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Author Topic: Health Insurance issues  (Read 2433 times)

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Offline justaguy

  • Member
  • Posts: 83
Health Insurance issues
« on: August 19, 2010, 08:23:33 PM »
The tiny company I work for is going under... quick.  Writing is on the wall.  No COBRA option for a company this small, and if the company and group health plan ceases to exist, it wouldn't be anyway.  I've already sent out dozens of resumes, and I plan on going on my own and becoming self-employed once this happens, so I've done some research on what my options are for coverage.  So far the best option is my state's high-risk pool, but this comes with a glitch.  Say my company ceases to operate next week, I know that my health insurance is paid through the end of this month, but not for September.  I can sign up for coverage with the state high risk pool, but I have to prove that I lost my coverage with some sort of certificate stating I've had prior coverage.  Here's where I'm having trouble making it work:  if we cease at the end of this month, then I won't be covered in September.  I can sign up for the new coverage, but their own rules say that I won't be covered until the "first day of the month following acceptance of my application".  Well, I can't apply until my current coverage is terminated.  I'm quite concerned that there will be a month of non-coverage, which means no Atripla refill in September for me unless I pay full price.  So then I have to weigh the option of "hmm...pay the full $1900 cost of atripla OR go without it for two weeks..." Considering that I'll be unemployed, starting a business, etc., $1900 is quite a hit.  A second option (one recommended by the caseworker at my HIV clinic) is my state's subsidized insurance.  If I'm unemployed, and qualify for unemployment benefits, I can qualify for the health insurance, but it takes "3-4 weeks to process an application".  And since I'm not CURRENTLY unemployed, I can't apply for unemployment benefits, OR the health coverage.  I feel like timing is going to be everything in this situation and it's stressing me big time, because I don't feel like those are good options, and frankly I don't know when the stuff is gonna hit the fan.  I know it's hard to help people in a situation like this without knowing all the details, but I really just wanted to vent.  :0)  Whew, much better.
Estimated infection: 3/2008
Tested HIV positive: 3/31/2009
CD4 136/unknown %/VL 150,000: 4/6/2009
Started Atripla 4/17/2009
CD4 255/19%/VL 409 5/27/2009
CD4 247/??/VL 161 6/27/2009
CD4 257/21%/VL 60 7/22/2009
CD4 352/22%/VL Undetectable 10/21/2009
CD4 490/27%/VL Undetectable 2/15/2010
CD4 397/?/VL Undetectable 7/2/2010

Offline phildinftlaudy

  • Member
  • Posts: 2,965
  • sweet Ann what you think babe...
Re: Health Insurance issues
« Reply #1 on: August 19, 2010, 08:30:36 PM »
What state are you in?  Is ADAP an option?  Also, I don't know all the ins and outs but I thought COBRA coverage was mandatory - insurance companies have to offer it - is has nothing to do with the employer - other then the fact that you get the insurance at the rate the employer pays.  You may want to check on this - as I don't think COBRA is tied to whether the employer is still around or not - because you are paying the total premium.  Also, I know that there was something in the previous unemployment bills that allowed for coverage of COBRA premiums.  I would check with your HR office, your insurance company, and/or your state's regulatory authority(ies).  Hope this helps.
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline aztecan

  • Member
  • Posts: 5,396
  • 29 years positive, 57 years a pain in the butt
Re: Health Insurance issues
« Reply #2 on: August 19, 2010, 08:37:14 PM »
Hey Justaguy,

COBRA would be an option if the company policy still exists, but I am not certain it would if the company went belly up.

Are you enrolled with an ASO? If not, I would look into it. I know that here, we have ADAP coveraga available in an emergency situation. So, for the month you weren't covered, ADAP would at least provide your Atripla.

I don't know if the same thing holds true where you live, which is why I recommended contacting your local ASO to see what is available to you.

I also know people are now enrolling with the federal medical insurance pool that appeared after the passage of the Health Care Reform Act.

It is hard to advise you because things are changing so quickly.

HUGS,

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

Offline BlueMoon

  • Member
  • Posts: 665
  • Calling from the Fun House
Re: Health Insurance issues
« Reply #3 on: August 19, 2010, 08:57:01 PM »
What state are you in?  Is ADAP an option?  Also, I don't know all the ins and outs but I thought COBRA coverage was mandatory - insurance companies have to offer it - is has nothing to do with the employer - other then the fact that you get the insurance at the rate the employer pays.  You may want to check on this - as I don't think COBRA is tied to whether the employer is still around or not - because you are paying the total premium.  Also, I know that there was something in the previous unemployment bills that allowed for coverage of COBRA premiums.  I would check with your HR office, your insurance company, and/or your state's regulatory authority(ies).  Hope this helps.

