JACKSONVILLE, Fla. -- Helen Ferguson, 66, has a lot of questions about the Affordable Care Act.
"I'm sorry but it bothers me," said Ferguson.
Ferguson has a pre-existing health condition; she's a heart patient and she's adialysis patient.
WhileMedicare covers about 80 percent of her health care needs, her case workertold her she is the perfect candidate forsupplemental health insurance policy under Obamacare.
Open enrollment under the Affordable Care Act began this month and one of its position statements is that no one will be denied coverage for a pre-existing condition.
"I called thenumber she gave me and was surprised," said Ferguson.
The number took her to Florida Blue and Ferguson said when she tried to apply for coverage, supplemental plan F, she was told she does not qualify and why.
"I was told that if I was 65 I would automatically qualify," said Ferguson, "but because I am 66 so I do not qualify and the exclusion is I am on dialysis."
Ferguson said his is the first time she has heard of an exclusion and it has left herangry, frustrated and disappointed
"I'm almost $40,000 in medical debt that I'm responsible for," said Ferguson, "I'm getting no help and my sugar doctor has quit me."
She's asking what happened to what was promised about pre-existing conditions under the Affordable Care Act?
"We were told that as Americans we had the right to affordable health care," she said.
Now she's being told by at least one insurance company she is not.
"I would like to see the insurance companies follow through on what the president said," she said,"It is not my fault I turned 66, It is not my fault I am on dialysis."
Patti Unruh with the Center for Medicare Services and theAffordable Care Act said the law is clear
"You cannot be denied for being 66," said Unruh," You cannot be denied for being a ERSD patient or have a pre-existing condition."
Unruh said it appears that Ferguson may have went outside the marketplace, the pool of insurance companies that are used to facilitate coverage. She said Ferguson can contact a Medicare Ombudsman and anyone on Medicare can do the same at 1-800-633-4227. As for Florida Blue, spokesperson Mark Wright this appears to be a Medicare issue since Ferguson is not a Florida Blue member.
The following information was sent to FCN by Wendy Zellner, Director of Media Relations for the Universityof Pittsburgh Medical Center:
"The application of insurance market reforms (such as the ban on pre-existing condition exclusions) included in the Affordable Care Act is complicated and varies across product categories. One critical element is that Medicare supplement plans were largely untouched in health reform, are not subject to the insurance market reforms that most other insurance plans must follow, and are unavailable for purchase on the new Health Insurance Marketplaces. Seniors generally have one, six-month open enrollment period for Medicare supplement plans, beginning the month in which they turn 65. During this time, seniors can buy any supplement sold in their state, even if they have pre-existing conditions. After this one-time open enrollment, supplement insurance companies may deny a person coverage due to a pre-existing condition, or charge more because of it. Again, these rules are specific to Medicare supplement insurance policies.
"This has been a source of confusion. Seniors need to know that the new Health Insurance Marketplaces are not for them. Medicare coverage satisfies the ACA's requirement that all Americans obtain health insurance (or pay a penalty). Medicare plans, including Medicare supplement plans, are not available for sale on the Health Insurance Marketplace, and insurers are not permitted to sell Marketplace plans to Medicare beneficiaries.
"Medicare's annual open enrollment period is October 15 - December 7. At that time, Medicare beneficiaries may choose to maintain enrollment in traditional Medicare or enroll in a private Medicare Advantage plan. The viewer you mentioned might want to explore options available to her during open enrollment to see if there is a plan that provides greater financial protection given her specific health care needs.
"Specific information about Medicare supplemental plans is available here: http://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html"
Unruh said it appears that Ferguson may have went outside the marketplace, the pool of insurance companies that are used to facilitate coverage. She said Ferguson can contact a Medicare Ombudsman and anyone on Medicare can do the same at 1-800-633-4227.
As for Florida Blue, spokesperson Mark Wright this appears to be a Medicare issue since Ferguson is not a Florida Blue member.