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Author Topic: need help choosing and understanding medical insurance and costs  (Read 216 times)

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Offline 2blessed

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  • Posts: 51
I am a poor college student trying to get insurance in Georgia under the aca I don't really understand any of the terminology and am afraid I will be stuck with a policy where my meds are like 1000 a month out of pocket which I obviously cannot afford. I have had been using adap since February 2013 but I don't want to go to my local clinic anymore for privacy reasons as well as sometimes they annoy me with lack of info. If anyone could help I would appreciate it greatly.

Offline Since1993

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  • Posts: 95
Re: need help choosing and understanding medical insurance and costs
« Reply #1 on: August 17, 2014, 11:12:01 PM »
I am a poor college student trying to get insurance in Georgia under the aca I don't really understand any of the terminology and am afraid I will be stuck with a policy where my meds are like 1000 a month out of pocket which I obviously cannot afford. I have had been using adap since February 2013 but I don't want to go to my local clinic anymore for privacy reasons as well as sometimes they annoy me with lack of info. If anyone could help I would appreciate it greatly.

Some initial questions:

1.  How old are you?  If you are 26 and younger, you should be covered by your parents plan, assuming you are not covered by any other employer-sponsored or group plan.  If you already covered by an insurance plan, you are stuck with it until 2015, unless it was lost due to a Qualifying Life Event:

https://www.healthcare.gov/glossary/qualifying-life-event/

2.  Why didn't you choose an ACA plan before the extended May 2014 deadline?  There is a Special Enrollment Period after May 2014, but only if you have a Qualifying Life Event. 

If you don't have a Qualifying Life Event, you are not eligible to sign-up for a 2014 ACA plan on the Georgia State Exchange.  You will have to wait until November 2014 to sign-up for January 2015 coverage. 

3.  What are you other options?  Apply for Medicaid through your local social services center OR seek a health plan through a broker.  There are also patient assistance programs that help cover co-pays of medications.  If you are not eligible for Medicaid or cannot afford a health plan, you would be covered under Ryan White Part A coverage for outpatient medical visits and labs, etc.  ADAP would continue to cover your medications.  If you are not satisfied with your current clinic, find another Infectious Disease provider who accept Ryan White (most all do).

I'm surprised when ADAP recertified you last (before the end of 2013), they didn't require you to sign-up for an ACA plan or apply for Medicaid if you weren't already insured?  You might want to contact a medical case manager at a local AIDS Service Organization to further review your options.
 
« Last Edit: August 17, 2014, 11:15:22 PM by Since1993 »
It is always permissible to private message questions related to Social Security Disability Process, Ryan White/ADAP, Affordable Care Act, Medicaid, Medicare and pharmacy coverage issues.  I am not an expert, but have a lot of experience to share in navigating the maze towards staying linked into care.  Supportive.  Healthcare background.  Not a physician.  Not Mr. Personality, flat affect at times.  Working on it.

Offline Since1993

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  • Posts: 95
Re: need help choosing and understanding medical insurance and costs
« Reply #2 on: August 18, 2014, 12:18:34 AM »
Information about applying for ACA insurance and Ryan White/ADAP assistance with helping to pay premiums and co-pays for medications while insured:

Georgia State Healthcare Exchange:
http://georgiahealthexchange.com/index.html

Georgia ADAP Information:
https://dph.georgia.gov/adap-program

Upon applying, it will immediately determine your Medicaid-eligibility.  If you are not Medicaid-eligible, you will have to choose a health plan and become insured in Georgia.  Understand that when you apply for healthcare coverage on the exchange, based upon your income, you will be eligible for Advanced Premium Tax Credit (APTC) which will help pay your insurance premiums (some not all the cost) AND Cost Sharing Reductions (CSR) which will reduce the amount of co-pays, deductibles and maximum out-of-pocket costs as long as you CHOOSE A SILVER PLAN on the exchange.  If your income is less than 250% of the Federal Poverty Level, you should qualify for CSR which heavily reduces the amount of co-pays, deductibles and out-of-pocket maximum you will have to pay.  Your annual deductible shouldn't be more than $750 and annual maximum out-of-pocket no more than $1500, in fact, likely less than if your income is low.

Understand that you will be able to view the ATPC savings upon application, but the CSR savings aren't made visually available online, but rather, until after you receive notification from the insurance company your chose, typically upon arrival of your insurance card.

Once you have successfully applied for a health plan on the Georgia exchange, there is more help available to pay for the remainder of your health care premiums and HIV-related medication co-pays in Georgia.  Ryan White Care Part B/ADAP will pay for the remainder of your insurance premiums and co-pays for all your HIV-related medications.  Every state has their own medication formulary of medications they assist paying for.

1.  Inform your ASO Medical Case Manager to inform them you applied for a Georgia State Exchange insurance and need assistance from Ryan White Part B/ADAP coverage.  Make sure upon confirmation of the appointment that you have all the documents they require for eligibility before the appointment.

2.  Upon completion of your appointment, your chosen Georgia State Exchange health insurance insurance premiums will be paid in-full going forward and the co-pays for your HIV-related medications.
It is always permissible to private message questions related to Social Security Disability Process, Ryan White/ADAP, Affordable Care Act, Medicaid, Medicare and pharmacy coverage issues.  I am not an expert, but have a lot of experience to share in navigating the maze towards staying linked into care.  Supportive.  Healthcare background.  Not a physician.  Not Mr. Personality, flat affect at times.  Working on it.