This is what the Wikipedia article on COBRA says --

"COBRA does not apply, on the other hand, if employees lose their benefits coverage because the employer has terminated the plan altogether or if the employer has gone out of business."

I would look into a short-term policy.  I used one about ten years ago while I was making the transition from COBRA to a personal policy.  I think it was offered by Fortis.  I wasn't diagnosed with HIV or anything else at the time, so I don't know what effect that would have.
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline Hellraiser

  • Member
  • Posts: 4,136
  • Semi-misanthropic
Re: Health Insurance issues
« Reply #4 on: August 19, 2010, 09:07:01 PM »
Viraday, $150 just to get you through a month.  Or you could see if anyone on here has a spare bottle they could loan you until you get covered again.  I don't guess you've followed those of us who have said "build up a surplus" just in case of emergencies like this eh?

Offline justaguy

  • Member
  • Posts: 83
Re: Health Insurance issues
« Reply #5 on: August 19, 2010, 11:03:26 PM »
Haha nope, no stockpile here...and I wish I had - so let me be an example!  I think I figured out a plan tonight though.  I have an appointment Monday.  I'm going to ask my doc to give me a 90 day refill prescription.  That way, I will have at least 90 days worth, rather than month to month as I am right now, so I can hopefully get some resolution, etc. within that 90 days.  :0)  Thanks for the other suggestions.

PS, COBRA doesn't apply to companies with less than 20 employees, if I'm reading things right 

http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html

, and it also doesn't apply if employer stops offering health insurance due to bankruptcy,  or otherwise lets coverage lapse due to nonpayment, etc. 
Estimated infection: 3/2008
Tested HIV positive: 3/31/2009
CD4 136/unknown %/VL 150,000: 4/6/2009
Started Atripla 4/17/2009
CD4 255/19%/VL 409 5/27/2009
CD4 247/??/VL 161 6/27/2009
CD4 257/21%/VL 60 7/22/2009
CD4 352/22%/VL Undetectable 10/21/2009
CD4 490/27%/VL Undetectable 2/15/2010
CD4 397/?/VL Undetectable 7/2/2010

Offline Assurbanipal

  • Member
  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: Health Insurance issues
« Reply #6 on: August 20, 2010, 02:03:17 PM »
COBRA does not apply to very small employers, nor if the employer ceases to sponsor any health care plan at all.

Your 90 day refill strategy sounds good.  If you run into problems with that you might look into the patient assistance option for Atripla https://www.atripla.com/pdfs/Atripla_PAP_Application.pdf  1-866-290-4767

 
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Granny60

  • Guest
Re: Health Insurance issues
« Reply #7 on: August 20, 2010, 11:17:22 PM »
Usually the prescriptions are for 30 days, but you can often get a refill in 23 or 24 days. If you continue to refill every 3.5 weeks or so,  you can build a little cushion. Husband has been able to get emergency assistance from medicaid  and Adap during some coverage lapses when things got screwed up and His ID clinic gave him an emergency bottle  one time also. The patient assistance programs most of the time send the meds to your doctor, sometimes pharmacy after enrollment. some work fast ( take an application over the phone or by fax),  some will take a few days. the Viraday from overseas is quite reasonably priced but our experience ordering meds from overseas,  it can take 3 to 9 weeks to get them, but we have been able to get  6 months meds at a time. Talk to your doctor. He may be able to  give you some meds out of their emergency cabinet  or sample starter packs to  give you the cushion time to resolve any  coverage lapses you may have.  Hang in there buddy,  It will work  out. Even if you do have a lapse for a while, your doctor  or case manager should be able to help you with treatment options later on to resume treatment.

