HIV care and treatment are costly. Health programs reduce—if not eliminate—out-of-pocket expenses.
HIV can affect you physically and mentally—and financially. Medical care and treatment for HIV are prohibitively expensive if you don’t have health insurance. Fortunately, various private and public programs are in place to help you secure access to care and treatment. “Planning ahead will save you future money and grief,” says Ken Fornataro, executive director of the New York City–based AIDS Treatment Data Network (ATDN). Here’s a primer of basic choices.
Private Health Insurance
Group Plans Provided by many small and large businesses, these plans generally offer the best coverage with the lowest out-of-pocket expenses to employees. Your employer’s personnel office will help you review the options.
Plans with lower premiums (the amount required every month for continued coverage) might come with higher deductibles and co-pays. Consider which option works best for your situation.
Individual Plans Paid for by the individual, these policies can cost hundreds of dollars a month. They also lack the bargaining power of a group, Fornataro says, to help you negotiate rejected claims and other problems.
Public Health Plans
Medicaid and Special Needs Programs (SNPs) Medicaid covers low-income people as defined by state and federal law. Medicaid pays for doctor visits, lab tests, hospitalizations, prescription drugs and mental health or drug addiction treatment. SNPs (pronounced “snips”) add specific HIV services.
Medicare This national program provides low-cost health coverage to people 65 and older or with long-term disabilities. Medicare kicks in right away for those 65 and older; younger people with disabilities have to endure a two-year waiting period after first qualifying for Social Security Disability Income (SSDI). Medicare covers hospitalizations (“Part A”), physician services (“Part B”) and drugs (“Part D”). Most people supplement gaps in Medicare coverage with private plans such as Medicare Advantage (“Part C”).
ADAP Funded with federal and state dollars, an AIDS drug assistance program (ADAP) provides treatment for low- and middle-income people living with HIV/AIDS. Eligibility requirements and coverage vary from state to state (and some states have waiting lists). It’s a safety net, so if you have decent coverage under any other program, you might not qualify for ADAP.
When selecting health coverage, don’t go it alone. “You have to have a case manager,” Fornataro says, to help you choose a plan, then manage the record keeping and negotiating. The Access Project by ATDN will help you sort through your options. Click on “Request Assistance” atatdn.org or call 800.734.7104.
HELP FROM PHARMA Do you lack health insurance but make too much money to qualify for government assistance? Are your prescription co-payments so high that you can’t afford other basic necessities? Help may be available from pharmaceutical companies in the form of patient assistance programs (PAPs) and co-pay programs.
Drug manufacturers have long maintained PAPs to help those who can’t afford their drugs. To qualify, recipients must prove that they have exhausted other options such as government programs and cannot afford private health insurance. They must also meet certain financial criteria, which will largely depend on personal income.
Several companies have also introduced co-payment assistance programs, available to people who have private health insurance with steep prescription co-pays.
To learn more about any of the available antiretrovirals, check out our comprehensive HIV drug pages: aidsmeds.com/list.shtml.
Click here to learn more about patient assistance and co-pay programs for HIV and viral hepatitis drugs.
Ken, seattle, 2011-12-14 02:38:12
i was diagnosed as HIV positive in april of 2011. i do not have health insurance but i make too much money to qualify for assistance. to day, December, i still have not gotten any treatment nor have i had labs done, i was told they were about $1800.00 to know my viral load and cd4. seattle aids alliance and the health dept. have nothing for me. is there anyone who may know of a way for me to get help? i cannot afford a private health policy. if there is a "doughnut hole" im stuck in it. suggest?