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Author Topic: US Insurance woes  (Read 2279 times)

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Offline darwin

  • Member
  • Posts: 69
US Insurance woes
« on: April 30, 2008, 05:33:54 PM »
Hi all,

Sorry for posting so much - I have so much on my mind!  I am one week into my diagnosis and learning lots!

I am currently uninsured.

The HIV clinic in town told me today that ADAP is for people who make $20k or less per year, and that their Ryan White is for services (not meds) and for people who make $25k or less per year.

I am self employed making $40k per year.  Taking on $20k+ in HIV meds costs per year is going to radically alter my life! I will have to rent studios and sell my car!

How do people handle this?!  Do people really spend $20k out of pocket? 

October 2007 - Chose love/stupidity over protection
23 April - Diagnosed
30 April - CD4: 364/22.1% VL: 2,198
11 July - Started Viramune/Truvada
13 August - Undetectable

Offline minismom

  • Member
  • Posts: 2,605
  • Quocumque jeceris stabit
Re: US Insurance woes
« Reply #1 on: April 30, 2008, 06:27:46 PM »
Are you on meds already?  I read your post about your numbers and they looked REALLY good.  Or, are you wondering about this for the future?

Hubby and I are also self-employed.  I'm not sure how it works with ADAP and RW, but for things like SSI, we only have to show our NET income and not the gross.  Owning a business, we get a lot of tax deductions and have a lot of expenses.  So, what we actually "make" to live on is very small compared to what the business "makes" to run.  Just a thought, but you may want to ask if it is the net or gross income that they go by.

Mum
www.watoto.com
www.MotherBearProject.org
"Whichever way you throw me, i will stand"
"Don't worry about the world coming to an end today...it's already tomorrow in Australia"  Charles Schultz

Offline darwin

  • Member
  • Posts: 69
Re: US Insurance woes
« Reply #2 on: April 30, 2008, 06:53:02 PM »
Yea, my case manager mentioned that.  If I can, somehow, get my net income to be under 20k I should be fine.

But I know so little about how to do that, but I've heard its possible.  Do you have an accountant that helps you?
October 2007 - Chose love/stupidity over protection
23 April - Diagnosed
30 April - CD4: 364/22.1% VL: 2,198
11 July - Started Viramune/Truvada
13 August - Undetectable

Offline minismom

  • Member
  • Posts: 2,605
  • Quocumque jeceris stabit
Re: US Insurance woes
« Reply #3 on: April 30, 2008, 07:27:01 PM »
Hubby does our taxes with tax software and then files them online.  He uses H and R Block for small businesses.  Because he used Hand R Block software, he can go to any of their tax places and get help for free.  We run our businesses from home, so we got a lot of breaks that way.  Plus, gas for travel, clothing, haircuts, food out, pens, paper, everything that we have a receipt for and used for the businesses.  For most things, we only get a % off, but that's something.  Also, any employees that you have are an expense to the business.  You may want to either call the IRS, look it up on your state's website, or look into an accountant.  Don't forget to consider your quarterly taxes when you file the "big" one in April.

I wish I could help more, but I don't do the taxes.  If you have specific questions, PM me and I'll ask Hubby.  He may be able to point you in the right direction of where to look for help / answers.

Mum
www.watoto.com
www.MotherBearProject.org
"Whichever way you throw me, i will stand"
"Don't worry about the world coming to an end today...it's already tomorrow in Australia"  Charles Schultz

Offline Florida69

  • Member
  • Posts: 428
Re: US Insurance woes
« Reply #4 on: April 30, 2008, 10:13:43 PM »
You can also write off a portion of home, as office space.  Mom is right, if you do not have a good tax professional it is a good idea to find softward as she mentioned. Every little bit helps, it is hard in our country right now without insurance.  I pay out of pocket for drugs, doctors and insurance around 9,000 per year, and work two jobs.   Thank goodness I have private insurance.  Hopefully the day will come soon where our government fixes this problem.   You have to evaluate and change yoiur life style a bit.  I had to, when I first found out.   My case worker suggested that I take on a room mate, but I have 3 cats.  Anyway, I hope things get better for you, keep us posted.  If there is anything we can do, please hit us up.  Hang in there, D
Nothing in the world can take the place of Persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan 'Press On' has solved and always will solve the problems of the human race.
Calvin Coolidge

Offline OneMoreGuy

  • Member
  • Posts: 77
Re: US Insurance woes
« Reply #5 on: May 01, 2008, 03:07:41 AM »
Hi Darwin,

I used to own several businesses in the USA before moving to Europe, so I am familiar with IRS and taxes.

