If someone is HIV+ and has an Aetna HMO, how much can he/she expect to be covered by the Aetna HMO?

Question

Anyone have any experience with Aetna? I heard that they cover a lot of HIV expenses for the people with their Aetna Medicare plans. But this person is not in Medicare, but aged in the 20s.

Is it true that Aetna looks to drop HIV+ people, by trying to find any small breach of info possible at the time that the person signed up for the insurance plan?

This person first got the Individual Aetna HMO plan in November 2006...over a year later, got exposed to HIV(tests haven't gotten back yet...but is planning what to do in the event that they come back positive). So the person has had the HMO for 1 yr now. The person didn't make a single claim or doctors visit with the HMO plan until September 2007, nearly a whole year after paying premiums...and this was for a simple preventive check-up that turned out to be nothing more than a common cold w/ generic $13 antibiotics prescribed.

Answer 1

They won't be able to drop that person, unless he/she doesn't pay their premiums *or* if they committed fraud against the insurer.

(For example, if he/she lied on the original insurance application...even if the lie didn't have anything to do with HIV. That's why I always tell people its always in their best interests to disclose everything on the application...even if its something as simple as say, a history of sinus infections...because it can be used against you later to cancel your policy if you lied.)

As far as what can be expected to be covered...he/she would have the normal coverage under their benefit plan. The benefit percentage should be the same as for any other treatment, copays should be the same, etc. Keep in mind that its unlikely that there will be coverage for any treatment considered "experimental." So, if the doctor recommends a brand new drug or course of treatment, there's the possibility that the insurance policy wouldn't cover those particular charges. (I'd imagine that the "experimental" issue might come up in the course of HIV treatment, since there are so many new treatments being tried all the time.)

But, aside from exclusions for experimental treatments, they should expect the same level of coverage as they'd have for any other treatments.

Answer 2

It depends on the individuals health plan. Every company writes the plans a bit differently.

It is against the law to drop someone from the plan, however it is always important to check to see if the plan has a pre-existing conditions clause in it. In that case, you have to wait 6 months before being able to be covered. If you've had 6 months of continuous coverage...the preexisting condition clause doesn't count because you'd already met the requirements for continuous coverage.

Answer 3

No insurance wants to cover HIV+ patients. However, they cannot drop her unless she doesn't pay her premiums. The amount they will cover depends on the policy. HIV is not a covered Medicare disease.