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Author Topic: Selecting A Marketplace Plan  (Read 8920 times)

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Offline HCVinIL

  • Member
  • Posts: 9
Selecting A Marketplace Plan
« on: June 07, 2016, 11:29:09 am »
I just recently took an std test and found out that I have the antibodies for HCV and need to get further testing/treatment.  I am currently uninsured but I have a special condition that will allow me to select a marketplace plan mid year so I have a few days to select a plan that will be valid next month.

I have done quite a bit of research on the subject to I generally have an idea of what to expect however my main area of concern is choosing a plan with a low max out of pocket but at the same time one that also has the fewest hoops to jump through for drug approvals.  I have found this article (http://hivcareconnect.com/harvard-and-afc-identify-best-illinois-health-plans-for-people-with-hiv/)that discusses Silver plans in Illinois but nothing that discusses Gold plans or which plans have lenient approvals as I'm assuming I've only recently become infected and currently have no symptoms.  If anyone has an information that can assist me I would appreciate it!

Offline Lynn K

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  • Member
  • Posts: 4,545
  • Get tested, get treated, get cured, fight Hep c!
Re: Selecting A Marketplace Plan
« Reply #1 on: June 07, 2016, 02:32:21 pm »
Is there a phone number to call for more information about the plans? Not sure if we have any Illinois medical insurance experts here.

Can you get the HCV RNA by PCR test to confirm if you do in fact carry the virus? This could help you make your decision.

Good luck
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!

Offline HCVinIL

  • Member
  • Posts: 9
Re: Selecting A Marketplace Plan
« Reply #2 on: June 07, 2016, 04:00:59 pm »
I'm not sure I can obtain the PCR test prior to the time limit that I'll need to select a carrier.  The tests that I was found positive on was the HCV antibody with Reflex to RIBA test.

Just doing research today I have been able to find the following documents mostly related to Medicare that state the F3 or higher isn't required for United Healthcare, Coventry or Health Alliance in 2016 for Harvoni.  I was not able to find information on Blue Cross or Humana.


Health Alliance appears to cover Harvoni, Sovaldi & Zepatier in it's Tier 4 category, appears to cover several Hepatoligists in my area and has a Gold plan with an deductible/out of pocket max of $2,100 so at the moment that appears to be the most economical way to go.

Offline lporterrn

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  • LucindaPorterRN
    • LucindaPorterRN
Re: Selecting A Marketplace Plan
« Reply #3 on: June 07, 2016, 04:44:46 pm »
The folks at the Hep C Careline are very good at sorting this out: www.hepatitisc.pafcareline.org
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)

Offline HCVinIL

  • Member
  • Posts: 9
Re: Selecting A Marketplace Plan
« Reply #4 on: June 08, 2016, 12:18:14 pm »
Thanks for the information!  I have contacted the care line and am awaiting a response from a counselor.


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