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Laid off with income too high for ADAP
Jun 21, 2012

It is likely that I will be laid off soon due to my company ceasing to operate. Obviously, I am concerned with how I will be able to pay for healthcare and my HIV medicine. My income for this year has surpassed the maximum for consideration of ADAP. I have enough money in a savings account to cover 6 months of living expenses, but that doesn't include the $1,500/month for the Atripla I am taking and associated anti-depressant medication i am on. How else do I get the medicine I need if I'm not eligible for ADAP? I'm fearful I will need to sell my home as a trade off so i can get my HIV medicine, but after that money runs out, then what? I live in NJ. Thanks.

Response from Mr. Chambers

I assume until now that you have been getting your medications through the insurance provided by your employer. If your employer closes its doors and cancels the health insurance then there is no COBRA. If you have had coverage for 18 months without a gap and there is no COBRA, you are eligible to buy an individual health insurance policy without regard to your medical condition as long as you purchase it within 63 days of your group coverage ending. This comes under a federal law, HIPAA.

In New Jersey: In New Jersey, if you are HIPAA eligible, you are guaranteed the right to buy individual health insurance from any individual market insurer at any time of the year. Each individual market insurer must offer at least three of the standardized individual plans (referred to as Plans A/50,B,C D and/or an HMO Plan) to make it easier for you to compare benefits and costs among the many participating carriers offering coverage. Plans A/50, B, C and D can be offered as indemnity or traditional plans, or as PPO or as POS plans. To request an Individual health insurance Buyer's Guide call (800) 838-0953. The following nine insurers offer individual health plans in New Jersey: Aetna Life Insurance Company at www.aetna.com Aetna Health Inc., at www.aetna.com AmeriHealth HMO, Inc. at www.amerihealth.com Celtic Life Insurance Company at www.celtic- net.com CIGNA HealthCare of NJ, Inc. at www.cigna.com Horizon Blue Cross Blue Shield of NJ at www.horizonblue.com Oxford Health Insurance Company at www.oxhp.com Oxford Health Plans of NJ, Inc., at www.oxhp.com For more information, contact: New Jersey Department of Banking and Insurance (609) 633-1882 ext. 50302 www.njdobi.org

This information comes from this site. It lists HIPAA plans available by state.

If you were getting your medications through ADAP and your income increased and you are now ineligible, you should contact an AIDS Service Organization in New Jersey to see if there are other local or state programs that might be able to assist you. Each pharmaceutical company has patient assistance programs also, but your income may be too high for most of them.

If you are able to find other employment that offers group insurance, under HIPAA, you cannot be refused that coverage because of your health conditions. Also, if your new employer coverage starts within 63 days of losing your other group coverage, they cannot apply a waiting period for your "pre-existing condition", again thanks to HIPAA.

I hope I have given you alternatives that cover your situation. If not, please write back.

Good luck, Jacques from this site.



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