Due to the fact that my COBRA is about to run out, I have recently been on an investigation of insurance options. I used to curse my old employer when I worked there (though I won't disclose who they are in this article), but I must admit they had some kick-butt insurance coverage, now that I'm looking at what other plans offer. I am luckier than most, in that I do have insurance coverage through my husband's employer, but our insurance choices were four HMOs (none of whom had either of my Internal Medicine/Infectious Disease doctors or my gynecologist listed in their books of participating physicians) and one 80/20 plan (where they pay 80% and I pay 20%) that allowed me to choose my own doctors. Since I've been with all my doctors a long time (my GYN since my HIV diagnosis in 1987), I went with the 80/20 plan (sometimes called a point-of-service plan, I believe). I also just qualified for Medicare.
I am very grateful to have any insurance coverage -- don't get me wrong -- but the deductible on this policy is a whopping $500 and -- and this is the biggest problem for me -- I have to pay 100% up-front for all of my prescriptions, then trust the insurance company to reimburse me 80%, in a timely fashion. Now, I currently am taking two protease inhibitors (no pharmaceutical names will be shared here, as I refuse to give them any free publicity), an antiviral, three prophylaxis medications and two vitamins. On the months I do IL-2, I add a whole host of other medications to combat the side-effects to my list of prescriptions. My monthly prescription bill can easily top $3000 most months. Never mind how to pay all of that cost up front, how can I even afford to pay my 20%, or $600?
Which brings me to the Medicare supplement portion of this column (you were waiting for that, weren't you?). Last fall, I participated in a week-long HIV retreat, and was talking with a friend of mine about this upcoming loss-of-COBRA dilemma. He shared with me that he had all of his HIV drugs paid for at 100%, by his Aetna Medicare supplement. It sounded too good to be true, but he gave me a contact number at Aetna and I followed up on it as part of my insurance investigation. Lo and behold, he was right! I am not acting as any kind of an insurance or Medicare agent here, just sharing my particular journey; but I must admit, that the Aetna Medicare supplement (the only supplement I investigated) fits very well into my particular prescription dilemma. Aetna will pay 100% of the cost of any HIV drug on their formulary, which is quite extensive -- I called their pharmacy and quizzed them -- even including such new medications as Sustiva. If your HIV drug is not on the formulary, they will charge only a $25 co-pay and you can submit a request for your medication to be added to the formulary. My three prophylaxis drugs have a $10 co-pay each. You can get a 90-day supply of medications for the cost of a 60-day supply, if it is a medication that you will be taking on a regular basis. For instance, I can get a three-month supply of Diflucan for $20. I haven't pursued whether or not Aetna will pay for my IL-2 yet, so I have no information to share with you on that.
My internists and GYN are not on the list of Aetna Medicare participating providers, so I will use my insurance coverage through my husband's job to pay for doctor visits. For me, the biggest expense was prescription costs and for that, Aetna's Medicare supplement works very well. Thanks to my friend, Richard, for the referral. I can also add that the agent who helped me get through the maze of Aetna pamphlets and jargon, and figure out if the supplement would be of any help for my particular case, was a real nice lady (not a high-pressure sales lady!) and I would highly recommend her. She came to my home, at no cost, and explained the various policies and coverage. If anyone is interested in a contact name and phone number to obtain more information, I would be glad to pass it on, like it was passed on to me. Just leave a message for Susan Cornutt at the ASP office.