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Author
Topic: medical help (Read 3950 times)

I have just been tested poz and I am scared to death!  so many things are going through my mind.  I am very worried about how I am going to afford this!  I have health insurance but my partner does not.  does anyone know of any kinds of medical assistance or assistance with the costs of medications?  we probably won't qualify for gov.  help due to our income, not that our income is high, it's just too high for gov.  assist.  we are barely able to make the bills how will we be able to afford health care and medications?  this is only one of the many things that are on my mind, but it's one of the big questions I have and not able to get much help with an answer, any help would be great.thanks

Sorry to hear about your diagnosis.  You did not give very many details so it is hard to discuss your situation.  Is your partner HIV positive as well?  Have you gotton labs to know that meds will soon be warranted?  What I have heard is that there is ADAP and ASO's often have more info about this.  My insurance covers my expensive meds with a ten dollar copay.  I hope you will continue to post to let us know more about your story.  The support and advise here are great and really helped me out when I started out herre a month ago. 

I have just been tested poz and I am scared to death!  so many things are going through my mind.  I am very worried about how I am going to afford this!  I have health insurance but my partner does not.  does anyone know of any kinds of medical assistance or assistance with the costs of medications? 

Hi, to help you get through this, we're "glad" you found us but sad you're HIV positive.  Everyone here at one time was new to HIV and yeah we know how the mind can zoom with 100 thoughts per minute.  You'll see many of us here cope pretty well - Having each other for support is a huge part of that.  In terms of details that might help us to help you, I strongly 'second' what Rob/Koi has said to you. 

Once the initial shock of testing positive begins to wear off, most people find themselves asking: “How in the world am I going to pay for this?” 

This section of HIVPositiveMagazine.com is designed to answer that question.  First things first: no matter how little money you have, you will be able to get the medical care and medicines you need to live a long, healthy life with HIV.  Regrettably, that isn’t true everywhere in the world.  But in the United States, assistance is available. 

That doesn’t mean that will be easy to access the care you need.  Most HIV clinics and agencies are concentrated in the larger cities, so if you live in a rural area you may have to travel a long way to get the care you need.  Dealing with insurance companies, HMOs, Medicaid, the Social Security Administration and other bureaucracies can be maddeningly frustrating! 

Hang in there.  Fill out the forms and jump through the hoops.  You deserve the best health care available.  And you’ll get it – if you ask for it, expect it, and refuse to accept anything less. 

If you’ve just been diagnosed with HIV, the best financial advice we can give you is to visit the nearest ASO (AIDS Service Organization), introduce yourself, and ask for help.  To help you find an ASO in your area, there’s a listing of HIV/AIDS hotlines for each state on this site.  Your state hotline should be able to give you the name and address of an ASO near you. 

If you’re going to need a lot of help for a long period of time, an ASO may assign you a “case manager.” ( Some ASOs assign all their clients a case manager.)  If you’re coping well on your own but need a little help with specific problems, you may work with a “benefits counselor.”  A savvy case manager or benefits counselor can be a real financial life-saver!  All the things that seem so frustrating to you are just “part of the job” to them.  They know how to fill out the forms.  They know who to call.  They know the difference between how a program is supposed to work and how it really works.  Find a good one and he or she will make your life a lot easier! 

Here are some of the options available to you for paying for your HIV care. 

Insurance

The first and best option for paying for your HIV-related health care and medicine is health insurance.  Unfortunately, few people have insurance that covers both HIV and their HIV prescriptions.  Many companies today are “self-insured,” and those companies may exclude certain expensive disorders from coverage – including HIV.  Also, although your health insurance may cover HIV treatment, it may limit coverage for prescription drugs, which will be by far your biggest expense. 

If you have good insurance, consider yourself fortunate.  Paying your co-payments and deductibles may take a chunk out of your income.  But with health insurance paying the lion’s share of your medical costs, you can keep working, moving up the career ladder, saving for retirement and building your future. 

If not, you have other options. 

ADAP

If you do not have prescription coverage and your income is relatively low, you may be able to get help paying for your medications through ADAP – the “AIDS Drug Assistance Program.”  ADAP is federally-funded but state-administered, and the federal funding for the program is determined by the number of documented AIDS cases in each state.  The qualifications for ADAP and the drugs the program covers vary WIDELY from state-to-state!  We’ve included a list of the ADAP qualifying criteria and covered drugs for all 50 states on this site.  As far as we know, we are the only publication that compiles this information every year.  We contacted every state directly in July 2005, and we’ve made every effort to make this listing as accurate as possible.  However, we take no responsibility for errors in information we received from the states or changes that may have taken place since press time.  We’ve included the phone number of each state’s ADAP program.  Please call to get the latest information and see if you qualify. 

