POZ Focus : Affordable Care - by Laura Whitehorn

HIV care and treatment is costly. Health programs minimize—if not eliminate—out-of-pocket expenses.

Living with a chronic disease without health coverage can be a financial nightmare. Fortunately, options abound for people living with HIV. “Planning ahead will save you future money and grief,” says Ken Fornataro, executive director of the New York City–based AIDS Treatment Data Network. 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) may 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 (those receiving SSDI). Medicare kicks in right away for those 65 and older; younger people with disabilities have to endure a two-year waiting period after qualifying for SSDI. “We’re working to eliminate the waiting period,” Fornataro says, “because people just get stuck with nothing in that gap.” 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, ADAP provides treatment for low- and middle-income people living with HIV/AIDS. Eligibility requirements and coverage—including the drugs provided, types of care covered, even the costs associated with private health insurance plans—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.

United States Department of Veterans Affairs (VA)
The VA runs the country’s most extensive system of health care facilities and programs. VA benefits cover health costs for vets who left active military service with something other than a dishonorable discharge—including many in prison or on parole. Find details at va.gov.

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, for one, will help you sort through your options. Click on “Request Assistance” at atdn.org or call 800.734.7104 ext. 22