On Friday, February 27, 2026, the Centers for Medicare & Medicaid Services (CMS) released a Special Enrollment Period (SEP) bulletin.
Consumers who are losing eligibility for premium subsidies for their Marketplace coverage under Florida’s AIDS Drug Assistance Program (ADAP) as of March 1, 2026, are eligible for a SEP to change their Marketplace plan. They have until April 30, 2026, to use their SEP to select a new plan, if they wish to do so.
Read and download the CMS letter here to get details about how to begin this process and meet the April 30, 2026 deadline to select a new plan.
Factors That Determine Whether a Plan Can Realistically Support Ongoing HIV Care
Individuals should review the following when making decisions during the special enrollment period:
Medication coverage
* Check whether your current HIV medications appear on the plan’s formulary.
* Look at tier placement, because higher tiers often mean higher out‑of‑pocket costs.
* Review whether the plan requires prior authorization, step therapy, or quantity limits for HIV medications.
Access to your care team
* Confirm that your HIV specialist, primary‑care provider, and preferred clinic are in‑network.
* If you rely on a specific pharmacy—especially one experienced in HIV care—verify that it is covered.
* Out‑of‑pocket costs
* Compare deductibles, copays, coinsurance, and maximum out‑of‑pocket limits.
* Plans with lower premiums sometimes have higher medication costs, which can matter for HIV treatment.
Additional factors that matter for HIV care
* Lab and monitoring coverage: HIV care requires regular labs. Look at how the plan covers viral‑load tests, CD4 counts, and other routine monitoring.
Emergency and urgent care
* Ensure the plan provides reasonable coverage for emergency care, especially if you travel or live far from your primary clinic.
Case management and support services
* Some plans offer case management, care coordination, or support programs that can help with navigating benefits and maintaining adherence.
Telehealth
* If you use telehealth for follow‑up visits or mental‑health support, check whether the plan includes these services.
A structured approach can make the process easier:
* Make a list of your current medications, providers, and pharmacies.
* Use the plan’s Summary of Benefits and Coverage to compare key features.
* Review the plan’s drug formulary and provider directory carefully.
* Consider how often you use care and what services you rely on most.
* Community‑based HIV organizations often have benefits counselors who can help review plan options.
NMAC Action
NMAC is continuing its advocacy efforts around the Florida ADAP change in income eligibility that removes more than 16,000 Floridians living with HIV from access to essential, lifesaving medications.
Read the Friday February 27, 2026 press release here to learn about the issue and NMAC’s advocacy actions.
Partner Resource: The AIDS Institute (TAI)
Download our partner, The AIDS Institute’ just-released fact sheet, “Options for Florida ADAP Enrollees When ADAP Premium Assistance Stops”
You can also view their Protect ADAP Action Alert here.