Positive Healthcare is leaving Florida, causing an insurance scramble for HIV/AIDs patients
HIV/AIDs patients scrambling after insurance provider leaves Florida South Florida Sun Sentinel
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Pete Povoli Assists Broward County Residents in Finding New Insurance
As a case manager at the AIDS Health Foundation, Pete Povoli is facing an overwhelming number of voicemails and people seeking his help outside his Fort Lauderdale office. His main task is to quickly find new insurance options for Broward County residents who will lose their low-cost health plan by the end of the year. Approximately 900 patients in Florida are currently scrambling for insurance after Positive Healthcare (PHP) announced that it will no longer offer coverage in the state after December 31. PHP has been providing insurance in Miami-Dade, Broward, and Duval counties for the past 15 years.
About Positive Healthcare (PHP)
PHP is a Medicare Advantage health plan that includes prescription drug coverage for individuals with HIV or AIDS. The plan, supported by the AIDS Healthcare Foundation, offers all regular Medicare benefits to its members, along with access to specialists at no additional cost. Prescription drugs, especially HIV medications, are also covered at a low cost.
While PHP will continue to operate in California, a Positive Healthcare executive states that Florida has become too expensive to sustain due to changes in Medicare reimbursement. Donna Stidham, chief of managed care for Positive Healthcare, explains that Florida hospitals demanded a higher rate and a stop loss, rather than accepting a percentage of Medicare payment like in California. Stidham reveals that PHP had been considering withdrawing from Florida for the past two years due to unsustainable losses.
Benefits of PHP for South Floridians with HIV
For South Floridians living with HIV, the insurance plan provided by PHP has offered crucial benefits. Stidham highlights that the majority of plan members have multiple co-morbidities and require frequent hospitalizations. The plan was established to provide extensive support to individuals with HIV and AIDS.
PHP’s plan design includes placing brand name antiviral drugs on the lowest cost tier to minimize co-pays. In-network primary care physicians are experts in HIV and infectious diseases, while specialists within the network possess HIV expertise regardless of their specialty. Stidham emphasizes that PHP’s plan is not a typical Medicare Advantage plan for retirees.
Assistance from the AIDS Healthcare Foundation
In response to PHP’s departure from Florida, the AIDS Healthcare Foundation has deployed 10 case workers to its Florida offices to assist patients in finding new insurance plans and navigate the healthcare system with their new coverage. Stidham affirms that while they are a Medicare Advantage plan, their primary focus is advocating for patients.
Angelo, a Broward County PHP member undergoing cancer treatments, expresses concern about losing his health plan. He shares that one of his doctors informed him that they can no longer accept his insurance. Angelo sought help from a case worker at the Fort Lauderdale office of the AIDS Health Foundation, and after three hours, they found a plan with similar coverage that included most of his doctors.
With nearly 1,000 people searching for new insurance options with similar coverage, Angelo advises PHP plan holders to seek assistance with their search as soon as possible. Povoli, from the AIDS Health Foundation, acknowledges the high demand for help and urges individuals to explore alternatives and learn how to navigate the medical environment without incurring additional costs.
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.
SDGs, Targets, and Indicators Analysis
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 10: Reduced Inequalities
The article discusses the issue of individuals with HIV or AIDS losing their health insurance coverage in Florida. This directly relates to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. It also connects to SDG 10, which focuses on reducing inequalities within and among countries.
2. What specific targets under those SDGs can be identified based on the article’s content?
- SDG 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines.
- SDG 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
The article highlights the need for individuals with HIV or AIDS to have access to affordable health insurance coverage that includes essential medicines and healthcare services. This aligns with SDG 3.8, which aims to achieve universal health coverage. The article also emphasizes the importance of ensuring that individuals have access to healthcare regardless of their economic status, which relates to SDG 10.2.
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
- Indicator 3.8.1: Coverage of essential health services
- Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and disability status
The article does not explicitly mention specific indicators, but it implies the need to measure the coverage of essential health services for individuals with HIV or AIDS. This can be measured using Indicator 3.8.1, which assesses the extent to which essential health services are covered. Additionally, the article highlights the potential financial burden faced by individuals who lose their health insurance coverage, indicating the importance of measuring the proportion of people living below a certain income threshold. This can be measured using Indicator 10.2.1.
4. Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines. | Indicator 3.8.1: Coverage of essential health services |
| SDG 10: Reduced Inequalities | Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status. | Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and disability status |
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Source: sun-sentinel.com
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