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New Health Care law
Jul 31, 2012

Do we know yet whether the new health care law will keep insurance companies from denying an HIV person insurance coverage? If I understand it correctly, denying a person coverage for pre existing health issues will be against the law.

If they can't deny you coverage will a pre existing conditions still make your premiums higher?

Also, after a person receives SSDI and begins on Medicare, does Medicare cover HIV drugs?

Response from Mr. Chambers

Good timing for your question.

Beginning January 1, 2014, insurance companies will have to sell health insurance policies to anyone who applies, regardless of their medical history, current medical condition or HIV status. Rates are pooled so you will not be surcharged for having a medical condition. More details of the rate pooling will be coming out as regulations are finalized.

You also asked about drug coverage under Medicare. Prescriptions are covered under Part D of Medicare, which was started in 2006. Part D is provided by private insurance companies, and most states have multiple carriers offering coverage. Again, you cannot be turned down for Part D because of HIV status. At www.medicare.gov, you can enter you prescriptions and it will show all the available plans in your state, what medications they cover and how much you will have to pay. Although each plan may select its own formulary, the law requires them to cover virtually all HIV medications.

If you choose a Medicare Advantage Plan instead of fee-for-service Medicare (HMO or PPO or other), they usually include drug coverage in their plan so you don't need to purchase separate drug coverage.

You should also explore AIDS Drug Assistance Program (ADAP) in your state as they will cover the copays that Part D does not, and, in some states, they will actually pay the premium for your Part D coverage.

Jacques



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