Leaving Job w/ benefits & Concerned with insurance options

[survivor703]

Hello everyone! I hope that 2018 is proving to be a great year to all of you. I have a quick question about prescriptions.

So, I've been employed for my entire diagnosis. However, I also own a web development agency (3 people total), that has been growing steadily over the years. It's finally time for me to transition into running my agency full time and leave the 9 to 5 job.

My question is this... Since we're small, we're not ready to get a group health insurance plan for the company. However, I wanted to know that if with the pre-existing condition, can I just go purchase my own health insurance without any obstacles? Currently I pay about $264 a month for insurance through payroll deductions, (and the employer pays the rest).

What are my options? Thanks for your help guys!

[Expat1]

What country are you in is the first question.  The next is (if USA, how much and how long can you get a COBRA plan) under your current employer.  I think it's 18 months, compare that to how much a plan on the Obamacare Exchanges would be and if you would get a subsidy or not. If you cannot get a subsidy the next question is what state.  Some states like California prices Silver plans expecting Trump to cause rates to rise.  So in some states a Gold Plan is cheaper and has more coverage that a Silver Plan. The next thing to consider is if and how you could use hiv discount cards from Pharma companies to meet deductible costs.   In some instances the cards pay up front and cause the insurance deductibles to be met.  That means that a low level Bronze plan would be better and cheaper if you get your hiv meds early in Jan, then you hit the maximum out of pocket limits.  Good luck.

[survivor703]

Thanks for the insight... I will check into this. I live in the United States (Maryland)

[Expat1]

Hi.  Although I live in Thailand, I am quite aware of the rules and regs of American Insurance.

Anyway, You will  be on a tight timeline after losing your employers insurance.  You have a limited time to either get COBRA (which I believe that  you can continue for 18 months) or enroll in Obamacare. 

Dont wait for open enrollment, as the Loss of employer coverage will allow you to enroll in the Maryland Exchange.  It most be done on time or you will not be allowed to enroll until open enrollment. 

In some states the Ryan White Grants through ADAP can pay your Insurance premiums (Cobra or Obamacare).  So read their site info below and contact them.
If they pay, they probably want you to have a certain carrier and specific plan.  It is also based you income.  Usually (Usually something like 3 or 4 times the poverty level).

Maryland AIDS Drug Assistance Program MADAP
https://phpa.health.maryland.gov/OIDPCS/CHCS/pages/madap.aspx
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MADAP pays for medications for eligible clients with no insurance and helps clients with insurance by paying for eligible co-pay and deductible costs so they can get their medication. The list of medicines covered by MADAP (the MADAP formulary) includes a wide range of medications used to treat HIV infection, ...

Hope that helps.   Contact an AIDS Service Agency near you for more information. 

[Expat1]

http://mdrxprograms.com/madap.html

[Expat1]

To qualify for MADAP services, a person must meet the following criteria:​
Be diagnosed as having HIV;
Qualify financially (anticipated gross annual household income must be at or below 500 percent of the current federal poverty level for the size of the legal household);
Be a resident of Maryland;
Not be eligible for Maryland Medical Assistance (Medicaid);
Submit a complete ​MADAP application ​​with required documentation.

From their website.