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Best Marketplace plan for young adult?
Mar 28, 2014

Hello I am hiv positive 24 year old on my parents health insurance in new york, moving to illinois next month and trying to plan for next year when i turn 26 and am kicked out. I don't anticipate secure workplace provided health insurance for the time being.

In reading about the AFA marketplace, I see that most young people are opting for affordable "catastrophic" plans while there are also bronze, silver, gold and platinum plans. Obviously the catastrophic plans are intended for young "healthy" people, but what of young hiv pos people who require expensive care?

In Illinois and overall what would the ideal plan be for a 26 year old hiv pos person, on stribild +valtrex and still needing to get lab work every 3 months, who is making $20,000-$30,000/year. Thank you!

Response from Mr. Chambers

First you should check to see what Illinois offers in the way of an AIDS Drug Assistance Program (ADAP) and help with insurance premiums. You can get information on that at this site. That will also give you a link to the formulary of medications covered by ADAP.

You may also want to talk to someone at a local AIDS Service Organization. If they have a premium assistance program in addition to a drug assistance program, you may not have to pay any premium for your insurance at all.

Every state offers different plans within each "metals" category. You can start checking the Illinois plans now, however. Illinois does not operate their own health exchange so you should use www.healthcare.gov which will show you the plans available in Illinois.

Follow the links to examine plans, giving information about your age, state and county of residence (in Illnois), and expected income (don't underguess if possible as that could cause problems if your actual income exceeds the estimate by a substantial amount). With an income of about $25,000 you would qualify for an advance tax credit to reduce the insurance premiums.

Chances are your medications are going to be expensive enough that the Comprehensive Plan for healthy young people will not work for you. Compare the benefits, especially prescription coverage of the various plans to see which might be best for you. If ADAP does not have a premium assistance program, then you will have to consider that as well. The broader the benefits, the higher the premium.

Once you have narrowed it down, you may need to contact the plans directly to learn what doctors are part of the plan and what HIV medications are on the drug formulary since both vary by plan. Keep in mind that ADAP will cover what the health plan doesn't cover of prescription drugs on the ADAP formulary so you need to know that list as well which is on the ADAP website.

Finally, when you are no longer eligible for coverage under your parents' plan, you will qualify for a Special Enrollment Period after losing your coverage so you will have 60 days to enroll in an ACA plan. Don't think you will have to wait for the next open enrollment.

Good luck, Jacques

at this site.



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