-free Part A and who may be eligible for the Qualified Medicare Beneficiary (QMB) program. Individuals must apply at SSA for “conditional” Part A during the GEP before applying with the State for the QMB assistance program. If the March 31, 2021, deadline is missed the individual will have to wait until the next open enrollment to apply for QMB coverage.

Medicare Advantage Open Enrollment Period (MA-OEP)

During the MA-OEP, individuals enrolled in Medicare Advantage (MA) plans can drop their MA coverage and choose original Medicare with a Prescription Drug Plan (PDP) or change from one MA plan to another, with or without prescription drug coverage. Individuals in Original Medicare may not use the MA-OEP to change their standalone Part D Plan choice or join an MA plan. For enrollees without the Low-Income Subsidy (”Extra Help”), this is the last opportunity in the year to change coverage during the year unless they qualify for a Special Enrollment Period A list of SEPs is here.


Great News: Covered California Open Enrollment Extended to May 15, 2021 to Help California’s Uninsured Who May be Eligible for Financial Help

In late January 2021, Covered California announced the establishment of a special-enrollment period to allow more people the opportunity to sign up for health care coverage. Effective February 1, 2021, anyone uninsured and eligible to enroll in health care coverage through Covered California can sign up through May 15, 2021.

It is estimated that 2.7 million Californians are currently uninsured, including 1.2 million who are eligible for financial help from Covered California or through Medi-Cal. In the Greater Bay Area, an estimated 122,000 individuals are uninsured who are eligible for help. Covered California reported “that 1.4 million people, or 90 percent of Covered California’s enrollees, are receiving some level of financial help that lowers the cost of their monthly premium…”

“In addition, consumers who sign up through may find out that they are eligible for no-cost or low-cost coverage through Medi-Cal, which they can enroll in online. It is important to note that those who are eligible for Medi-Cal can enroll year-round and have coverage that is effective immediately.”

The move by Covered California to create a special-enrollment period follows President Biden’s executive order to declare a special enrollment period from February 15 through May 15, 2021, for the 36 states served by the federally facilitated marketplace, reopening the doors to coverage for millions of Americans.

For those San Franciscan residents who are living with HIV and are in need of health care coverage, PRC’s Equal Access to Healthcare Program (EAHP) team can help. Please contact the team by emailing to [email protected] or call (415) 972-0870 and ask for the EAHP team.


In History: Medicare and Medicaid Celebrates the 55th Anniversary

On July 30, 1965, Medicare and Medicaid programs were establish when President Lyndon B. Johnson signed the legislation them into law. This year marks the 55th anniversary of these important healthcare programs and they have continued to protect the health and well-being of millions of families, saving lives, and improving the economic security in the United States.

To learn more about Medicare and Medicaid in San Francisco follow this link:


Congratulations to SF HIV FOG for acceptance of their AIDS2020 Abstract

PRC would like to congratulation the San Francisco HIV Frontline Organizing Group (SF HIV FOG) for the acceptance of their AIDS2020 abstract: CREATING A PROFESSIONAL COMMUNITY OF FRONTLINE WORKERS AS AN INNOVATIVE METHOD TO IMPROVE THE CARE OF PEOPLE LIVING WITH HIV/AIDS.

Below is the poster which was shown at the virtual AIDS2020 conference, July 6 thru 10.

COVID-19 ADAP Update from the California Department of Public Health Office of AIDS

  • For all participants whose enrollment expired or was set to expire before August 30, 2020
    • ADAP & PrEP-AP has extended eligibility to August 31, 2020
  • OA-HIPP, EB-HIPP & MDPP enrollments have been extended through September 30, 2020
  • New ADAP applicants can reach out by phone or email to an enrollment worker
  • If you are having difficulty finding an enrollment worker, call 844-421-7050 for assistance
  • Until July 15, 2020, applicants can provide their 2018 tax returns as proof of income for program eligibility

What is PrEP?

Have you heard of PrEP and wondered what it stood for?

PrEP stands for Pre-exposure prophylaxis. PrEP is a daily HIV prevention pill for those who are HIV-negative and want to reduce their risk of exposure to HIV.  Research shows that, when taken consistently, PrEP provides protection from contracting HIV in a high percentage of individuals.

The California Department of Public Health Office of AIDS offers assistance to those without insurance to cover PrEP. You may be eligible to receive PrEP free of charge as part of the Patient Assistance Program, known as PrEP-AP.  The program provides assistance with PrEP-related medical costs and other medications for the prevention of HIV and the treatment of sexually transmitted infections.

PrEP-AP Eligibility:

  • California resident
  • At least 18 years old
  • Negative HIV/AIDS test result (dated within six months of the PrEP-AP application)
  • Annual Modified Adjusted Gross Income (MAGI) cannot exceed 500% of the Federal Poverty Level
  • Medication expenses are not fully covered by Medi-Cal or other third-party payers
  • Enrolled in the manufacturer’s assistance program (if eligible)

If an individual is HIV+, the California Department of Public Health Office of AIDS has other programs to help pay for medication and health coverage related expenses:  AIDS Drug Assistance Program (ADAP),  Health Insurance Premium Payment program (OA-HIPP),  Employer-Based Health Insurance Premium Payment (EB-HIPP), and Medicare Part D Premium Payment (MDPP) Assistance.

