How Much Does HIV Cost in Healthcare Plans.

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[TheRoof]

At the moment I am covered with my family plan. Though I am in college going into finance. In two years I will get my Bachelors Degree in Finance so hopefully I can start making decent money and claim myself as independent.

My question is how much of your income does HIV take. 5%, 25%? Personally which health plans or health care options are probably the best with living with HIV. In your opinion? Basically talking about general health care.

I know for each individual it will be different due to their health. Though if to use the general numbers for The Meds. How would you calculate that. Share your experiences with the health care system.

[WildcatCC]

As posted before, I'm very lucky to work within a world-class health care organization. My benefits are excellent, especially if I utilize my employer (self insured) as my care giver.

Here is what I've experienced. It may not be typical but may serve as a framework.

When diagnosed with HIV/AIDs (I went right to AIDs - always trying to be an over achiever), it was when I was rushed to the hospital for what turned out to be PCP. 2 weeks in the hospital (1 in ICU), my total bill was slightly over $46,000. Since I was receiving care at my facility (and I humbly believe the best care ever!), my total out-of-pocket expense was $100 which was later reimbursed as I was admitted via the ER.

Since that time, my only other HIV-related expenses have been co-pays for meds and office co-pays for my ID doc. Here is the breakdown:

MEDS

Initial Regimen - $600 every 90 days x 4 times a year = $2400 (2008)
New Regiimen - $250 every 90 days x 4 times a year = $1000 (2009)

Androgel - $500 (2 months but then switched to testosterone shots which are an office procedure not a drug cost)

OFFICE

Co-pays $250 ($20 every 8 weeks for a year plus $20x 6 for 6 testosterone procedures)

I hope this info helps.
Mark
 

[Assurbanipal]

With a degree in finance plan to go to work for a large company with a good health plan.  Most of them will be glad to talk about their benefit programs and give you a link to them if you ask.

Predicting how much you will be asked to pay for a health plan two years from now while we are in the middle of passing a huge change in the laws governing health insurance may not be very productive.

[justaguy]

I've only been diagnosed for about 7 months..but with the same employer/health insurance plan for 5 years or more.  My biggest fear was that my group insurance would drop me, but i guess that's not likely to happen....that's why it's GROUP insurance.  I'm in it for about $1,000 so far.  I was diagnosed with AIDS, though I had no opportunistic infection, just a low CD4...no hospital stays now (or ever hopefully).  There was $685 for genotype testing which I had to pay out of pocket towards my deductible.  My labs are free as long as I use the insurance company's preferred lab.  Then $45 a month for the Atripla copay, which is a drop in the bucket compared to the $1800 the receipt shows.  Add in $20 per doctor visit copay.  I'm estimating I"ve been to the doctor about 6 or 7 times since diagnosis, plus therapy sessions :0).  Of course, your mileage may vary.  As someone who hardly ever even used their health insurance before, I'm getting a real education.  I've been saving all my receipts - I think some of it can be deductible, but only if it adds up to a certain percentage of your income.  Again, it's time for me to do more research.  

[GSOgymrat]

I have health insurance through my employer. I spend around $2000 a year out of pocket on healthcare expenses not including what my employer deducts for my health/dental/vision insurance. Those expenses are generally medication, MD office and lab co-pays. I use a flexible spending account through my employer to avoid taxes on those expenses.

[chguy78]

I am self-employed and have a private plan with a large health insurance organization.  My policy is up for renewal in January and just increased $15/month for my premium.  In my state, your premium is supposed to increase only for specific reasons: e.g., age, where you live, general costs (not specific to your case). 

So, I pay:

Premiums: $2400/year
Co-payments (office visits): ~5/year x $30/visit = $150/year
Co-payments (rx): 12/year x $35/drug x 3 drugs = $1260/year
Total: $3810

[onemoretime]

i spent 2500 this year;  not counting the ins itself work pays for that

[pos2007]

My self pay premium  is $994.00, up  from the  $387.00 it used to  cost  just 2  years ago.  Deductable $2800.00  unless an out  of  network provider;  then  it  is 20% plus $5800.00 deduct.   My bills so far  this  year  have been $101,000.00 not  including  yesterdays hospital/ doctor bills knock on wood mostly  paid by  the  insurance. Medicaid  is paying  for my meds ( 15  now)  since   Healthlink  won't due  to  hiv.  Retail  price  for  my  prescriptions (  I am  sure medicaid  pays a discounted rate)   has  been  just  over $27,000.00 so far this  year. I pay a $2.00 co pay  for  each prescription  each  month. Last  Year HSI/  Adap paid  for  part  of  my  meds till medicaid  finally  started  paying.  My  out  of pocket was still  over $10,000.00 since HSI  & ADAP  wouldn't  pay  for  some  meds nor  would  medicaid. Medicaid  has  finally  picked  up  paying  for all  of  my  meds except 3.  An interesting part,  is  part  of  my meds are available self  pay at a local county  clinic for  under $50.00 but neither medicaid nor  my  insurance  will  pay  for them  at  the clinic nor  will the  clinic accept medicaid  or  insurance,   but   medicaid and will pay for  the  same  meds at  the  doctors office at 12  times  the  price.  Go  figure.

