Suggestions for Self-Employed Insurance

[noregrets]

Hi everyone,

I'm wondering if anyone can help me here.

I'm currently employed & have health coverage at work that covers my doctor visits & my Atripla prescription each month.  The problem is I hate (I mean, H-A-T-E) my current job & an opportunity has come up to start working from home again, something I did for a number of years until the economy went South and I had to go back into the real world.  To say I miss working from home & working on my own schedule is a true understatement.

The thing that's holding me back is that I'm having a pretty hard time finding health insurance coverage that I can afford that has decent prescription benefits.  Anything I look at that's affordable has rotten prescription coverage and anything that offers good coverage is way out of my price range.  Most of the plans seem to be ok with doctor visits, hospitalization, etc. but anything other than a random prescription here & there just isn't remotely affordable.  I mean seriously, who can afford several hundred dollars a month plus 1/3 the cost of a $2500/month prescription??

So, here's my question…  Does anyone have any suggestions for someone who is planning on working for themselves?  As far as I know, I probably make too much money to qualify for any "assistance" (& I wouldn't want to take anything from anyone who truly needs it), but I don't quite make enough where it's not going to be a challenge each month.  I'd love any suggestions for insurance coverage (I"m in VA but might be moving back to NC later this year) or any kind of help for someone in my situation.

Thanks in advance for any suggestions!

[Jmarksto]

Hey Noregrets;

Thanks for the post, I have been wondering the same thing.  I am currently paying several hundred in health insurance and several hundred in meds per month (after the copay card).....and yes its a stretch.

[mitch777]

If you guys can hold off on making the change until Jan.1st,2014, the states should be offering alternative choices that are supposed to be more reasonably priced due to Obamacare. I am self employed and pay around $12,000. per year for insurance. Some of my med co pays are $40.00 each and doctor visits are another $45.00. it adds up quick!
Some states will be offering multiple plans to choose from. These are all currently still being developed and the cost is not yet known but I believe the deadline for announcing these options and the cost is Oct. 1st of this year.
I plan on checking them out carefully and hope to find a plan similar to what I've got at a much better price.
I could be wrong, but I think insurance companies cannot deny someone (adults) insurance for preexisting conditions after 1/1/2014. Insurance companies have been charging outrageous prices to the self employed for years.
Hope this helps.

[Jmarksto]

Mitch; Thanks for the reply -- I am hoping that there is an obamacare plan that reduces the cost, but I am not holding my breath.  Right now my insurance is about $9k/year. My doctor visits arn't bad at a $30 copay, but the labs kill me - its about $300 - $400 every time my labs are done, and my co pay on my meds is 50%!!!!  I'll be curious to see what comes out in the next year....

[noregrets]

Thanks for the replies, guys.  The labs are something I hadn't even considered when I did my original post.  I'm going to the doctor about every 3 months now (bc I'm close to undetectable, but not quite yet) & that's a fortune each time.  Luckily, my current provider is great with that, they usually end up costing me about $100 each trip. I'm not sure with the new coverage I've been looking at what that might run.

How about Ryan White or state help?  At what point can you at least get some assistance usually?  I hate to ask about that bc I'd much rather  just buy my insurance & do it myself but they make it practically impossible.

[mitch777]

Mitch; Thanks for the reply -- I am hoping that there is an obamacare plan that reduces the cost, but I am not holding my breath.  Right now my insurance is about $9k/year. My doctor visits arn't bad at a $30 copay, but the labs kill me - its about $300 - $400 every time my labs are done, and my co pay on my meds is 50%!!!!  I'll be curious to see what comes out in the next year....

Yikes! A $9000/year plan with only 50% med coverage? And poor lab coverage?!
You must be paying over $20,000/year out of pocket including insurance.
(it's around $15,000 for me)

Thanks for the replies, guys.  The labs are something I hadn't even considered when I did my original post.  I'm going to the doctor about every 3 months now (bc I'm close to undetectable, but not quite yet) & that's a fortune each time.  Luckily, my current provider is great with that, they usually end up costing me about $100 each trip. I'm not sure with the new coverage I've been looking at what that might run.

How about Ryan White or state help?  At what point can you at least get some assistance usually?  I hate to ask about that bc I'd much rather  just buy my insurance & do it myself but they make it practically impossible.

My labs are covered under my plan. (with a $20 co pay if I get my blood draw at the hospital clinic)

Never looked into Ryan White. I think it income based and might vary by state. ADAP is also income based and does vary by state. Some states requirements are much better/easier than others. I think in Connecticut it is 400% of poverty level. We also have state assistance available for insurance coverage but I don't know the details. (I read them once and didn't think I qualified)
Anyway, I would look into it. Maybe your local ASO could help.

[OneTampa]

I am currently self-employed working as a consultant after leaving my last job December 2012.