Offline justaguy

  • Member
  • Posts: 83
Re: Health Insurance issues
« Reply #8 on: September 04, 2010, 04:32:45 PM »
Update:

The inevitable happened.  Company has folded.  On the same day of the announcement, I received my 90 day supply in the mail.  Whew.  Now I need to get my certificate of credible coverage to turn into the state high risk pool, and I will then be covered under their plan.  Having enough medicine to get me through Christmas is a NICE feeling.  Self employment, here I come!  :)
Estimated infection: 3/2008
Tested HIV positive: 3/31/2009
CD4 136/unknown %/VL 150,000: 4/6/2009
Started Atripla 4/17/2009
CD4 255/19%/VL 409 5/27/2009
CD4 247/??/VL 161 6/27/2009
CD4 257/21%/VL 60 7/22/2009
CD4 352/22%/VL Undetectable 10/21/2009
CD4 490/27%/VL Undetectable 2/15/2010
CD4 397/?/VL Undetectable 7/2/2010

Granny60

  • Guest
Re: Health Insurance issues
« Reply #9 on: September 04, 2010, 09:45:33 PM »
Sorry the place went down the tubes, but glad things have worked out.  Thanks for letting us know. Good luck!

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Health Insurance issues
« Reply #10 on: September 05, 2010, 01:52:15 AM »
I am so glad that the med supply came through! Any landing you can walk away from , I always say

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Inchlingblue

  • Member
  • Posts: 3,119
  • Chad Ochocinco PETA Ad
Re: Health Insurance issues
« Reply #11 on: September 05, 2010, 01:30:28 PM »
Update:

The inevitable happened.  Company has folded.  On the same day of the announcement, I received my 90 day supply in the mail.  Whew.  Now I need to get my certificate of credible coverage to turn into the state high risk pool, and I will then be covered under their plan.  Having enough medicine to get me through Christmas is a NICE feeling.  Self employment, here I come!  :)

Congratulations.

Just curious, because I read that some state's high risk pools require people to wait 6 months. Will you be able to get coverage without a waiting period? Can you give an idea of the cost?

Offline Assurbanipal

  • Member
  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: Health Insurance issues
« Reply #12 on: September 05, 2010, 06:41:17 PM »
Congratulations.

Just curious, because I read that some state's high risk pools require people to wait 6 months. Will you be able to get coverage without a waiting period? Can you give an idea of the cost?

Under HIPAA, states have to provide some way for eligible individuals to buy coverage after COBRA ends (or when, as for justaguy, it is not available because the employer closed up).  It is important to stay on top of this though, as you may only have 63 days to elect coverage.

Since states control the regulation of health insurance in their state they can satisfy HIPAA by forcing insurers to provide coverage.  If they don't want to do that they can allow people who are HIPAA eligible into a high risk pool.  If the state is using a high risk pool to provide HIPAA policies (instead of requiring insurers to do so) they can't impose a 6 month limit on HIPAA eligible individuals.


HIPAA Eligibility Criteria for Individual Coverage
Guaranteed right to purchase individual coverage under HIPAA.
HIPAA eligibility in the individual market (either in the commercial market, the state
high risk pool, or other means the state may choose) gives an individual access to health
coverage on a guaranteed issue basis, without the imposition of a preexisting condition
exclusion. HIPAA does not regulate premiums. The states do, if they have rating
authority. The Federal standards for HIPAA eligibility for portability to individual
coverage are:
the individual must have a total of 18 months of creditable coverage;
the individual must avoid a significant break in health coverage of 63 or more full
days in a row (unless your state is more generous). A significant break in
coverage results in the individual losing credit for the coverage before the break;
the individual may not have any medical coverage, other than that which will
soon be exhausted;
if COBRA, state continuation coverage, or Federal Temporary Continuation
Coverage has been offered, a person must accept and exhaust it. Although an
individual may apply for HIPAA coverage before the termination of COBRA,
COBRA must be exhausted and then the new coverage will start;
the individual may not be eligible for any other employment related group health
coverage, Medicare or Medicaid;
the individual must have the last coverage through an employer or union plan
(COBRA, State and Federal continuation coverage meet this requirement);
the individual must not have lost their last coverage through fraud or non-payment
of premiums;
generally, the individual must not accept, after losing group coverage, a
conversion policy (although a few states use this as part of their mechanism) or
policy of limited duration because they are both forms of individual coverage and
end the individual's HIPAA portability rights.
If you are a HIPAA eligible individual, contact your State Department of Insurance
(DOI) and identify yourself as a HIPAA eligible individual. The State DOI can provide
contact information for issuers who sell HIPAA policies or the high risk pool if the state
meets Federal standards through that means. If you do not qualify as a HIPAA eligible
individual, your State DOI may have information about additional state protections


http://www.cms.gov/HealthInsReformforConsume/Downloads/HIPAA_Eligibility_Criteria.pdf
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline Inchlingblue

  • Member
  • Posts: 3,119
  • Chad Ochocinco PETA Ad
Re: Health Insurance issues
« Reply #13 on: September 05, 2010, 10:19:26 PM »
So I guess this falls under HIPAA and is not part of the new high risk pools being established by the new health care legislation?

