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Author Topic: Question about declining my employer health insurance  (Read 688 times)

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Offline survivor703

  • Member
  • Posts: 104
Question about declining my employer health insurance
« on: May 04, 2014, 11:01:47 AM »
Hello everyone,

I just have a question about whether or not I should terminate my employer group insurance and go with an Obama Care out of pocket. I just read the following quotation on <a href=“http://forums.poz.com/index.php?topic=53711.0
”>another thread</a>
, and I must admit, I got a little scared.

Quote
I know that previously, the cost increase to the Smaller Employer was a red flag and then HR would be "Notified" by the insurance company (or glance at the application as they were the person entering the info), and the HIV+ person would be terminated for some obscure reason.

So the time for re-enrollment is here, and I could just decline the health care coverage, and pay for the obama care coverage that I was approved for. The cost of the obama care will cost me about $40 more per month, and it covers a little less than the employer health care.

What do you guys think?
02/14/2012 Diagnosed (Happy valentines day)
02/15/2012 CD4 502 21%, VL 69,134
04/10/2012 CD4 607 22%, VL 60,893
10/08/2012 CD4 615 15%, VL 155,981
03/01/2014 CD4 340 17%  VL 65,689
05/05/2014 1:18PM EST Started Truvada + Tivicay
06/03/2014 CD4 620 20% VL 30 (almost UD!)
Next Labs 08/2014

Offline vertigo

  • Member
  • Posts: 138
Re: Question about declining my employer health insurance
« Reply #1 on: May 04, 2014, 01:13:18 PM »
If you have good insurance through your employer I would stick with it.

The real cost of HIV treatment is the meds, not the doctor's visits or lab work.  I've read that some of the new Obamacare plans have quite high prescription deductibles.  This would have to be carefully investigated before making a switch.

Also, HIV-positive people in the US are protected under the ADA.  That's not to say that an unscrupulous employer might not try to fire someone for it, but you do have protection under the law.  And I believe that insurance companies are no longer allowed to raise rates for small employer group plans based on individual employee's medical conditions.

For myself, I was worried that I would have to fight to get coverage, or that my plan wouldn't cover the "good" drugs, but it's really all been pretty easy.  Turns out my insurance coverage was better than I thought.  Hopefully you will also have a good experience.

Offline Irish Eyes

  • member
  • Member
  • Posts: 163
Re: Question about declining my employer health insurance
« Reply #2 on: May 04, 2014, 02:04:00 PM »
Though I never had any health insurance before, four hours after signing up for Obamacare, Anthem Blue Cross Bronze @ approx. $290 per month, I was diagnosed positive.
Thankfully, by sheer coincidence, for the prior couple of months I had adjusted my salary and qualified for ADAP.
I'm still trying to figure out what Anthem covers and what ADAP covers, but one thing that ADAP does cover is paying my Anthem premium.
Granted for the first few months I did pay the premium and received a full refund from Anthem, but they're still trying to figure it out as I still receive a Anthem bill which I pay in anticipation of getting another refund.

My Anthem deductible is $5000 and so far from initial diagnosis, for all bloodwork, doc visits, 2 months Stribild, my total out of pocket expenses have been $1300.00 which was for all lab work only.


10/30/13          Exposure
Mid-Nov-Jan    Seroconversion (7-8 rough wks)
12.26.2013      WB dx. HIV+
02.01.2014      OraQuick (result Negative?)
01.31.2014      VL 250700
02.03.2014      CD4  491  26%
02.26.2014      CD4  503  26%
03.05.2014      HLA B6701  not present
03.18.2014      VL 530873 (typical fluctuation)
03.21.2014      Start Stribild
04.14.2014      VL 104 after 24 doses
05.12.2014      VL 129 after 52 doses
06.10.2014      CD4 940 32%
06.11.2014      VL 87
07.22.2014      Undetectable

Offline AusShep

  • Member
  • Posts: 207
Re: Question about declining my employer health insurance
« Reply #3 on: May 04, 2014, 06:25:59 PM »
The Obamacare open enrollment period has ended, and I don't think voluntarily canceling your employer insurance counts as a life change event that allows special enrollment.  I'd stick with the employer plan anyway with better coverage and lower cost.