I have insurance coverage under COBRA and now pay about $485 a month premium. I also pay the $30 co-pay for doctor visits (I see him twice a year) and $0 or $30 prescription refill co-pay depending on the generic or brand name.

The COBRA coverage can go for 18 months and I can request an extension if needed.

I also have been checking out market insurance coverage here among other places: https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition

[Habersham]

There is an article in NYTImes today about how the new health care law will cut premiums in half for the self- insured in NY. Savings should be similar in other states who adopt the insurance exchanges.   Of course, these will all be different and probably in the South - not so much.

http://www.nytimes.com/2013/07/17/health/health-plan-cost-for-new-yorkers-set-to-fall-50.html?hp&_r=0

As for ADAP the limits vary widely state to state. In NY and PA dollar limits can be as high as 90k before you stop receiving benefits.  In Georgia and some other states people die on the waiting lists. I urge you to find out the exact limits for your state. I myself am moving to Oregon. Hope to see you there. 

[Jmarksto]

Habersham;

I am in Oregon, so we look forward to seeing you here!

Regarding the Oregon plan "Cover Oregon", here is the link:

http://coveroregon.com/individual_families.php

I don't qualify for any financial benefits (ie. tax deductions) based on my annual income and family size, and it isn't clear if Cover Oregon would allow me to buy insurance through them to get a better plan than I have now with no pre-existing condition restriction.

Again, welcome to Oregon!

[Habersham]

JM,

Thanks for the info and the welcome! Although I am not there yet I have been conducting my own informal study on the best cities to live with HIV. I'm comparing ADAP services, rental costs and Walkscore. The obvious places like Boston and New York are prohibitively expensive as is San Francisco. So far, Portland and Pittsburgh are the leaders. I lived in Pennsylvania most of my life however, and the winters are brutal.

The CAREAssist program looks great:

http://www.oregon.gov/dhs/pages/ph/hiv/careassist/index.aspx

and it may seem like a small thing but they have a great website.  I've often wondered why if Target and Nordstrom can design a friendly website the knack eludes government agencies.

I should be out there in a few months, thanks so much.

Regards,
Charles

[bmancanfly]

Generic atripla can be purchased online for as little at $168 for a 30 day supply,  cheaper if you buy in quantity.

PharmacyChecker.com has a good reputation.

http://www.pharmacychecker.com/compare-drug-prices-online-pharmacies/efavirenz+&252+emtricitabine+&252+tenofovir-600&252200&252300+mg/67876/194150/

[a2z]

NoRegrets, one thing I think that has already been suggested is COBRA for 18 months.  Are you in a position where if you decided to quit your job, you can A) Afford the COBRA cost, B) easily get back into the industry and a job if you can't find replacement insurance through a state health exchange that you can afford.

[justaguy]

I was in your shoes a few years ago.  I would check to see if your state currently has a "high risk pool".  I live in one of the most backwards red states in the nation, and we actually had a really good one in place when I decided to become self employed about three years ago.  Basically, all insurance companies in this state put money in to this system to help subsidize the higher cost of high risk patients like us with pre-existing conditions.  You have to pay a premium that is slightly higher than the standard rate for an individual your same age with no pre-existing conditions.  There was no basis on income or anything like that.  My state allowed you to qualify based on several different criteria, but basically all I had to do was get a letter from my doctor indicating my status/diagnosis, prove that I had been covered by insurance for the last year or something like that, and I qualified immediately.  I think some conditions require that you prove you have been rejected by other insurance companies, but HIV was kind of like a hall pass that let me bypass that.  I'm in my mid-late 30's, my monthly premium is around $350, with a $1,000 annual deductible, and $100 per month copay for my Atripla.  Other medicines that they don't call "specialty" meds are lower, usually $15 or $30.  I usually spend around $6,500 per year including premiums, but I only go for labs every 9-12 months since things are so stable with my numbers, and since my deductible is $1,000 I usually have to pay it all out of pocket, around $3-500 depending on what the doctor is checking.  I'm not sure what's going to happen once 2014 rolls around.  Since individual market insurance policies won't be allowed to deny based on pre-existing conditions, I have to wonder if the high risk pools will be going away?  I've done some shopping around, and I can't really find any kind of great deal on the regular individual plans out there now.  Most have horrible prescription plans!  20-50% copay on meds, or the meds have an annual deductible that has to be met.  I honestly have no complaints about what I have right now, even though it's not nearly as sweet as the group health insurance I walked away from.

Another suggestion that several people gave to me when I was looking was to check with any professional organizations (i.e., bar association or even college alumni groups).  Nothing I qualified for had individual health plans, they all required a group of 2 or more, but apparently that route does work for some people.