If you can't afford an accountant, tax software is nowadays pretty good and for the most part, easy to use. I personally used to use TurboTax.

Being self-employed you will get to deduct many of your expenses and should be able to bring your net income around or below the $20k line.

Medical costs (blood work, doctors visits, etc.) can become a financial nightmare, and once you start taking HIV meds, they can start around $1200 and higher depending on what your doctor recommends.

As long as your numbers are still good, it wouldn't hurt to start finding out what resources are available to you in the event that you fall in financial hardship in years to come.

And from what denb has shared in another thread, you might consider moving to New Mexico.

Good luck.

OMG
Psychologist, PhD
Counseling patients with HIV since Jan 1991
HIV since Dec 2005
There are three parts to any successful relationship (platonic or romantic): trust, honesty and communication

Offline aztecan

  • Member
  • Posts: 5,382
  • 29 years positive, 56 years a pain in the butt
Re: US Insurance woes
« Reply #6 on: May 01, 2008, 10:57:55 AM »
Hey Darwin,

Did your case manager say they would accept net income?

How states handle Ryan White funds, etc., differs, but in my experience, when they ask for income, they are talking gross not net.

If that's the case, all the clever bookkeeping in the world won't change your income.

Are there other options out there for you? We have a program here that actually enrolls people in a state-sponsored insurance plan that covers most expenses, minus copays, etc.

Unfortunately, at $40,000 a year, you would be responsible for the premium if you lived here. We can only enroll people in insurance assistance (paying premiums for them) if they earn less than 300 percent of the federal poverty level.

(Edited to add, that is $31,200 a year.)

I would check to see if programs other than just Ryan White or ADAP are available.

Also, don't panic. Your numbers are still fine.

HUGS,

Mark
« Last Edit: May 01, 2008, 02:47:52 PM by aztecan »
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline Miss Philicia

  • Member
  • Posts: 23,872
  • celebrity poster, faker & poser
Re: US Insurance woes
« Reply #7 on: May 01, 2008, 11:35:11 AM »
If you need to see what the ADAP financial eligibility is in each different state this is a handy resource to have bookmarked:

http://www.statehealthfacts.org/comparemaptable.jsp?cat=11&ind=543

The federal poverty levels for 2007 are here:

http://aspe.hhs.gov/POVERTY/07poverty.shtml

(and it's amazing when you notice that if you lived a couple miles away, over a river you can see from your kitchen window, that your cut off level would be fully 150% higher)
"Iíve slept with enough men to know that Iím not gay"

Offline ga1964

  • Member
  • Posts: 188
Re: US Insurance woes
« Reply #8 on: May 01, 2008, 01:35:40 PM »
I was wondering if you have insurance, but still show an income under $20,000 annually, can you still qualify for ADAP or Ryan White Foundation for  help to pay the deductables that insurance won't cover.  I take Atripla ($1600.00/mo.), Nexium ($150.00/mo.), Paxil ($8.oo/mo. thanks to Wal-Mart's Generic program.),  Thanks to all the test that have to be run every couple of months also, help to run up the cost that I have to take responsibility for.  I have to spend at least $3000.00/yr to cover the deductables for tests and co-pays on prescriptions.  I don't know how I would have made it the past year if I didn't have insurance, but due to all the co-pays that I have to pay I am at the point that I don't know how long I will be able to keep my insurance.

Offline OneMoreGuy

  • Member
  • Posts: 77
Re: US Insurance woes
« Reply #9 on: May 01, 2008, 01:57:28 PM »
Hey Darwin,

Did your case manager say they would accept net income?

How states handle Ryan White funds, etc., differs, but in my experience, when they ask for income, they are talking gross not net.

If that's the case, all the clever bookkeeping in the world won't change your income.

Mark


There is a caveat here Mark.

I used to practice in California before moving to Europe. There, in order to get ADAP, my patients had to have a Federal Adjusted Gross Income (AGI) of no more than $50,000. Here the key word is ADJUSTED which allows for several deductions from the overall Gross Income. Unreimbursed business expenses are part of the allowable deductions before achieving the AGI.

