- October 11, 2013
Post submitted by John Peller, Vice President of Policy, AIDS Foundation of Chicago
October 1 marked a massive win for gay men and other men who have sex with men. Yes, we’re talking about the intersection of health insurance marketplaces and the LGBT community.
Nearly 500,000 gay, bisexual, and other men who have sex with men are living with HIV. This makes health care reform vital. The U.S. Centers for Disease Control and Prevention (CDC) reported that gay men or other men who have sex with men comprise 56 percent of people living with HIV.
Before October 1, people with HIV were discriminated against in the private health insurance market because they were labeled with a preexisting condition. But with the opening of new insurance marketplaces, that practice has fallen to the wayside.
Medicaid and comprehensive private coverage through health insurance marketplaces will revolutionize health care access for a major segment of the LGBT population: gay men and other men who have sex with men, who are living with HIV.
But hold on.
It’s tempting to jump into health reform and sign up for coverage. But if you have HIV, resist the urge to be among the first to enroll.
October 1, 2013, was important, but it wasn’t paramount. December 15 matters more. You must enroll in a health insurance plan by then to begin coverage the first day it’s available: January 1, 2014.
If you’re living with HIV, there are three things you need to get right when selecting a health plan: ADAP, medications, and providers.
ADAP: HIV is treatable, and people who receive treatment have an opportunity to live long, full, productive lives if they have adequate access to early, comprehensive treatment. But medications and doctors are expensive.
Even with insurance, HIV medications can cost up to $300 a month. Many people who are living with HIV need financial assistance from the AIDS Drug Assistance Program (ADAP) to afford life-saving medications now, and that will still be the case with health reform.
However, ADAP officials in every state need time to review the new plans, which, like the general public, they received on October 1. Once they determine which ones they can cover financially, your opportunity to select the best plan for you--at the lowest cost--greatly increases. Not every state ADAP will be able to cover health reform plans, so check with your state.
Medications: When you examine potential plans, ask yourself: are my HIV medications and other prescription drugs covered, and how much will it cost to fill them?
People with HIV rarely have the option to switch medications, since drug regimens are individually tailored to each person’s particular strain of HIV. So make sure your drugs are covered by your new insurance plan and find out if there are medical criteria you must meet before obtaining the drug. Many health plans list HIV medications as specialty drugs, meaning you may face high out-of-pocket costs to purchase them.
Providers: Make sure your health care providers are in-network for the plan you’re selecting. You have probably worked hard to find providers that meet your needs, which translates to better HIV care. If your current providers are not in-network, your visit might not be covered at all, or you could face much higher costs to see them. Switching doctors jeopardizes your wellbeing and undermines the benefit of being with a doctor you know and trust.
Select a plan that includes a high number of your health care professionals in network, including your HIV doctor, other specialists, mental health or substance use providers, and pharmacists.
As with every step in the human rights movement, ending discriminatory practices isn’t easy. We understand that enrolling in health insurance without facing judgment is a major victory for men with HIV in the LGBT community, but savor this win with patience.
Make sure you get in the right plan when the time is right. Health reform can only improve your life if you enroll in the plan that’s best for you.
Stay tuned to HIVHealthReform.org–a website targeted to people with HIV and services providers–to see when the yellow light turns to green.
Need help selecting a plan? Fortunately, a number of organizations across the country have received funding to help you enroll in a plan. Search for an enrollment helper in your area or find your own state’s marketplace. You can also contact a local AIDS services organization for assistance. In addition, you can find your state AIDS Drug Assistance Program and review the POZ Magazine health care reform guide.