People facing life-threatening illness such as HIV need better financial tools. Until 1990 no such tools existed. In 1993 David Petersen and I founded Affording Care, a nonprofit, to develop these tools and to provide financial education for those facing serious illness. New approaches, new resources and new data have been brought to bear to better fight disease financially, to decrease financial uncertainty, and to preserve quality of life. In 1994 we gave the first workshop on financial planning for the seriously ill at the annual meeting International Association of Financial Planning.

The expenses associated with today's illnesses have never been higher. Comprehensive planning can meld together employee benefits, private insurance, and public programs into a seamless financial package. Let's focus here on the key areas of medical insurance, income protection, debt resolution, career management, and getting cash out of life insurance.

So much progress has been made in obtaining and protecting medical insurance that no longer must people resort to impoverishing themselves to qualify for Medicaid. The crucial issue of pre-existing conditions, key decisions in going out on disability, and changing HMO cost-cutting practices are now joined by the risk of losing pharmaceutical coverage when COBRA coverage expires - unless crucial steps are taken.

Income protection through individual and group disability coverage is complicated by unethical sales tactics that gave many people contestable policies. Claim design and management plus expert medical testimony now exists that can make claims more likely to be approved. The early use of disability benefits to help preserve health and play catch-up with unfulfilled dreams must be weighed against possible risks and rewards of returning to work.

Properly planned, taking advantage of disability benefits can not only free up time and reduce stress in the fight against disease, it can remind us of long-shelved dreams. Computerized interest, style, and psychological testing by professionals who know disability is a major career transition may indicate what those dreams are - and how to realize them.

Debt often accompanies disease, especially when past expenses were to be offset by future earnings. Sometimes it takes a neutral party to determine whether repaying debt would be an intolerable burden or not - and to assess its impact on future finances. It is often possible to protect disability payments from claims, negotiate favorable settlements, and even use credit to access indirectly disability and life insurance coverage.

A job move can often mobilize far more funds and insurance protection than mere individual measures. Job moves are particularly effective in acquiring life insurance benefits. With new treatments using job moves to acquire missing benefits becomes a possibility.

That it's possible to get cash out of life insurance is the most dramatic of these new techniques. Sellers may sell too soon for too little. Brokers receive high commissions based on the face value of policies - and have no incentive to get the highest price. Sellers are not told about accelerated benefits directly available from the insurer. Tax regulations in 1977 have strict requirements about licensing that many companies can't meet - making their payments taxable.

To continue the financial education of those with HIV I've written over 20 articles on these topics. I regularly give workshops at Friends Indeed on the issues raised by disability and on the financial impact of new treatments. Help is available to social workers, physicians, therapists, attorneys, and AIDS service organizations through materials, phone support, and in-service training. Because employers often do not realize that benefit procedures, communications, and design actually hinder the ability of employees to fight illness financially, I also work with them to redesign plans, update communications, and to streamline processing.

When individuals need tailored advice, often a single consultation plus written materials can provide enough of an overview for people to then plan - given the opportunity to consult by phone on specific questions. Sometimes due to physical limitations, all advice can be given via fax, overnight carrier, and phone. This approach - quite unlike the traditional emphasis in financial planning on meetings and formal written plans - lowers costs, enables people to minimize travel, focuses attention on one issue at a time, and responds to questions quickly.