Other allowable adjustments-for example, Individual Retirement Accounts, SEP and Keogh payments, and alimony payments. Other adjustments include forfeiture of interest penalties because of premature withdrawals from a certificate of deposit; capital loss deductions up to $3,000; rent and royalty expenses; 50% of self-employed tax liability; health insurance deductions for the self-employed, and net operating losses. Other adjustments include student loan interest; jury duty pay turned over to your employer; moving expenses; Health Savings account contributions; tuition and fees deducations; and hybrid vehicle deductions.

Federal AGI is the individual's or couple's income before itemized deductions such as medical expenses, state and local income taxes, and real estate taxes.

So, depending on Darwin's business situation, and where he lives, he might still have a good chance to lower his overall gross income to meet his State's Federal AGI requirement.  :D

In reference to one's AGI and the poverty level, the main point here is whether a co-pay will be required or not. For California, a co-payment is required of anyone whose annual adjusted gross income is between
400 percent of federal poverty level (currently $40,840.00) and $50,000.00. Persons
with an annual adjusted gross income below 400 percent of the federal poverty level
receive ADAP drugs at no cost.
« Last Edit: May 01, 2008, 02:00:57 PM by OneMoreGuy »
Psychologist, PhD
Counseling patients with HIV since Jan 1991
HIV since Dec 2005
There are three parts to any successful relationship (platonic or romantic): trust, honesty and communication

Offline aztecan

  • Member
  • Posts: 5,382
  • 29 years positive, 56 years a pain in the butt
Re: US Insurance woes
« Reply #10 on: May 01, 2008, 02:53:20 PM »
That is interesting. I don't deal with too many people who are self employed.

By the way, the 2008 poverty guidelines are out and, as usual, are slightly higher than 2007.

Federal poverty level is now $867 a month, or $10,404 a year.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline darwin

  • Member
  • Posts: 69
Re: US Insurance woes
« Reply #11 on: May 01, 2008, 03:07:26 PM »
Very informative, everyone, thank you so much!

Here is my current plan of attack (almost all guesswork):

1) Adjusted gross income at less than 20k, but earn 40k+ with my business.  Pay with dividends, smaller paychecks, I am still researching how to do this.

2) If #1 is not possible, I have about 10 months of ADAP eligibility.  So I will find an insurance agency that takes HIV+ as a preexisting condition, pay premiums for 12 months, pay full price for my meds for months 11 & 12, and then use my insurance for meds from then on.  And never give up insurance again so I never have to deal with preexisting conditions.

3) If #2 is not possible, I will move to a state that has good High Risk Pool Insurance.  Idaho, my current state, has one but its 50% coinsurance for meds!!  Insane.  Oregon has much better, and I do love Portland :)

Any thoughts?
October 2007 - Chose love/stupidity over protection
23 April - Diagnosed
30 April - CD4: 364/22.1% VL: 2,198
11 July - Started Viramune/Truvada
13 August - Undetectable

Offline rick21007

  • Member
  • Posts: 286
Re: US Insurance woes
« Reply #12 on: May 01, 2008, 05:01:58 PM »
Hey Darwin--I was just looking at your numbers on another thread.  You may not have to go on meds for a while.  I was diagnosed Dec. 06, most likely had been infected for a year prior to that.  I am still not on mades though looking at the possiblity sooner than later.   Anyway seems like you might have time to purchase medical insurance and get through the waiting period for pre-existing conditions which is generally 6 months to a year.   While I don't have great insurance myself, I priced my co-pay of $35 a month for Atripla which would run $1500 a month without insurance.

Rick

Offline Desertguy

  • Member
  • Posts: 183
Re: US Insurance woes
« Reply #13 on: May 01, 2008, 08:06:08 PM »
Are you a Veteran by chance?

Offline darwin

  • Member
  • Posts: 69
Re: US Insurance woes
« Reply #14 on: May 01, 2008, 08:48:33 PM »
Hi Desertguy - Nope, I am not a veteran :(

rick - My doc said I could go either way right now.  I'd like to start meds simply because I don't want to do a seconds more damage to my CD4 count, plus I am hyperaware of the chronic infection.