Disability and Medicaid

If you are unable to work because of HIV or HIV-related problems, you may be able to collect from your private disability insurance or qualify for Supplemental Security Income (SSI) from Social Security. 

(Note: Years ago, people with HIV were automatically assumed to be “disabled.”  Now, of course, they are not.  But since issues like fatigue, despression and even diarrhea are very difficult to disprove, you can probably be “disabled” by HIV if you need to be.  Don’t jump at it if you have other options!  Disability becomes a trap that many people have a hard time getting out of!) 

When you go on disability, you may get cash income from Social Security, depending on how much other income you receive and what you own.  But it’s slim pickings!  To find out how much you may receive, contact your local Social Security office. 

Qualifying for SSI usually also qualifies you for food stamps and – more importantly - Medicaid (which is called Medi-Cal in California and has different names in some other states as well.)  Medicaid is a lifeline to HIV care for approximately 50% of people living with HIV (and 90% of HIV-positive children.)  Medicaid pays for inpatient and outpatient treatment, home health care, prescription drugs and medical supplies. 

If you’re relying on Medicaid or plan to, ask your local ASO for help from a case manager who has experience dealing with your state’s Medicaid program. 

Medicare

If you’ve been getting Social Security disability benefits for 24 months (or, if you are over 65) you may be eligible for Medicare, which is an entirely federal program.  Medicare has two parts: Part A (which you get automatically) pays hospitals for treating you.  Part B pays doctors to see you.  Part B currently costs $78.20 a month (it goes up every year.)  Because Medicare pays your doctor more than Medicaid, you’ll find that more doctors are willing to see you. 

Veterans Affairs

If you are a veteran of active duty in the U.S. Armed Services, you may be eligible for health care from the VA.  Full information is available at va.gov. 

Patient Assistance Programs

Most of the pharmaceutical companies that manufacture HIV medications have “patient assistance programs” that provide free or low-cost drugs to people who could not otherwise afford to pay for them.  Each program has specific criteria about who is eligible and what kind of help they will receive.  Details differ greatly between programs.  Most of them require that your doctor make the call.  A list of phone numbers for the most commonly-prescribed HIV medications is on the Internet at www.needymeds.com. 

Other Options

In almost every large community in the United States, there are additional resources available to you, including free or sliding-scale clinics, organizations that offer free or sliding-scale complimentary treatments like acupuncture and massage, and more.  Your local ASO is usually your best source of information on local and community-based resources like these.  All you have to do is ask! 

Itstallionman--welcome to the forums!  Rob did a good job covering the resources.  Probably the biggest challenge depending on where you live is finding a primary care physician who has the knowledge and experience to monitor and treat hiv.  Well worth traveling to find a good one if need be. 

It has been helpful for me to stay focused in the moment and not worry about what may or may not be coming down the road in terms of treatment or even what the course of my own hiv will take.  My energy is freed up to manage what I am able to do today---even if that is only to eat healthy, take my vitamins and go to the gym--and stay connected with the people in my life who give me support. 

WOW!  Thanks for all the great advice, information and compassion.  I have been tested HIV+ but have not had a follow up visit yet to get the counts and/or any other information about this.  My doc basically said I was Pos and made me an apt with another doc 4 weeks away!  Yikes!  anyway, my partner has not been tested yet.  I have insurance through my work but he does not.  He is affraid to get tested without insurance thinking once he is diagnosed it would be hard to get medical coverage due to the whole pre-existing condition thing.  I think it is just a matter of us both being a little scared and not having enough info to go by.  But some good news, my boss has agreed to add him to my policy (of course I had to out myself at work to get this arranged...sure hope my partner appreciates it).  I will be in touch and love to come back to learn as much as I can about all this.  Thanks again.  I am off to call some of these resources!!! 

It is gret to hear that your boyfriend will be on your policy.  Insurance is good to have regardless of HIV status.  You are a great guy for getting your boyfriend on you policy.  And I am sure he does appreciate it. 

First off... unless you live in Massachusetts, your income is not going to affect whether your partner qualifies for medical assistance, and won't until marriage is legal fo everyone... so that being said... the access your partner has to medical care is entirely dependent on where you live.  If you are from Washington State, you probably got it made.  If you live in South Carolina, you better move.  Now. 

Check out your local AIDS organizations.  They know everything about where to do for assistance.  And, for your partner's sake, I hope you live in a good state. 

As for you... be glad you have insurance.  They can't deny you coverage since it is not a preexisting condition.  and even then, they have a tough time doing so. 

Logged

Floating through the void in the caress of two giant pink lobsters named Esmerelda and Keith.