What to know about important insurance changes in 2026

Must-know info for people living with HIV, people on PrEP and/or people who are immigrants about changes in insurance coverage and programs that can offer assistance.

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There are many changes happening to insurance coverage beginning in 2026, including eligibility changes for some immigrants and significantly higher premiums for Covered California plans.

We urge all people to review their insurance coverage and contact a health insurance benefits counselor with any questions before the end of the 2025 calendar year.

SFAF counselor talking to a client

Medicare benefits support

HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare. Call 1-800-434-0222.

More info

Covered California benefits support

Find a certified enrollment counselor to answer questions about Covered California plans.

Available here

I need help affording PrEP and other sexual healthcare

PrEP-AP is a California program that provides medications and medical care to people at risk for HIV. 

Services include PrEP, DoxyPEP, PEP, STI treatment and prevention, HIV & STI testing, gender affirming care, and more 

There are no restrictions based on immigration status.  

For more info, contact a PrEP-AP enrollment site near you.

I need help affording HIV medications and care

AIDS Drug Assistance Program: 

The AIDS Drug Assistance Program (ADAP) provides eligible California residents with free HIV medications and premium payment assistance. 

There are no restrictions based on immigration status.  Look here for more info or call (844) 421-7050.

Medicare Premium Payment Program (MPPP): 

If you have Medicare, and are eligible for ADAP, the Medicare Premium Payment Program (MPPP) can pay Medicare Premiums. Visit this page or contact your ADAP Enrollment worker for additional information. 

Office of AIDS Health Insurance Premium Payment program (OA-HIPP): 

The Health Insurance Premium Payment program by the Office of AIDS (OA-HIPP) pays for health insurance premiums and certain out-of-pocket costs for California residents who are also part of ADAP. 

There are no restrictions based on immigration status. 

This program is only for people who are not fully covered by Medi-Cal 

The program can pay up to $2,996 per month in combined premiums (including the cost for medical, dental, and vision insurance plans) 

Enroll through an ADAP enrollment worker or look here for more information on how to enroll.

ADAP Enrollment Sites

The AIDS Drug Assistance Program (ADAP) is for people diagnosed with HIV or AIDS, and provides eligible Californians with free HIV medications and premium assistance.

Available here

Health Consumer Alliance

The Health Consumer Alliance (HCA) is a statewide partnership that offers Free Over the Phone or In-Person Assistance to help California residents struggling to get or maintain health coverage and resolve problems with their plans.

Available here

I am an immigrant. What should I know?

The U.S. Department of Health and Human Services (HHS) has recently changed the definition of who qualifies for certain health programs, like Medicare and Medicaid, based on immigration status. 

Previously immigrants of certain statuses (like green card holders, DACA recipients, survivors of domestic violence, survivors of trafficking, asylum seekers, and others) could access public insurance benefits. This is changing. 

Review your insurance coverage now. Contact a health insurance benefits counselor with any questions before the end of the 2025 calendar year. 

Medi-Cal: If you are undocumented, need health insurance, and may qualify for Medi-Cal – enroll in Medi-Cal by December 30, 2025. People with “unsatisfactory immigration status” (UIS) will no longer be eligible to enroll in Med-Cal starting in January, 2026. You can find out how to enroll at sfhsa.org/services/medi-cal, SFMedi-Cal@sfgov.or, or call 855-355-5757.   

“UIS” includes: undocumented adults; asylum applicants with work authorization; DACA recipients; some green card holders; people who have applied for a visa; people who are on visitor, student, or temporary work visas; and others. Find the entire list of “UIS” on the California Department of Health Care Services website.

Medicare: There may be impacts to Medicare coverage for people of certain immigration statuses–including refugees, asylees, and people with temporary protected status–in the next year. Reach out to a benefits counselor with any questions about your coverage. (HICAP: 800-434-0222) 

I am on Medi-Cal. What should I know?

Starting January 1, 2026, Medi-Cal will freeze new enrollments for certain adults who are undocumented and do not have a “satisfactory immigration status.” 

“Unsatisfactory immigration status” (UIS) is a term the government uses to describe people with certain immigration statuses. 

“UIS” includes: undocumented adults; asylum applicants with work authorization; DACA recipients; some green card holders; people who have applied for a visa; people who are on visitor, student, or temporary work visas; and others. Find the entire list of “UIS” on the California Department of Health Care Services website.

But, if you are already enrolled in Medi-Cal by the end of 2025, you will be able to keep your coverage no matter your immigration status (as long as you complete your annual renewal). 

If you are part of Medi-Cal and lose your coverage, you won’t be able to sign up again (except for emergency and pregnancy care). If your coverage stops because of a late renewal or missing paperwork, you will have 90 days to fix it and stay enrolled.

If you are undocumented or have another UIS, you need health insurance, and you may qualify for Medi-Cal – now is the time to apply for coverage. Enroll in Medi-Cal by December 30, 2025! 

You can find out how to enroll at sfhsa.org/services/medi-cal, by emailing SFMedi-Cal@sfgov.or, or by calling 855-355-5757.  

I am on Medicare. What should I know?

Review your plan during open enrollment (October 15 – December 7, 2025) 

Part B premiums will increase to $206.50; Part B deductible is projected to be $288  

There are assistance programs available to help cover costs associated with HIV and PrEP through the State Office of AIDS. 

There have been recent changes to Medicare eligibility for some immigrants. Some lawfully present immigrants will no longer be able to enroll in Medicare, including individuals with status as refugees, asylees, and temporary protected status designees. If you’re losing coverage due to these changes and you are living with or at risk of HIV, see “I need help affording HIV medications and care” and “I need help affording PrEP and other sexual healthcare” above.  

About the author

San Francisco AIDS Foundation

San Francisco AIDS Foundation promotes health, wellness and social justice for communities most impacted by HIV through sexual health and substance use services, advocacy, and community partnerships. Each year more than 21,000 people rely on SFAF programs and services, and millions more access SFAF health information online.