Edited:  Just googled, doesn't look like Virginia has a plan in place, but NC does..  http://www.nchirp.org/eligible.htm

[dballin77]

Hello  I live in New York and have AmidaCare insurance. They cover 100% of my medications. There is no out of pocket expense even to see a specialist. Here is the number for more information: I had Adap at first and even then I had no copay for medications. I would recommend others to look to AmidaCare. They are a Managed Care type of insurance specifically for Hiv/Aids patients

[Jeff G]

Hi Dballin and welcome to the forums . I removed the phone # from your post because we do not encourage any marketing on the site . If members wish to web search the company they can do so on their own .

I assume you are HIV positive yourself from your post ?  . It would be nice if you shared a little about yourself so we can get to know you . Thanks , Jeff .   

[JR Gabbard]

I checked out AmidaCare, and it looks like they are Medicaid providers specifically for NYC---not even sure about the rest of the state.
If you do not qualify for Medicaid, you will not be able to use this company.  Same thing if you live outside NYC (most likely).
The OP could go to the government website for more information on available plans in the area where he lives, or where he will be relocating.
Best of luck!

[noregrets]

I think, for the time being, I'm just going to stick with my Cobra coverage from my current employer (as of next week "ex employer).  It's $469/month & that's way more than I'd like to spend but it's really only about $200 more than I was hoping to get coverage through Aetna for on my owm.  I started the approval process with them today & 5 minutes into it as soon as they learned I was on Atripla they wanted to pass me onto another department (in case my application was denied).  That told me right there where things were headed.  So, I'll have the Cobra for 18 months and I'll cross my fingers and pray (& I'm not even a praying man) that the exchanges & rates that start to kick in next year will make life a little more bearable. *fingers crossed*

[mitch777]

I think, for the time being, I'm just going to stick with my Cobra coverage from my current employer (as of next week "ex employer).  It's $469/month & that's way more than I'd like to spend but it's really only about $200 more than I was hoping to get coverage through Aetna for on my owm.  I started the approval process with them today & 5 minutes into it as soon as they learned I was on Atripla they wanted to pass me onto another department (in case my application was denied).  That told me right there where things were headed.  So, I'll have the Cobra for 18 months and I'll cross my fingers and pray (& I'm not even a praying man) that the exchanges & rates that start to kick in next year will make life a little more bearable. *fingers crossed*

I wish you well and I hope the new healthcare options starting in January will ease the burden. Healthcare has gone down hill and the expenses gone through the roof.
 m.

[mecch]

I watched Rand Paul on the Daily Show and the main topic was health care.
What a load of malarky!!!!!  Sheesh!  Its really f'ing offensive that John Olivier didn't trash Paul's "facts" but it's a comedy show, alright. I hope Paul gets a good grilling face to face with a real journalist, to discredit some of this rosey picture of "85% of Americans have health insurance" and no further discussion needed about them.  Worse, he advocates a total free market on this, WHICH THE US WILL NEVER GIVE, so the end result of having Paul in control would only be less and less....  Harder and less secure lives all around.  Piled on top of how bad it is at the moment.

I mention this in the thread because its ALREADY been announced that insurance rates in the pools are going to be MUCH lower than the corporate rip-offs available now.  I can only imagine the copays and deductibles are going to be more reasonable, as well. 

Some of your experiences above, are nightmares!!!  I'm really sorry to hear it.

[noregrets]

That's what I'm hoping too.  What concerns me is that the states that seem to be embracing this (CA, NY, etc) have said that rates will be lower.  Other states that aren't so cooperative I'm not so sure & haven't really heard much about rates (good or bad).  Currently I'm in VA & plan on moving back home to NC after the first of the year.  I'm hopeful the rates will be better in both of these, but I dunno.

[mecch]

In the 80's I had a lover sick with AIDS and suffering and anxiety was all the worse because of lack of health insurance.  In the 90s this repeated with two friends in New York. Meanwhile I had a swiss bf who didn't have any of this extra anxiety about health care. 

There were quite a few things happening in NYC in the 90s that just seemed that my state and my city (ok maybe the whole country but I don't know) was destroying working average people's standards of living - giving everything to the rich.

I think everyone should stay and fight to improve where they live. Its noble. Its home.  Why leave?  But also some people (for example people with chronic health problems) should be realistic and shrewd and theres a point where its a good idea to go to where its possible to live and thrive on the resources available.

I guess what im trying to say is that people can be lulled into thinking its a universal or unavoidable reality, that health care is precarious and unaffordable expensive.  It sure worked deep into my bones in NY.

I think you should watch very closely what your state is going to do and if it isn't liveable, and if it isn't respectable to human dignity, than you should make a study to see if its feasible to live somewhere else, a state that is going to set up something humane and responsible...

If I were in such shoes, I would never quit a job that offers affordable health care until I was sure that there was a long-term affordable solution for my next step.  That's just my opinion.  I wouldn't do well with the anxiety, and I also get very pissed off if Im being ripped off by corporations for something so basic as health care, housing, education, etc.