Selecting an Obamacare Plan When You're Starting Treatment for HIV
October 30, 2014
The Patient Protection & Affordable Care Act (PPACA, or ACA), generally known as "Obamacare," has some clear benefits for people living with HIV. You can no longer be denied coverage because of a pre-existing condition and premiums can't be based on sex. If you have kids, they can be covered by your policy until age 26, and there's no lifetime cap on covered costs. Sounds good, right? But if you are looking at ACA exchange plans as you get ready to start HIV treatment, here are some suggestions to help find one that will best meet your specific needs.
Talk to a Human
The whole process of buying insurance can be handled on the Internet. But for your own protection, it may be best to consult a specially trained "navigator." Prepare yourself for the consultation by:
Though it's good to go into this optimistic, and with an open mind, you may find that answers to your questions will differ from person to person. It's best to have proof of everything you've been told.
Will it Provide for Your Providers?
If you already have a doctor you trust as your primary care physician (PCP):
Will They Cover the Drugs You Need?
You may have read about people with HIV facing higher costs for their HIV treatment in the new plans. This is a point where the more information you have, the better off you'll be.
Understanding the True Cost of a Plan
Many people make the mistake of only looking at the cost of a plan's premium. Many people will qualify to receive either subsidies or tax credits to help them pay their premiums. But in addition to the premium, you must also pay OOP costs before your health insurance starts to pay 100% for the covered essential health benefits. Until that limit is met, you'll pay from 10 to 40% of the total cost. The maximum OOP cost limit for an individual in 2015 can be no more than $6,600 (up from $6350 in 2014) and $13,200 for a family plan. This limit includes:
This limit does not include the following items. That means that if you pay them, it does not contribute toward the OOP total and does not get you closer to reaching the maximum cost limit:
So here is how you can estimate the true maximum cost of your insurance:
The Bottom Line: Do the Legwork to Get the Plan You Need
Unfortunately, there is no simple way to be sure that your health insurance guarantees to provide the actual health care you need when you are starting treatment for HIV. Just like with HIV itself, you're a step ahead of the game if you go into it armed with knowledge and by taking advantage of the resources that can help you in your quest.
HIVHealthReform.org has many resources for people with HIV and providers about getting a plan to meet your needs.
Sue Saltmarsh has worked in the HIV/AIDS field for over 20 years, the first 10 as an herbalist and energy therapist at Project Vida, the last six as a writer and copy editor for Positively Aware magazine. She is now a freelance writer and editor and is also able to devote more time to her passion as founder and director of the Drive for Universal Healthcare (DUH).
Copyright © 2014 Remedy Health Media, LLC. All rights reserved.
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