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Thursday, April 3, 2014

Leveraging ACA and PrEP for My Health

The Affordable Care Act is one new system I leveraged to my benefit (which has saved me over $5K to date as of March 29, 2014), and PrEP is a pretty new system I'm leveraging to my benefit as well.
I use PrEP as a fall-back plan, not as the only method of protection in my life.

by Kevin Plover
Minneapolis, MN

In 2009 through 2013, I was paying between $3K-$8K in out of pocket medical expenses. I had "amazing health insurance" through my employer, but I considered those kind of costs to be a major burden. Truvada cost ~$970 through my insurance - again, I considered that cost to be a major burden.

At the end of 2013, everyone on the news was complaining about ObamaCare, so I figured "I'm going to check this out for myself" so I hoped onto and selected my state.

I live in Minnesota, so we actually opted in to the Affordable Care Act (also known as ObamaCare for those that haven't watched the Jimmy Kimmel episode about the subject), so forwarded me to our state's marketplace exchange website MNSure.

The process was pretty easy - put in my birth date and zip code and answered a couple other questions, then I was whisked away to a list of tons of insurance plans. If I was going to enroll in an ObamaCare plan, it was going to be to save money (which I didn't think it could at the time), so I selected the platinum level plans.

A quick note: My deductible with my employer plan was ~$300. My maximum out of pocket with my employer plan was about $8K for 2014. Truvada for PrEP cost $970/mo through my employer plan - I'd be hitting that maximum out of pocket without any effort and it would be killing me financially.

So I saw a lot of high deductible plans on the MNSure website - like $3K deductibles before the insurance started paying anything... but the maximum out of pocket was also $3K, so once you hit your deductible, you paid nothing - my employer plan didn't do that - once I hit the $300 deductible with my employer plan, that's when I started paying $970/mo for Truvada for PrEP until I hit $8K.

I looked a bit more and found a plan that had $750 maximum out of pocket with a $750 deductible. And the premiums? $186/mo. My employer plan was $800/mo (I paid $200/mo, employer paid the rest).

It was one of those "this is too good to be true" moments - so I called up the insurance company and asked a lot of questions and gave them a lot of scenarios - it was true - they actually blew my employer plan out of the water.

I didn't "Qualify" for any subsidies or tax credits, because my income is too high, so I didn't register on the MNSure website - I registered on the insurance company's website - less paperwork, cutting out the middle man, etc. In January 2014 I got my prescription of Truvada for PrEP. It didn't cost me $970 like my employer plan would have - it cost me $550 because I had a $200 Gilead Copay Coupon from the website. And with that one prescription I met my maximum out of pocket for the entire year on my Affordable Care Act marketplace insurance plan.

I've gone to several doctor visits for various things, filled various prescriptions, and had other medical care since January - and it never gets old when the bill is .00.

PrEP is helping me achieve my health goals - one more layer of protection in my life - but it's also helped me towards my financial goals by reducing my medical costs dramatically thanks to the Affordable Care Act.

Sometimes you just have to leverage new systems to your benefit. The Affordable Care Act is one new system I leveraged to my benefit (which has saved me over $5K to date as of March 29, 2014), and PrEP is a pretty new system I'm leveraging to my benefit as well.

And I'm always asked, "Since you're on PrEP, does that mean you don't wear a condom anymore? Because you know PrEP only protects against HIV - it doesn't protect against all the other sexually transmitted infections"

And I respond "Yes, I am on PrEP which only protects against HIV. And my habits haven't changed - I don't have riskier sex because I'm on PrEP, and I use a condom with the same frequency I always have. Unless you can honestly say you use a condom 100% of the time, no exceptions, then you are at risk for HIV - and even condoms break. I use PrEP as a fall-back plan, not as the only method of protection in my life."

So that's my story - I wanted to add an extra layer of protection in my health maintenance plan, so I got on PrEP. I wanted to save myself money, so I leveraged PrEP to meet my out of pocket maximum on the insurance plan I leveraged through the Affordable Care Act.

No side effects, still testing negative for HIV as well as testing negative for those other sexually transmitted infections.

Still having .00 out of pocket for the rest of the year on all my medical care.

[EDITOR: If you have a personal PrEP experience you would like to share, send it to Words or video.]

1 comment:


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