[bufguy]

I'm a civil servant, my insurance is Blue Cross/Blue Shield, Community Blue. I pay no premium for my health care. My co pay for my primary care physician who is also an ID Doc is $5 per visit (once every 4 months). I pay nothing for my labs. I get my Atripla through Medco. Co pay is $30 for 3 month supply.
I am unbelievabl lucky. Health care costs me $135 per year.

[skeebo1969]

I'm a civil servant, my insurance is Blue Cross/Blue Shield, Community Blue. I pay no premium for my health care. My co pay for my primary care physician who is also an ID Doc is $5 per visit (once every 4 months). I pay nothing for my labs. I get my Atripla through Medco. Co pay is $30 for 3 month supply.
I am unbelievabl lucky. Health care costs me $135 per year.

LOL unbelievably lucky is an under statement!   

[David_NC]

I'm a civil servant, my insurance is Blue Cross/Blue Shield, Community Blue. I pay no premium for my health care. My co pay for my primary care physician who is also an ID Doc is $5 per visit (once every 4 months). I pay nothing for my labs. I get my Atripla through Medco. Co pay is $30 for 3 month supply.
I am unbelievably lucky. Health care costs me $135 per year.

I'm in a similar position with BC/BS, though I don't think I can get 3 months of Atripla for $30.  Some things might have changed very recently with our Medco plan, so I'll have to check on that.  It's normally $30 for a month's supply.  My ID Dr. (also my PCP) visits are $25, labs are at no cost, and I pay no premium for my coverage.  I'd say I pay around $80 per month (meds) and $25 x 4 (office visits) for my yearly medical costs.  Like Ford and others, I have a healthcare spending account (Flex account) for drugs and co-pays.  It comes in handy.  I try to not get reimbursed from it too often and save the largest chunk for reimbursement at the end of the year.  It helps with holiday expenses (gifts).  I'd say that those of us with comparable or even remotely similar policies with a company / organization that's not merging or closing are more fortunate than we could imagine.

[megasept]

Hi: I'll give you the $ amounts so you can compute your own percentages. Nothing like a good employer-based plan. I have the "private option"   meaning I have to buy insurance on the market (middleman).

You cannot precisely predict your medical costs because you are a living organism; if you have an older model car you would be wrong to just add up maintenance, tire replacement, brake pads, but exclude repairs. Repairs, even diagnostics can be costly. To make matters worse, your insurer may deny this or that now, even though they paid for the same thing previously.

I spend $11472 on premiums, $1320 on meds (not entirely HIV meds), and enough copays for labs, treatments, diagnostic tests, and visits (negligible), to reach $17000-21000 annually. I also spend $2-6,000 more on dental (I buy dental insurance, but it hardly saves me money). HIV costs plenty more than just meds, especially after many years of infection. Plus older people have more medical problems than younger.

My premiums increased 5 times or 107% over 30 months. HIV, or my utilization of my policy was not the reason. I turned 50 and stayed living for 4 more back-to-back increases. My insurer disrupts treatments and rations my care (I fight back and usually prevail). They absolutely get between me and my MD.

I have been fighting for a Public Option (love Medicare NOW) so I can get out of this insurance scam. I trust my MDs, so that's more important than cost. Future costs? Not a clue.

Good Health!
  -megasept

[tednlou2]

I'm new to this forum.  I notice many put their lab info at the end of their replies.  They all look like the same size print--as if they previously entered their CD-4 and VL info somewhere else on this site and posted it.

Can anyone tell me how this is done?  Or, is everyone just using the same font, font size, and so happen to put lab info in the exact same place following their replies.  Also, I've noticed many didn't know they were poz until CD-4 was dangerously low--such as single digits.  I know statistics show many don't know until their CD-4's have almost totally crashed.  I'm wondering whether these people felt fine until they got some OI like PCP-pneumonia?

I found out last Dec after getting strep-pneumonia--the community acquired kind.  My CD-4 rebounded to over 1,000 and I'm not on meds yet.     

Thanks,
Ted

[confidentIwillbeOK]

Ted, go to "Profile" and then  "Forum profile information" and edit the "Signature" section.