Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

Kaiser: Obamacare & HIV

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Miss Philicia:
Kaiser Family Foundation today released a .pdf file/brief on the Affordable Care Act and its implications for people living with HIV

A summary of it is available at this link:

1) Obamacare will prevent insurance companies from denying HIV-positive Americans coverage simply based on their HIV status. The health care reform law prohibits insurance companies from discriminating based on pre-existing conditions, including HIV. Before Obamacare, Americans living with HIV often struggled to find insurance companies willing to take them on — according to the Kaiser Family Foundation, just 13 percent of HIV-positive individuals were covered under private insurance in 2010.

2) Obamacare’s expansion of the Medicaid program helps low-income Americans with HIV who otherwise wouldn’t qualify for coverage. Over 40 percent of HIV-positive Americans accessed their health insurance through the Medicaid program in 2010, and expanding Medicaid even further will extend additional coverage to this community. Furthermore, under Obamacare, HIV-positive individuals do not have to have to be diagnosed with AIDS as a precursor to qualifying for Medicaid coverage. Although this was an old eligibility requirement for the program, the health reform law ensures the states that accept Obamacare’s Medicaid expansion will not have to impose this restriction on Americans living with the HIV virus.

3) HIV-positive Americans will no longer reach limits on the amount of treatment their insurance companies are willing to cover. Obamacare eliminates lifetime coverage caps and phases out annual limits, which will help all Americans with chronic conditions — including the Americans who rely on treatment for HIV infections — continue to be able to afford the care they need without reaching an arbitrary cut-off set by their insurance companies.

4) HIV testing will likely be covered under Obamacare. This year, the U.S. Preventive Services Task Force is expected to recommend routine HIV screenings as a part of regular preventative care, similar to a routine blood pressure test. Since the health reform law requires insurers to cover the preventive services recommended by the Preventative Services Task Force, a new standard for HIV testing could ensure that it becomes a standard part of annual check-ups. The Centers for Disease Control estimates that about 20 percent of the total population of Americans who are infected with HIV don’t know they have the virus, so regular tests that don’t incur an out-of-pocket expense could help encourage more Americans to learn their status.

5) Since Obamacare helps close the prescription drug coverage gap for Medicare beneficiaries, HIV-positive individuals will be more likely to afford their drug treatments for the virus. By closing the “donut hole,” or the gap in coverage for expensive prescription drugs under the Medicare program, Obamacare will help ensure that older Americans living with HIV aren’t unable to afford any of the 26 antiretroviral drug treatments that can be used to combat HIV infections. Twelve percent of Americans with HIV relied on Medicare for their health coverage in 2010, and that number may rise significantly as the population of HIV-positive Americans continues to age.

6) Obamacare increases resources for HIV research and prevention. The health care reform law allocates $10 billion over ten years for a new fund that focuses on prevention, wellness, and public health activities. In 2010, $30 million from that fund was awarded to the Centers for Disease Control for HIV prevention activities, including new investments in HIV surveillance and testing among high-risk populations.

JR Gabbard:
Thanks ever so, Miss Philicia, for posting this!

One minor quibble (and I mean really minor) is that Medicare is not just available after retirement age (65).  If you are on SSDI for 30 months, you are automatically enrolled in Medicare.  Lots of younger HIV+ people use this benefit.
Losing the doughnut hole will be nice as well, but ADAP (or Medicaid if you are dual-eligible) covers co-pays and the doughnut hole.
Most people with HIV who are on therapy move into catastrophic coverage by February.  Depending on your plan, that can mean no further out-of-pocket medication expenses until the following January.

buginme2:

--- Quote from: JR Gabbard on September 26, 2012, 01:24:52 PM ---Thanks ever so, Miss Philicia, for posting this!


Most people with HIV who are on therapy move into catastrophic coverage by February.  Depending on your plan, that can mean no further out-of-pocket medication expenses until the following January.

--- End quote ---

Can someone clarify this for me? I had not heard of this.  Is this a medicare rule or a new insurance in general rule.

Mus1cl0V3R:

--- Quote from: buginme2 on September 26, 2012, 01:45:29 PM ---Can someone clarify this for me? I had not heard of this.  Is this a medicare rule or a new insurance in general rule.

--- End quote ---
I can't clarify this for Kaiser but my insurance (a Medicare Part D plan) works this way (although it happens for me around April).

It also depends on the medications you are taking and how expensive they are.

The way it was explained to me was...after the total cost of your medications (what you pay and what the insurance pays combined) goes over some limit (I do not recall the amount) then you are no longer required to pay a co-pay.

HTH
Cheers

chgo2012:
at what cost?  My Kaiser "individual policy" is already $ 720.00/month plus deductives and co-pays and I was already told that will going UP on Jan 13... I can't understand why insurances can have different groups (i.e. for companies, charging a fraction of what I pay) and for individuals, high as a punishment. I don't know where Obama's plan will help on this matter, as I don't know for how long I will be capable to pay such expensive health insurance policy... all of this plan of have people covered sounds pretty, but if people can't afford it, what's the point?   Whatever it is should be effective immediately and not wait until insurance companies find ways to raise premiums and cut benefits as they are already doing. 

I have private insurance for over 20 years and I've never seem so expensive and lousy as lately... and that's has nothing to do with the HIV or age... has been like that for a while and without consequences for them.

We need an intervention on health insurance companies NOW.

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