Questions regarding relocationg and accessing HIV treatment

[markabz21]

Hi there,

I am currently living in the United Kingdom where I get free HIV treatment on the government run health service but have recently been asked if I wanted to relocate to the USA with my work and have a few questions about accessing healthcare in the USA especially HIV treatment. My work doesnt know about my HIV status and I am not sure if I would have to reveal it to them if I decided to take the job in the US office or not?

Also I know that since January 2010 the US government no longer bans HIV+ people from entering the country but does this also apply to people applying for long term work visas? I checked the US Edinburgh Consulate website but there was no information on entry requirements for HIV+ individuals and work visas.

And I know that most health care in the USA is on a private fee basis and I know that my firm offers health insurance to all US based staff so coverage wouldnt be a problem but I am concerned with how health insurance actually works in the USA. Will my firm pay the full cost of health insurance or would I have to pay a part of it? Also how would I register to see a doctor? When I arrive can I just go to any doctor and tell them to charge everything to my firms health insurer? Or would I have to use specific doctors approved by my firm? Most importantly how long would it take for me to start receiving treatment through my health insurance? Is there anything I could do just now that would save time when I arrive?

Im not sure if it is different in each state but I would be moving to Portland in Oregon and would be due to start the new role in June or July so I have a few months to sort everything out healthcare wise before I move.

I hope these questions dont appear trivial as I am worried I would have delays in accessing treatment if I decide to move and start this new job.

Thanks

Mark

[richie]

Mark --

I was a director with a large company with UK offices, so I understand your concerns.  The US systems is VERY different.  To address some of your concerns:

Your status (HIV+) is no issue entering the US to work for your company.  No one will ask for a test.  You don't need to reveal a thing.

While your Firm may pay the full healthcare fee, they probably won't.  There's usually a monthly co-pay for the insurance (an individual might pay <$100/month), plus co-pays for services (20%) for a service, up to a chosen deductible amount that you choose when you choose your coverage levels (usually $1k to $2k annually).  Most coverages are through PPOs (Preferred Service Providers), and almost all doctors participate in these (even the top HIV specialists).  This shouldn't pose an issue for you.  Chances are you'll participate in a large group like Blue Cross, etc., and all docs participate in these plans.  All plans for large companys cover prescriptions drugs, with small co-pays (which you can defray by taking advantage of drug company co-pay programs in the US).

In the US, these plans you can choose from your employer are highly variable, from bare-bones to Cadillac plans, depending on your needs and preferred cost exposure.  Bottom line, in my opinion, is that the cost of this is probably well worth your while for the job experience you might gain, the cultural education you'll get by working in the US, and experiencing Portland!.  Additionally, you won't take a pay cut (probably), which means you'll get a 50% pay raise just due to the dollar!  Knowing what I know about the UK vs. US systems, I wouldn't have many concerns if I were in your shoes. 

Best,

--rich

[markabz21]

Hi there Rich

Thanks for such a detailed response. In many ways the US system is similar to the UK system as here we pay a national insurance tax which covers the state run healthcare in the same way as deductibles in the US system plus the co-payments are just like the prescription tax we have to pay when filling a prescription.

I checked with my HR department and they said I would have to pay a $250 deductible for health insurance which is less than that £250 I pay a month in national insurance taxes here!

Im more looking forward to the relocation now I know that healthcare wont be a problem and Portland does look like a really cool city to live in. Im sure everything will be fine and yes with the exchange rate I do end up with a 40% higher salary...I just hope living costs are not 40% higher otherwise I wont see any increase!

Thanks again for your advice

Mark

[richie]

Mark --

Enjoy your sojourn to the US!  One last word of advice -- BE SURE to utilize the drug co-payment assistance plans offered by the drug companies.  For example, I use Truvada as well as Lexiva, and both pharmas offer co-payc ards that pay 100% of my monthly co-pay (which is > $400/month!).  It adds up quickly... 

Here's a link for the Lexiva copay, as an example. 

http://www.lexiva.com/hiv-support/patient-savings.html

--richie