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/


Offline Irish Eyes

  • member
  • Member
  • Posts: 163
Re: Question about declining my employer health insurance
« Reply #4 on: May 04, 2014, 08:04:00 PM »
Correction to my previous post.
It is HIPP that covers my insurance premium and not ADAP, both have same income requirements.
10/30/13          Exposure
Mid-Nov-Jan    Seroconversion (7-8 rough wks)
12.26.2013      WB dx. HIV+
02.01.2014      OraQuick (result Negative?)
01.31.2014      VL 250700
02.03.2014      CD4  491  26%
02.26.2014      CD4  503  26%
03.05.2014      HLA B6701  not present
03.18.2014      VL 530873 (typical fluctuation)
03.21.2014      Start Stribild
04.14.2014      VL 104 after 24 doses
05.12.2014      VL 129 after 52 doses
06.10.2014      CD4 940 32%
06.11.2014      VL 87
07.22.2014      Undetectable

Offline BKKKevin

  • Member
  • Posts: 39
Re: Question about declining my employer health insurance
« Reply #5 on: May 04, 2014, 08:11:16 PM »
You can switch in 2015... Open enrollment starts Nov 15th...

https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=7

Also to IrishEyes... You might look to going to a silver plan next year... I have a Blue Cross Silver Plan for $374 that has $30 doctor visit/All Labs/Prescription Copay $50 all which are separate for the $6K deductible...

Offline survivor703

  • Member
  • Posts: 104
Re: Question about declining my employer health insurance
« Reply #6 on: May 05, 2014, 09:27:24 AM »
Hi guys, thanks for all the good advice! Well, the thing is this, I actually already have an approved app, I just have to pay for it. Once I pay, I'll be "grandfathered" in according to the representative from Kaiser.

Quote
I have a Blue Cross Silver Plan for $374 that has $30 doctor visit/All Labs/Prescription Copay $50 all which are separate for the $6K deductible...

This sounds like something that I'd pay for. Although it's slightly higher than my work insurance. At least I wouldn't have to worry about any adverse effects of using the company insurance to pay for my treatment and meds.

Quote
And I believe that insurance companies are no longer allowed to raise rates for small employer group plans based on individual employee's medical conditions.

I really really really hope this is the case. This would eliminate my worries altogether, since nobody, except my hubby, knows about my status (e.g., no one at work.)

Again, thanks all. And HAPPY MONDAY to you all.   :D
02/14/2012 Diagnosed (Happy valentines day)
02/15/2012 CD4 502 21%, VL 69,134
04/10/2012 CD4 607 22%, VL 60,893
10/08/2012 CD4 615 15%, VL 155,981
03/01/2014 CD4 340 17%  VL 65,689
05/05/2014 1:18PM EST Started Truvada + Tivicay
06/03/2014 CD4 620 20% VL 30 (almost UD!)
Next Labs 08/2014

Offline vertigo

  • Member
  • Posts: 138
Re: Question about declining my employer health insurance
« Reply #7 on: May 05, 2014, 08:20:44 PM »

I really really really hope this is the case. This would eliminate my worries altogether, since nobody, except my hubby, knows about my status (e.g., no one at work.)


I just posted a link verifying this in another thread.  Since it seems to be a question on people's minds lately, here it is again:

https://www.healthcare.gov/how-do-i-choose-insurance-thats-right-for-my-business/#question=will-i-have-to-pay-more-if-i-have-employees-with-health-problems

Offline survivor703

  • Member
  • Posts: 104
Re: Question about declining my employer health insurance
« Reply #8 on: May 06, 2014, 12:45:16 AM »
Quote
I just posted a link verifying this in another thread.  Since it seems to be a question on people's minds lately, here it is again:

Thanks vertigo! Good stuff... I saw at the bottom where it says, "Will I have to pay more if I have employees with health problems? No. A plan can't charge higher premiums for employees with high medical costs or pre-existing medical conditions. They can't hike your premiums when someone needs care, and they can't charge women more than men."

This is GREAT news. And I'm assuming this is all across the board, right? Not just with the "SHOP marketplace" insurance plans.

Thanks for the insight!  ;D
02/14/2012 Diagnosed (Happy valentines day)
02/15/2012 CD4 502 21%, VL 69,134
04/10/2012 CD4 607 22%, VL 60,893
10/08/2012 CD4 615 15%, VL 155,981
03/01/2014 CD4 340 17%  VL 65,689
05/05/2014 1:18PM EST Started Truvada + Tivicay
06/03/2014 CD4 620 20% VL 30 (almost UD!)
Next Labs 08/2014

 


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