For decades, many people living with HIV were denied life insurance coverage, deemed too risky to insure. To this day, most life insurance applications ask applicants to answer “yes” if they are HIV-positive, and many companies deny coverage to those who do.

But treatment for human immunodeficiency virus has greatly improved, and the 1.2 million people diagnosed with it in the U.S. can now expect to live almost as long as people without the virus.

Life insurance companies have noticed, and in recent years, some have started to offer policies to people living with HIV. In California, new legislation will ban life insurers from denying coverage based on an HIV-positive test result.

Still, people with the infection may have difficulty finding coverage. Options like group or guaranteed issue life insurance could be alternatives for people unable to secure a standard term or whole life insurance policy.

A handful of companies offer term and whole life
In the 1980s, a diagnosis of AIDS, the disease caused by HIV, meant an average life expectancy of one year, and insurers shied away. Today, medical treatments can prevent most HIV cases from progressing to AIDS.

“HIV is much more understood than when it was first discovered in the 1980s,” Chris Abrams, a life insurance agent and founder of Abrams Insurance Solutions in California, said by email. Abrams says he has helped HIV-positive clients purchase policies from American National, John Hancock and Prudential.

Guardian Life also recently opened the doors to HIV-positive people. “Healthy individuals living with HIV now have access to both whole life and term life,” according to Mark H. Lewy, Guardian’s chief medical director.

The COVID-19 pandemic has slowed approval in some cases, Abrams says, but it has not stopped insurers from writing new policies for people with HIV. “I just had an HIV-[positive] client approved last week.”

Expect higher costs and strict requirements
People living with HIV will pay much more for life insurance than a healthy person without the infection. For a typical term life insurance policy, an applicant with HIV might pay 10 times as much as someone in excellent health without HIV, says Jeremy Hallett, CEO of Minneapolis-based life insurance brokerage Quotacy.

Insurers also impose requirements for age and treatment. Guardian Life asks that people with HIV be between the ages of 20 and 60 and show they’ve received at least two years of antiretroviral therapy, or ART, a daily regimen of medication that reduces the amount of HIV in the bloodstream. John Hancock has stricter requirements, covering people 30 to 65 years old, with at least five years of effective treatment. Both companies require customers to receive regular care from a doctor who specializes in HIV treatment, and applicants with a history of substance abuse, intravenous drug use, hepatitis or AIDS are denied.

Even then, it’s not guaranteed that a person with HIV will qualify. Some prospective customers have been turned down despite meeting the requirements, says Scott Schoettes, counsel and HIV project director for Lambda Legal, a nonprofit that provides HIV advocacy, among other services. The reasons for denial aren’t always clear. “If a person is denied, they should be able to demand the reason for being declined,” Schoettes says.

Some policies offer guaranteed coverage
If a person with HIV can’t get a standard policy, other options may be available.

Many employers offer group life insurance as a benefit to employees, and it typically doesn’t require a medical exam. “Group policies are the best opportunity for anyone with HIV,” says Hallett. He recommends maxing out any group life insurance that’s available without health questions, often one to three times an employee’s salary.

Guaranteed issue life insurance is another possibility. These policies typically are limited to people 45 and older, and death benefits may not pay out within the first two years of the policy. Coverage amounts are generally low, often $25,000 or less, but Hallett notes these policies are “stackable” — you can buy policies from a variety of life insurers to grow the total death benefit.

More options could be on the horizon
Medical and legal developments indicate more life insurance options could be ahead for people living with HIV.

In January, the U.S. Food and Drug Administration approved a monthly injectable treatment for HIV, an alternative to the often forgotten daily medication of ART. Since insurers require years of consistent adherence and doctor supervision before coverage begins, a monthly treatment could help more people qualify.

And starting in 2023, California insurers won’t be allowed to deny life insurance or disability income insurance based solely on an applicant’s positive HIV test. Gov. Gavin Newsom signed the Equal Insurance HIV Act in September.

But the new legislation doesn’t mention decreasing the cost for people living with HIV. “While I obviously applaud the move to provide life insurance to people living with HIV,” says Schoettes, “what we really need is ... to get it to a place where it’s no longer discriminatory in its pricing.”