Health, whatever the lifestyle: Covering HIV testing and treatment

Today is National #HIV testing day and the end of Pride Week! Read up on these important HIV-related health insurance tips:

Bisexual Women and Lesbians

Where penile penetration is absent from one’s sex life (even if only for the last few years), many women assume they’re not at risk of sexually transmitted diseases. Yet one study revealed that half of lesbian and bisexual women who are screened have some sexually transmitted infection - and 25% of those screened only had sex with women in the last 5 years. The Affordable Care Act requires coverage of STD/STI screening for everyone, as well as free annual visits to an OBGYN - so there’s no reason not to screen yourself if you buy a “qualified health plan” through Stride and/or on an exchange.

Single, open relationship, or polyamorous gay men

Or HIV-negative men with partners who are HIV-positive - may care very much about whether their health plan covers the HIV-prevention medication Truvada (aka “PrEP”). While Truvada copays and coinsurance vary widely by plan, sometimes we find it would be worthwhile to pick a plan that requires you to pay more for Truvada coverage, and here’s why:

A year’s daily Truvada dose will cost you around $180 in copays on a common California “Platinum” plan and about $600 in copays/coinsurance under a common “Bronze” plan, but the Bronze premiums are so much cheaper that if you’re otherwise healthy and/or young you’re probably better paying more out of pocket and keeping a lower premium and “metal tier” of plan.

Beware “pre-approval” requirements from an insurer for Truvada, which some carriers may use to deny coverage of drugs they identify to the government and the public as being “covered” (our support team can help you check for these kind of requirements if you’re trying to keep taking PrEP). If you’re uninsured or denied coverage, Truvada will cost you a minimum of about $1480 per month (and that’s with Stride’s (prescription discounts program).

HIV-Positive Status

HIV-positive folks in general face a painful conundrum, as insurers who aren’t permitted by the Affordable Care Act to “discriminate” are increasingly putting drugs for chronic conditions like HIV, cancer, and multiple sclerosis in their highest “coinsurance” tier (read: of that potential $20,269 per month for your HIV-management regimen, you’d have to cover $8,107 yourself).

Formularies chosen by insurers and the “drug tiers” those formularies describe change every year - so your plan can change what it covers next year and you may have no idea. You can use our recommendation engine to specify what drugs you’re on, and at what doses (plus the doctors you want to see), to identify and sign up for the plan that will cost you the least over the whole year given these kinds of limits.

[Photo cred: torbakhopper]