Offline Jeffreyj

  • Member
  • Posts: 1,403
Re: Health Insurance issues
« Reply #14 on: September 06, 2010, 12:18:29 AM »
I have extra Norvir ....if anyone needs it please pm me
Positive since 1985

Offline justaguy

  • Member
  • Posts: 83
Re: Health Insurance issues
« Reply #15 on: September 07, 2010, 11:51:22 AM »
So I guess this falls under HIPAA and is not part of the new high risk pools being established by the new health care legislation?

Correct.  My state actually has three different high risk programs.  One for people like me who have lost their coverage (or are about to).  We are "federally defined" and can sign up, no pre-existing condition exclusions.  It's similar to buying my own health care coverage.  The second is "medically defined", meaning someone who meets the medical requirements, but hasn't had coverage - those people have up to 12 months pre-existing condition exclusion.  The third is the NEW pool that is part of the health care reform package.  I didn't research it as much since it didn't apply to my situation, but my understanding is that if you haven't had coverage for at least 6 months, you can sign up for it, and there is no exclusion period...on the state website, it basically tells you "Sign up for this one, not the existing state pool" since it would make no sense to sign up for a year of premiums that won't cover the pre-existing condition.  I'm not sure why they still offer both.
Estimated infection: 3/2008
Tested HIV positive: 3/31/2009
CD4 136/unknown %/VL 150,000: 4/6/2009
Started Atripla 4/17/2009
CD4 255/19%/VL 409 5/27/2009
CD4 247/??/VL 161 6/27/2009
CD4 257/21%/VL 60 7/22/2009
CD4 352/22%/VL Undetectable 10/21/2009
CD4 490/27%/VL Undetectable 2/15/2010
CD4 397/?/VL Undetectable 7/2/2010

Offline Inchlingblue

  • Member
  • Posts: 3,119
  • Chad Ochocinco PETA Ad
Re: Health Insurance issues
« Reply #16 on: September 07, 2010, 11:54:02 AM »
Thanks for the info.

The premiums will be affordable? There is a current thread in Off-Topic about how most people will not be able to afford the new high risk pools.

LINK:

http://forums.poz.com/index.php?topic=34295.0

By the way, how ridiculous to make people with pre-existing condition wait 6 months or longer? WTF?

Offline dvinemstre

  • Member
  • Posts: 96
  • hot in carolina
Re: Health Insurance issues
« Reply #17 on: September 08, 2010, 07:46:31 PM »
I would also commend anyone who is presently working and is HIV+ to go to the local state department of vocational rehabilitation office and apply for services. You may well be over the $$ limit now if you work, but there is a deductable and in such incidences as you have described you would be able to get them to pay for your meds while you were uninsured. They also assist people with re-employment training, self employment/small business start up and other things. There is also such a thing as gap insurance for health which covers short term while a perosn is changing insurance status.

Offline justaguy

  • Member
  • Posts: 83
Re: Health Insurance issues
« Reply #18 on: September 10, 2010, 12:11:57 AM »
Thanks for the info.

The premiums will be affordable? There is a current thread in Off-Topic about how most people will not be able to afford the new high risk pools.

LINK:

http://forums.poz.com/index.php?topic=34295.0

By the way, how ridiculous to make people with pre-existing condition wait 6 months or longer? WTF?

Well, they're affordable in that they aren't completely out of control.  Mine will be somewhere in the mid-200's per month.  My previous employer paid the entire premium for us, so yes, it sucks, but what can ya do.  I'll make it happen.
Estimated infection: 3/2008
Tested HIV positive: 3/31/2009
CD4 136/unknown %/VL 150,000: 4/6/2009
Started Atripla 4/17/2009
CD4 255/19%/VL 409 5/27/2009
CD4 247/??/VL 161 6/27/2009
CD4 257/21%/VL 60 7/22/2009
CD4 352/22%/VL Undetectable 10/21/2009
CD4 490/27%/VL Undetectable 2/15/2010
CD4 397/?/VL Undetectable 7/2/2010

 


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