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Per month for insurance premiums:

Per month for drug costs:

This would be a monthly total of:

You will wait appoximately days for reimbursement

Reimbursement with no deductible:

Reimbursement with a possible deductible:

6. Summary

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In this case you are generally paying a monthly premium of:

For monthly coverage worth:

With a deductible included and a monthly premium you would be paying a total of:

For monthly medication coverage worth:

5. Assessing the Plan

The costs associated with private insurance are greater than the cost of PrEP in your situation. It would be cheaper to pay for it out of pocket unless you also intend to purchase other medications.
The costs associated with private insurance are less than buying PrEP outright. It would be worthwhile to purchase private insurance in order to afford PrEP.
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Will you have to pay for the full cost of the drugs up front or is it automatically billed to the insurance company (you can determine this by asking potential plan companies). Keep in mind you will have to fill out an online claims form, submit receipts and wait for a direct deposit.
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NO

How many days will you be waiting for reimbursement?


4. Claims

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This is the cost with the deductible included - if it happens to apply to this payment:

This is the "uninsured portion" of the drug cost. It is how much money you must pay for one month of HIV PrEP medication out of your own pocket with no deductible:

3. Payments

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This is how much money will be covered by your insurance policy to pay for one month of PrEP:

How much do you pay once a month to your insurance company? This is called your insurance premium.


What percentage of drug costs are covered by the plan?


How much does PrEP cost for one month?
Your local pharmacy can tell you.


2. Coverage

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Enter the deductible amount here


1. Deductibles

(Example: The first $100 is paid upfront by you every year, and then the company covers 70% of drug costs.)

Deductibles are amounts of money you must pay upfront before the benefit starts working.  Deductibles vary greatly from policy to policy.

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If you’re considering purchasing private insurance, consult with an experienced professional to see if you qualify for a public plan or need to use a public and private plan combination.

Check if Truvada or its generic versions are covered in the plan; ask healthcare providers, including pharmacists if they can recommend a plan to use.

Information like deductibles and how much the plan can cover will be listed in your potential plan. Have your insurance with you before you start the calculator.

This form will help you assess private insurance for covering HIV Pre-Exposure Prophylaxis (PrEP).  It can do some of the calculations for you when you type information into the blanks. Please contact prepaccess@actoronto.org for further assistance.

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Private Insurance Worksheet