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Author Topic: General USA Insurance and HIV Care  (Read 1419 times)

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Offline Clinch

  • New Member
  • Posts: 2
General USA Insurance and HIV Care
« on: May 08, 2018, 08:11:47 am »
Hello everyone,

Iím a US citizen thatís been living in France since 2009 and I'd like to move back to the USA.  I got my positive diagnosis in 2011 so my entire HIV experience has been in France.  Iíve been on Eviplera / Complera since 2013 and just switched to Odefsey. 

Iím having a confusing time understanding how the medical system in the USA is working now, especially regarding HIV.  Iím a freelancer (so no company healthcare), not rich by any means, and Iím not sure exactly which city or state I want to live in - maybe healthcare options will help me decide. 

Eviplera / Complera worked great from me, and I imagine Odefsey will as well so Iíd like to stick with it. 

I know this is a big question, but what are my options for healthcare including insurance and payment assistance?  Iím pretty confused and donít even know where to start.  Will I possibly be forced to change meds?  Do I need to have a permanent address or is moving to different states easy? 

If anyone could please give or point me towards links with current information Iíd greatly appreciate it.  Iíve tried looking it up online and reading these forums, but there are many options and everything seems to be changing and Iím not sure whatís current and whatís not.

January 2011 tested +
April 2013 start treatment Eviplera / Complera
May 2013 undetectable
April 2018 switch treatment to Odefsey

Offline Expat1

  • Member
  • Posts: 213
Re: General USA Insurance and HIV Care
« Reply #1 on: May 09, 2018, 03:31:57 am »
General Considerations:
Blue states tend to have better ADAP programs.
You will be able to buy insurance on the Exchange.  Find a state that can pay your insurance premium through ADAP.
If you buy a program from the exchange Platinum and Gold packages give more coverage.
California has good programs.  New York also from what I  have heard.

Offline Clinch

  • New Member
  • Posts: 2
Re: General USA Insurance and HIV Care
« Reply #2 on: May 14, 2018, 09:28:51 am »
Thank you for the info Expat1. 

I contacted a couple local HIV organizations in the areas I'm considering moving, and learned I need to be a resident for 30 days before I can apply for ADAP.  I can ask for assistance from Gilead as well.  I think these are the only 2 options available in the US?

And a few more questions:

If someone doesn't qualify for ADAP what are their options? Would I have to pay 100% of the medicine costs as well as lab work, etc. out of pocket?  At $2700 per month that seems difficult.

In order to get insurance on the Exchange, do I have to wait until November?  It seems enrollment is closed until then.
January 2011 tested +
April 2013 start treatment Eviplera / Complera
May 2013 undetectable
April 2018 switch treatment to Odefsey

Offline Expat1

  • Member
  • Posts: 213
Re: General USA Insurance and HIV Care
« Reply #3 on: May 15, 2018, 08:13:32 am »
Two weeks before you move back, contact the exchange in the state you will move to.

You qualify for insurance when you move back and their is no waiting till November,  It will likely take 2 to 6 weeks to get enrolled and a company, and possibly another month to get the company all set up to pay your bills.  You should probably look for a gold or platinum plan.  But it depends on the various rules and offers.

Moving back to the USA would be a qualifying event, so make sure you do enroll within the time limit (I think it is within 60 days of returning).  If you know your address that you will move to before hand, you might be able to time your registration with return.

Do you know which state?  New York I think  you mentioned before.   

What is your current combo ARV Treatment. 


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