I did another round of CD4s today, so we will see if maybe I can stay of meds longer.
October 2007 - Chose love/stupidity over protection
23 April - Diagnosed
30 April - CD4: 364/22.1% VL: 2,198
11 July - Started Viramune/Truvada
13 August - Undetectable

Offline Desertguy

  • Member
  • Posts: 183
Re: US Insurance woes
« Reply #15 on: May 01, 2008, 10:51:44 PM »
Just ,Hang in there. I know it seems bad but it's really not that bad.
You have found a pretty good place to get ifo & lean on shoulders

Offline OneMoreGuy

  • Member
  • Posts: 77
Re: US Insurance woes
« Reply #16 on: May 01, 2008, 11:45:53 PM »
Hi Darwin,

Portland is nice, but before you look into moving to Oregon, or any other State for that matter, I suggest you research what their ADAP program requirements are. The Oregon ADAP program is called CareAssist.

Beginning now to look at all your future options is definitely a plus (as opposed to waiting until you really need financial and medical help).

And use your case manager as much as you can to get as much help and information as he / she can give you. They are normally up do date in all the options available to you, but you have to have a lits of questions for them and not expect that they will be an open palette of information. And by that I mean, that they are normally overwhelmed with many cases and when they meet with you they try to meet specific issues. So you can help them along by having your own list of questions prior to your next meeting.

Good luck.

Psychologist, PhD
Counseling patients with HIV since Jan 1991
HIV since Dec 2005
There are three parts to any successful relationship (platonic or romantic): trust, honesty and communication

Offline rondrond

  • Member
  • Posts: 1,712
Re: US Insurance woes
« Reply #17 on: May 02, 2008, 12:07:23 AM »
Very informative, everyone, thank you so much!

Here is my current plan of attack (almost all guesswork):

1) Adjusted gross income at less than 20k, but earn 40k+ with my business.  Pay with dividends, smaller paychecks, I am still researching how to do this.

Any thoughts?

I don't know what kind of business you have but I had a vending business and was allowed to set money aside for expansion, new vending machines, new truck, ..just a thought...
"I may not be exactly where I want to be, but I sure as Hell am not where I was"
Wynnona Judd

Diagnosed/HIV
1993
AZT
Norvir
1994-2001
Crixivan/Epivir/Zerit
No Meds for 7 Years

04jul07/DVT-right leg/Bi Lateral PE's     
16oct08/DVT-left leg
Sept '09  6 blood clots in left arm
Coumadin 5mgs
                                     
Atenolol/50mg/2x
Hydrochlorth 25mg/1x
Gemfibrozil/300mgs/2X
Symbicort
Proventil Inhaler
Potassium
Rhinocort


*APR 08~Viramune/Truvada
March08  CD4 330 23% VL 452.000 
*Jan09 Med change~Epzicom/Viramune

Aug09   CD4 523 23%  VL<48
Diagnosed: COPD
Dec 2013: CD4 645 45% VL 49
Med Change: Viramune/Epivir/Ziagen/Isentress

Offline rick21007

  • Member
  • Posts: 286
Re: US Insurance woes
« Reply #18 on: May 02, 2008, 03:48:29 PM »
You might call Cascade AIDS Project in Pdx.  Their number is 503-223-5907.  Bet a casemanager there could answer a lot of your questions.

Rick

Offline LordBerners

  • Member
  • Posts: 415
Re: US Insurance woes
« Reply #19 on: May 03, 2008, 07:28:03 AM »
I think it is advisable that you reduce your activities so that your income falls below $20,000.  There's really no sense in working half the year for something which should be free, and besides working too much is unlikely to be good for your health.
Please, just call me Berners.. or Baron.

Offline darwin

  • Member
  • Posts: 69
Re: US Insurance woes
« Reply #20 on: May 03, 2008, 01:57:30 PM »
Thank you, everyone, for your insights and feedback.  It seriously makes me feel better and more clear on things.

I am chewing on that, LordBerners.  I still need to do some crunching - I have enough debt that making less than 20k would make it hard to pay the bills.

Thanks again, everyone!  I have some investigating to do - And I will definitely get back to y'all!!
October 2007 - Chose love/stupidity over protection
23 April - Diagnosed
30 April - CD4: 364/22.1% VL: 2,198
11 July - Started Viramune/Truvada
13 August - Undetectable

 


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