First, thank you so much for your service to this community. Thebody.com has kept me sane as I live with HIV.

I am in the USA in an at-will employment state and work for a large employer with good health benefits. I am unhappy in my job and am talking with some people I know who have started a small business that is very successful. They do not know I have HIV. I take Atripla and I am very healthy. I have several concerns. If I join the small company (less than 10 people) will my prescription costs cause their medical insurance to skyrocket; will they know I am taking HIV meds; and can they fire me for causing their insurance cost to rise?

Are there any other things I should consider in moving from a large employer to a small one (from an insurance perspective)? Thank you!

Since this is a small employer, most likely they have an insured small group health plan. So they will not have access to your claims. Depending on how premiums are determined by the insurance company, significant increases in health care costs related to employees covered could impact premiums at renewal time. However, there could be other employees or dependents under the plan who have high health care costs. HIPAA requirements would prevent the insurer from disclosing employee-specific claim information to the employer. High health care costs related to you could not be grounds for termination.