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Author Topic: Insurance .......  (Read 2252 times)

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Offline resilientboy

  • Member
  • Posts: 16
Insurance .......
« on: April 29, 2007, 09:04:43 PM »
Hello.  I have been poz for 3 years now and I am 21.  I'm still young and somewhat carefree, but as I mature and realize what adulthood means to me I start to realize that you have to be prapared for unexpected situations.  Well right now I don't worry for insurance or the cost of my meds because I qualify for medicaid I guess because I meet the poverty cut off.  Well I have a new job now and I can see that I can start making money good money from my job.  My job offers insurance and I did not sign up for it because I have medicaid.  Now I am affraid that the government will revoke my benefits of free healtcare because of the money I will start making.  Not only that but I heard that insurance companies will not cover the cost of health care if the person that tested poz was not insured at the time of their infection.  Can anyone shed some light on the subject????

Offline resilientboy

  • Member
  • Posts: 16
Insurance.......
« Reply #1 on: April 29, 2007, 09:06:04 PM »
Hello.  I have been poz for 3 years now and I am 21.  I'm still young and somewhat carefree, but as I mature and realize what adulthood means to me I start to realize that you have to be prapared for unexpected situations.  Well right now I don't worry for insurance or the cost of my meds because I qualify for medicaid I guess because I meet the poverty cut off.  Well I have a new job now and I can see that I can start making money good money from my job.  My job offers insurance and I did not sign up for it because I have medicaid.  Now I am affraid that the government will revoke my benefits of free healtcare because of the money I will start making.  Not only that but I heard that insurance companies will not cover the cost of health care if the person that tested poz was not insured at the time of their infection.  Can anyone shed some light on the subject?

Offline Blixer

  • Member
  • Posts: 712
Re: Insurance.......
« Reply #2 on: April 29, 2007, 09:30:56 PM »
The rules vary slightly from place to place, but generally you have to sign up for your group help plan at work within a certain number of days of when you are eligible iin order to be covered without any pre-existing conditions.  If you have missed that window, they insurance company can refuse to pay for any pre-exisiting conditions for a period of time (often something like a year--at least in Missouri).  If there is a group plan, it is my understanding that they still have to take you but they can refuse to pay for a period of time for anytihng that was already diagnosed.  If you are still on medicaid, you may want to check this out with your human resources person and sign up before you get tossed from medicaid or you could likely be stuck with paying for your own HIV treatment for a while.   Thats my understanding from dealing with group health policies in Missouri where I've learned much more about insurance in the past year than I care to know.
David
Diagnosed 1/9/06
8/27/2007 CD4 598, 29%, VL 58 (72 wks)
11/19/2007 CD4 609, 30%, VL < 50 (84 wks)
2/11/2008 CD4 439, 27%, VL <50 (96 wks)
5/5/2008 CD4 535, 28%, VL <50 (108 wks)
10/20/2008 CD4 680, 28%, VL <50 (132 wks)
Changed to Atripla in 2012
1/14/2013 CD4 855, 35%, VL <40

Offline gerry

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  • Posts: 522
  • Joined AM Feb 2003
Re: Insurance.......
« Reply #3 on: April 29, 2007, 09:32:28 PM »
You're going to have to do some homework in your local area regarding income guidelines and government programs.  If your income exceeds Medicaid limits in your state, then you could be dropped from coverage.  You may have a fallback with ADAP/Ryan White, but that program will also have income guidelines and coverage varies from state to state, but is much more restricted than Medicaid.  Contacting your local ASO may be the way to go to plan in advance what you are looking at. 

If you enrolled in your employer's health plan, it is not true that you will be subjected to "pre-existing condition" because you did have the Medicaid coverage before switching over.  However, if you wait until your Medicaid coverage gets dropped if you become ineligible and there is a lapse in coverage of 63 days till you get covered by your employer's health plan, then the plan can impose the pre-existing clause period in which it will deny coverage for any pre-existing illness for a period of time (usually at least 6 months).  Other than this pre-existing condition clause, employer-sponsored health plans cannot deny an eligible employee coverage due to the nature of his/her medical condition.

It doesn't hurt to plan ahead.

Offline resilientboy

  • Member
  • Posts: 16
Re: Insurance.......
« Reply #4 on: April 29, 2007, 09:42:19 PM »
thanx guys that was nice of you to respond.   ughhh i hate hiv.  i never thought i'd be stressing about this.  this is why i feel i should go to college and get into i high paying job just so i dont have to worry much about out of pocket costs!!  i hate the government toooo and bush fucken bastard.  i mean the stupid administration has cut back on the hiv budget and he funds tooo much of our tax money towards a war.  no i see why activism is important!  i dont know.  do you guys feel me?  i mean im 21 and i shouldnt have to worry about these kinds of things!   thanx once againg guys. 

