THMP – Texas Insurance Assistance Program-PLUS (TIAP-PLUS)

What is TIAP-PLUS?

The Texas HIV Medication Program (THMP) was approved to 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.

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 the costs below: 

• 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) in some local areas support these costs. Health Insurance Premium and Cost Sharing Assistance | Texas DSHS)
• 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 the following information:

• 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 follow the steps below:

• 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.

More program information is being finalized. Updates coming soon.

THMP encourages you to subscribe to the THMP News to stay updated

Revised November 20, 2024