THMP – Texas Insurance Assistance Program-PLUS (TIAP-PLUS)
What is TIAP-PLUS?
The Texas HIV Medication Program (THMP) can now purchase health insurance for uninsured Texans living with HIV through a new service offering, TIAP-PLUS. Before enrolling in insurance, participants must meet THMP eligibility criteria, including income requirements.
Which health insurance plans will TIAP-PLUS cover?
To qualify for coverage under TIAP-PLUS, applicants must enroll in plans that meet the following criteria:
- Be a qualified health plan.
- Have appropriate primary care services, including the medical location where the applicant receives HIV medical care.
- Have at least one drug in each class of core antiretroviral therapeutics from the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.
- Include the prescription medications the applicant needs, especially those for HIV treatment.
- Include a TIAP participating pharmacy convenient to the applicant.
- Be cost-effective, as determined by THMP.
Pre-approved Marketplace Plans for Clients BELOW the 100% Federal Poverty Level (FPL) | Pre-approved Marketplace Plans for Clients ABOVE the 100% Federal Poverty Level (FPL) |
Pre-Approved Marketplace Plan List for Individuals below 100% FPL | Pre-Approved Marketplace Plan List for Individuals above 100% FPL |
Pre-Approved Marketplace Plan List for Individuals below 100% FPL – Instructions | Pre-Approved Marketplace Plan List for Individuals above 100% FPL – Instructions |
What costs will THMP cover on TIAP-PLUS?
THMP will cover the costs associated with the medication needs of the program participant. This includes the following:
- Health insurance premiums
- Medication copayments and deductibles
What costs will THMP not cover on TIAP-PLUS?
THMP does not cover some costs:
- Fines or tax obligations the participant may incur while participating in an Affordable Care Act (ACA) Marketplace Plan
- Medical visit deductibles or copayments. Local Health Insurance Assistance Programs (HIA) support these costs in some local areas.
- Expenses related to inpatient hospitalization, emergency care, or any other medical services
- Expenses for other family members or dependents on the health insurance plan
- Costs related to free-standing vision or dental plans
- Other costs outside of those outlined above under the “What costs will THMP cover on TIAP-PLUS” Section
How does an applicant apply for TIAP-PLUS?
To qualify for THMP, applicants must complete a THMP eligibility application and submit:
- Proof of an HIV diagnosis
- Proof of Texas Residency
- Proof of income, which must be at or below 200 percent of the federal poverty level
Applicants can contact THMP at 1-800-255-1090 with questions about the TIAP-PLUS application process. Local HIV service agencies can also assist with THMP application submissions. To apply for TIAP-PLUS, an applicant must:
- Navigate to TakeChargeTexas to submit a THMP application.
- Select TIAP from the My Needs page in the TCT portal.
- Under contact preferences, select “mail” and “phone.” THMP will need to contact the applicant during the insurance enrollment process.
- The applicant may contact THMP at 1-800-255-1090 for a paper application, if preferred.
What are the TIAP-PLUS health insurance applicant enrollment requirements?
- Applicants must be eligible for THMP and maintain active THMP eligibility.
- Applicants must be eligible for the plan they wish to enroll in, as determined by the ACA Marketplace or other insurance plan eligibility requirements.
- Applicants cannot select a Consolidated Omnibus Budget Reconciliation Act (COBRA) plan if they qualify for a more cost-effective health insurance plan.
- If eligible, applicants must accept the monthly Advanced Premium Tax Credit to help pay for insurance premiums.
- If applicable, the applicant must accept cost sharing reductions and enroll in a silver plan.
- The applicant must enroll in a THMP pre-approved plan or submit a different plan for THMP program approval before enrollment. If the applicant enrolls in a plan before THMP program approval, there is a chance that the plan will not qualify for THMP.
How do I find more information on THMP?
For more information, visit the Texas HIV Medication Program.
Supporting Documents |
THMP Insurance Expansion – Poster (English) | THMP Insurance – Poster (Spanish) – For community agencies to display for clients. |
THMP Insurance Expansion – Flyer (English) | THMP Insurance Expansion – Flyer (Spanish) – Information for community agencies to display and distribute to clients. |
Insurance Purchasing Flow – Graphic showing TIAP-PLUS Insurance Assistance application process. |
My Insurance Information – Tool for TIAP-PLUS applicants for use in selecting an insurance plan. |
Premium Payment Information Form |
Texas HIV Medication Program (THMP) Affordable Care Act (ACA) Insurance Assistance Program Client Agreement (English) | Texas HIV Medication Program (THMP) Affordable Care Act (ACA) Insurance Assistance Program Client Agreement (Spanish) |
TIAP-PLUS Factsheet |
More program information is being finalized. Updates coming soon.
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Revised 12/9/2024