December 20, 2010

December 20, 2010
Possible Insurance Coverage


Welcome to another day in my life. Today is Monday and I hope you had a safe and great weekend. Dab the AIDS Bear and I are still running errands and staying busy.

Today we will be speaking at a Town Hall ADAP Meeting in Miami and 6pm. I hope you can join us down there. Stop by and get your picture taken with Dab the AIDS Bear in support of people living with HIV and AIDS.

Now speaking about ADAP, a lot of people with HIV and Medicare Part D are worried. Heck, people on ADAP are worried period. So here is another possible solution for some.

I have been researching options for prescription assistance for those individuals who have higher incomes and are uninsured (or those who will be taken off ADAP due to the reduction of the income limit). It appears the Pre-Existing Condition Insurance Plan(PCIP) is an option that we may be able to provide to some of our higher income uninsured clients. More health insurance options are supposed to become available to individuals beginning in 2014, however this PCIP is supposed to be a current option available in the interim. See more information at https://www.pcip.gov/Default.html

It appears that in Florida the max someone would have to pay per month for this pre-existing condition insurance plan is $842/mo. (the cost depends on the person's age and the particular coverage plan they choose) https://www.pcip.gov/StatePlans.html

Each plan covers preventative care at 100% and office visits with a $25 copay. They do have deductables that have to be met and some out of pocket coinsurance and copays, but so do most commercial insurance plans. These plans also have no lifetime maximum (something that is a concern for those with HIV/AIDS due to this high cost of medical care). One of the most positive things is that all plans have prescription drug coverage. The cost of the medications depends on the plan chosen, however it appears that the max that would have to be paid for a specialty med (i.e. all antiretrovirals) would be $300 a month (or less depending on the chosen plan). This is understandably still a lot of money but it is definitely better than the alternative of paying full cost for meds. https://www.pcip.gov/PCIP_%20pamphlet_benefits_summary.pdf

Eligibility is that the person must be a US citizen or be residing in the US legally, have been uninsured for at least 6 months, and have a pre-existing condition or have been denied coverage because of your health condition. The application itself seems relatively easy.

This would primarily benefit those individuals who make more money but simply cannot get insurance due to their pre-existing condition (**this is definitely not a viable option for individuals with low income). As of February 1, 2011 the income limit for ADAP is being reduced to 300%. This type of income will also make these individuals ineligible for PAP programs as well as Welvista. I worry that we do not have many solutions for these individuals and others who make too much money for Ryan White programs but not enough to pay for their medical care/prescriptions out of pocket. Perhaps we can provide these indivdiuals with information on this PCIP as a possible option for them.

Now it is time for Dab the AIDS Bear and I to get headed out for our event. Hope you have a great day.

Until we meet again; here's wishing you health, hope, happiness and just enough.



big bear hug,





Daddy Dab