References and Resources:

PrEP Facts

Getting to Zero SF PrEP

ORDER OF THE HEALTH OFFICER No. C19-09 & -07c – Shelter In Place through May 31

April 29th – San Francisco’s health orders were updated and extended through May 31st.

Click here to access the updated order, Frequently Asked Questions, and information about “what has changed” from the San Francisco Department of Public Health.

March 31st – San Francisco Department of Health has issued “ORDER OF THE HEALTH OFFICER No. C19-07b (SHELTER IN PLACE)” which outlines requirements for San Francisco residents, businesses, and visitors.

Click here for access to an overview and full information on this order

March 20th – San Francisco Department of Health has issued “ORDER OF THE HEALTH OFFICER No. C19-09 (LIMITATIONS ON RESIDENTIAL FACILITY VISITORS)” which outlines the constraints currently in place on visitors to PRC BP residential facilities.

Click here for access to the full information on this order.

HIV Prevention Starts with Each of Us:Women and Girls Awareness Day and Let’s End the HIV Epidemic Together

Every year on March 10th,  the U.S. observes National Women and Girls HIV/AIDS Awareness Day. HIV prevention and treatment are critical to reducing new HIV cases among women and girls.  Women and girls – as well as their partners, friends, and family members who care about them – are encouraged to learn more about how they can take control of their own health to prevent and treat HIV. HIV/AIDS is an equality opportunity virus. Any woman or girl who is sexually active can contract HIV/AIDS regardless of race, ethnicity, age, or sexual orientation. However, statistics show that African American and Latinx women and girls have a higher chance of acquiring HIV than their counterparts. [Facts] There is great news! With today’s advancements in HIV/AIDS research and treatment it is possible to prevent HIV infection or passing the virus on to a partner or baby.  Some unique challenges women and girls face are related to STDs, which may increase the risk of HIV infection. Ending the HIV Epidemic (EHE) is addressing the specific needs of women and girls who could be exposed to the virus or living with HIV. Please take a minute to view this important message from Rear Admiral Sylvia Trent-Adams, Ph.D., R.N., F.A.A.N., Principal Deputy Assistant Secretary for Health in the Office of the Assistant Secretary for Health. Follow these links to: Learn more about National Women and Girls HIV/AIDS Awareness Day Find a local HIV testing or a healthcare provider, visit Find out more about PrEP at and see if you qualify for the Ready, Set, PrEP at Together, we can stop HIV.

How to Qualify for Social Security Disability Benefits With HIV/AIDS

If you have HIV or AIDS, and your symptoms have advanced and made it impossible for you to work and earn a living, you may qualify for Social Security Disability benefits. The Social Security Administration (SSA) oversees two different disability programs that offer monthly benefits to disabled workers. A medical guide, which is called the Blue Book, is used to determine if an individual meets the medical criteria to qualify for disability benefits. There are several listings in the Blue Book that may apply to an HIV or AIDS diagnosis, but there is a specific listing that focuses on the condition itself. Meeting the Medical Criteria Section 14.00 of the Blue Book applies to adult immune system disorders. Listing 14.11 itself applies to HIV infection itself. To qualify using this listing, you must provide documentation to confirm your diagnosis, and you must also be able to prove one of the following:
  • Multicentric Castleman disease that affects multiple groups of organs containing lymphoid tissue or lymph nodes OR
  • Primary effusion lymphoma OR
  • Progressive multifocal leukoencephalolopathy OR
  • Primary central nervous system lymphoma OR
  • Pulmonary Kaposi sarcoma OR
  • Absolute CD4 count of 50 cells/mm3 or less OR
  • Absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent, and one of the following – BMI measurement of less than 18.5, hemoglobin measurement of less than 8.0 grams per deciliter, or complications of HIV infection requiring a minimum of three hospitalizations within a 12-month period at least 30 days apart with each hospitalization lasting no less than 48 hours.
For your claim to be successful, you must provide hard medical evidence that includes test results and different laboratory tests that confirm your diagnosis and that support your claim. Any opportunistic diseases that you have been diagnosed with should have indications of a cell-mediated immunity and should have been diagnosed by the proper testing. As an example, provide biopsy results for any cancer diagnosis and biopsy results for toxoplasmosis of the brain. You should provide detailed records that confirm any systems, restrictions, and limitations, such as headaches, fever, brain lesions, and seizures. Even if your diagnosis does not meet any of the specific Listings set out above, you can still be found disabled if you can show that your impairment prevents you from being able to perform the functions of your past relevant work or other full time work. Medical tests, including positive serology tests, should be provided to help confirm the diagnosis and its severity. Some blood tests, including CD4 tests, aren’t adequate for confirming a diagnosis of HIV or AIDS. Remember, hard medical evidence and supporting documentation are essential for a disability claim to be successful. Applying for Disability Benefits If you are unable to work because of HIV or AIDS, or because of an opportunistic disease resulting from either of those conditions, you should apply for Social Security Disability benefits. You can start your application process online at the SSA’s website or by calling 1-800-772-1213 and talking with a representative or by scheduling an appointment at your local SSA field office. While it sometimes takes months for a claim to be approved, the more documentation that you provide to support your claim, the more likely you are to get an approval and be awarded disability benefits. Resources: