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HIV+ and looking for independent health insurance with prescription coverage: where to start?
May 17, 2006

My partner of two years is HIV+ and is about to start taking HIV medications. He cannot afford them, but he does not qualify for state assistance. He has also been denied by the drug assistance programs offered by the drug makers. Our last resort is seeking health insurance with prescription coverage for his medications. We're not even sure that any providers out there will cover someone with HIV, and if those companies do exist, we're not sure how to locate them. We have so many questions: when applying for health insurance, should he be open about being HIV+? Will this likely be considered a pre-existing condition? He works for a small non-profit organization that does not provide insurance, so he will be looking for independent coverage. I guess the main question is: how will we really know if an insurance company will actually cover the cost of his meds? Descriptions of "pre-existing conditions" can be confusing.

Response from Ms. Franzoi

Your partner would have to apply for an individual health policy. Unfortunately, since he doesn't currently have coverage and he is HIV+, he might not be able to get an individual policy. If he does, he would be considered to have a pre-existing condition and there would be a period of time (probably 12 months) during which the plan would not cover treatment for any HIV-related services, including prescription drugs. Since any health plan application will include questions relating to current health conditions, he should answer them honestly. Failure to do so could be considered insurance fraud and cause the coverage to be cancelled. Has he considered looing into what benefits might be avaialble to him through ADAP?



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