Offline 2blessed

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  • Posts: 51
Re: need help choosing and understanding medical insurance and costs
« Reply #3 on: August 18, 2014, 02:40:29 AM »
I'm 23. Thank you guys I'm gonna talk to my mom about me being under her insurance but since she lives in a different state.would it make a difference? Btw this is why I won't go into medicine it's so confusing

Offline Since1993

  • Member
  • Posts: 95
Re: need help choosing and understanding medical insurance and costs
« Reply #4 on: August 18, 2014, 02:58:26 AM »
I'm 23. Thank you guys I'm gonna talk to my mom about me being under her insurance but since she lives in a different state.would it make a difference? Btw this is why I won't go into medicine it's so confusing

https://www.healthcare.gov/can-i-keep-my-child-on-my-insurance-until-age-26/

If it is determined you can be covered under your Mother's health insurance policy, what level of coverage you have out-of-state is determined by the insurance company that issued the policy.   You would need to make sure the prescription formulary of your mother's health care plan includes coverage for all the antiretroviral medications you currently take. 

But first, I urge you to contact your case manager at your local AIDS Service Organization to help determine what would be the best path for your personal circumstance.  Because you are under 26 and in school, you have more options in the path toward become insured.  There are jurisdictional issues related to which state would assist you with Ryan White/ADAP assistance that I'm not privy. 



« Last Edit: August 18, 2014, 03:02:30 AM by Since1993 »
It is always permissible to private message questions related to Social Security Disability Process, Ryan White/ADAP, Affordable Care Act, Medicaid, Medicare and pharmacy coverage issues.  I am not an expert, but have a lot of experience to share in navigating the maze towards staying linked into care.  Supportive.  Healthcare background.  Not a physician.  Not Mr. Personality, flat affect at times.  Working on it.

Offline wolfter

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  • Posts: 4,460
Re: need help choosing and understanding medical insurance and costs
« Reply #5 on: August 18, 2014, 04:24:49 AM »
You're about the same age as my beloved nieces and nephews so I hope you tolerate my speaking to you as I would them.  ;)

So, you're a poor college student who is preparing to make major financial decisions because of privacy and annoyance?  And you're also OK with causing your parents to assist with these decisions?  ADAP personel isn't up to your knowledge standards?

There has been a major overhaul to our insurance/ medical system in the last couple of years if you haven't noticed.  Most of the professionals I've interacted with in the OADAP system have been educated in social sciences.  Most have been overwhelmed dealing with the changes. 

If your parents already have a family plan there might be no additional cost to them.  But, if you're an only child or only have one other sibling, there might be considerable cost for your parents to include you on their insurance. 
Complacency is the enemy.  ;)  Challenge yourself daily for maximum  return on investment.

Offline Since1993

  • Member
  • Posts: 95
Re: need help choosing and understanding medical insurance and costs
« Reply #6 on: August 18, 2014, 01:25:57 PM »
You're about the same age as my beloved nieces and nephews so I hope you tolerate my speaking to you as I would them.  ;)

So, you're a poor college student who is preparing to make major financial decisions because of privacy and annoyance?  And you're also OK with causing your parents to assist with these decisions?  ADAP personel isn't up to your knowledge standards?

There has been a major overhaul to our insurance/ medical system in the last couple of years if you haven't noticed.  Most of the professionals I've interacted with in the OADAP system have been educated in social sciences.  Most have been overwhelmed dealing with the changes. 

If your parents already have a family plan there might be no additional cost to them.  But, if you're an only child or only have one other sibling, there might be considerable cost for your parents to include you on their insurance.

I'm not sure what the circumstances surrounding the young gentleman not already being insured.  He says he's been receiving ADAP since February 2003, and most all ADAP programs were requiring everyone uninsured to minimally apply for Medicaid and/or apply for an ACA plan for 2014.  Even if the state he resides didn't expand Medicaid and he couldn't afford an ACA plan singularly, he could afford one with Ryan White Care Part B assistance.  It makes me wonder if he somehow fell through the cracks.  In the absence of insurability, Ryan White Part A/ADAP would assist him, which is where he is now.

Because of the newness of all the changes with ACA, there has been a steep learning curve for Ryan White ADAP program specialists around the country.  When I applied for an ACA plan, a navigator who was specifically trained for Ryan White/ADAP clients attempted to tell me I wouldn't be eligible for Advanced Premium Tax Credits for a 2014 ACA plan because I was disabled and Medicare-eligible in 2015.  I told them this information was incorrect and they processed my ACA application through the state exchange incorrectly which created problems and a delay in receiving my first months benefits.   They were incorrect.  I had personal knowledge of this information beforehand because a relative works for HHS and the ADAP program specialist wouldn't listen to me.  They finally "got the memo", but it took some time to get kinks like that worked-out.  That being said, because of the newness of ACA, I'm wondering if this young gentleman didn't somehow fall through the cracks.
It is always permissible to private message questions related to Social Security Disability Process, Ryan White/ADAP, Affordable Care Act, Medicaid, Medicare and pharmacy coverage issues.  I am not an expert, but have a lot of experience to share in navigating the maze towards staying linked into care.  Supportive.  Healthcare background.  Not a physician.  Not Mr. Personality, flat affect at times.  Working on it.

 


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