Offline mark54

  • Member
  • Posts: 26
Re: Insurance .......
« Reply #5 on: April 29, 2007, 10:17:34 PM »
you can not be denied company sponsored insurance.  medicaid will cut you off at some point you will have to check with your medicaid office, they may have a program to cover you until your insurance kicks in.  there may be a waiting period for the company insurance and you can find that out from your personal office.  it's been a long time since i have done this sort of work so i don't know all the current specifics.  i have  a good friend who is still in the business for a major corporation unfortunately she is in europe for the next two weeks.  probably someone on this forum knows all the current laws so just keep checking till someone finds the thread.  good luck on your new job and career with your current attitude i'm sure you'll go far.  if you don't find the answers you need i'll have my friend contact you when she gets back.  i also believe medicaid will force you to take the company insurance but don't worry you can not be denied.  you can be denied life insurance but if you don't have kids you don't really need it that does not include a small insurance policy your company automatically may give you.  also if they offer short term disability insurance buy it that's preparing for your unexpected situations.  i'll keep checking the thread if you have any other questions.   mark

Offline AlanBama

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  • Posts: 3,604
  • Alabama: the 'other' 3rd World Country!
Re: Insurance.......
« Reply #6 on: April 29, 2007, 10:28:57 PM »
I'm confused r.b.  --  so you are taking meds now?  or not?
"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

Offline Ann

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  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Insurance .......
« Reply #7 on: April 30, 2007, 06:18:09 AM »
Hi Resilient,

I merged your two threads. You posted the same in the Long Term Survivors forum, which really isn't the appropriate place for your thread. As you received a reply in that forum, I moved the whole thread over for you.

Ann
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline allanq

  • Member
  • Posts: 689
  • still life with pills
Re: Insurance .......
« Reply #8 on: April 30, 2007, 01:08:42 PM »
You should move as quickly as possible to sign up for your employer-sponsored health insurance. If you wait too long after it was initially offered, you may have to undergo regular medical underwriting.

Allan
Top (Breakfast): Prezista, Norvir, Isentress, Zoloft (2), Glyburide (2), Aspirin
Bottom right (Dinner): Prezista, Norvir, Isentress
Bottom left (Bedtime): Sustiva, Trazodone (2), Lipitor, Septra (no longer taking this)
Center: Alprazolam (Xanax)
Not shown: various vitamins & supplements

Offline resilientboy

  • Member
  • Posts: 16
Re: Insurance .......
« Reply #9 on: May 01, 2007, 02:25:16 AM »
well yes i am taking meds im on sustiva and epzicom.  and i posted on long term survivors because i thought that people in there would be familiar with the situation.

Offline redhotmuslbear

  • Member
  • Posts: 605
  • A genuine certified freak of nature, and a hot one
Re: Insurance .......
« Reply #10 on: May 01, 2007, 12:19:40 PM »
RB,
Don't let the moved posting get to you.  Sure, long-term survivors might have more experience, though this is an issue faced by any HIVer in the workforce.

A lot of misinformation is spreading here, I'm afraid, though.

Your employer's insurer can exclude HIV for a period as a pre-existing condition, even if this is a new benefit to the employees.  The one way around any such exclusion is to have a Certificate of Creditable Coverage from a carrier who has covered you within the number of months of the new carrier's exclusion policy....and I don't believe that Medicaid counts as a source of creditable coverage, as I've never had experienced the transition from Medicaid to a private insurer myself or through a friend.

You need to look at two things promptly:
1. the new insurer's exclusion policy
2. Texas ADAP benefits
If your employer's coverage has an exclusionary clause, ADAP funds may help you cover part or all of the cost of meds, based on local eligibility requirements.

Also, get in touch with the benefits case workers at a local AIDS service organization to help you make sense of it all.

Cheers,
David

P.S.  PM me if you'd like some local HIVer contact in and around Austin who can help you make connections.

"The real problem is not whether machines think but whether men do." - BF Skinner
12-31-09   222wks VL  2430 CD4 690 (37%)
09-30-09   208wks VL  2050  CD4 925 (42%)
06-25-08   143wks VL  1359  CD4 668 (32%)  CD8 885
02-11-08   123wks off meds:  VL 1364 CD4 892(40%/0.99 ratio)
10-19-07   112wks off meds:   VL 292  CD4 857(37%/0.85 ratio)

One copy of delta-32 for f*****d up CCR5 receptors, and an HLA B44+ allele for "CD8-mediated immunity"... beteer than winning Powerball, almost!

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Insurance .......
« Reply #11 on: May 01, 2007, 01:07:38 PM »
....and I don't believe that Medicaid counts as a source of creditable coverage, as I've never had experienced the transition from Medicaid to a private insurer myself or through a friend.

Actually, David, Medicaid does count as creditable coverage...

"What is creditable coverage?

Most health coverage is creditable coverage, such as coverage under a group health plan (including COBRA continuation coverage), HMO, individual health insurance policy, Medicaid or Medicare."


Link: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Edit:  I agree with most everything else you said, except that you were basing your advice on the assumption that Medicaid is not creditable.  But since it is, it makes it all the more important for RB to get enrolled in his employer insurance plan ASAP if there is a chance that his Medicaid coverage can be cut off due to his current employment and anticipated increase in income.  This will help keep him from having a lapse in creditable coverage, which will prevent the insurance carrier from imposing the pre-existing condition clause.  This is irrespective of whether or not he is eligible for having ADAP help him keep this insurance (e.g., by assisting with premiums and co-pays, but this of course depends on what state regulations allow).
« Last Edit: May 01, 2007, 02:41:34 PM by gerry »

 


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