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Pre-existing condition exclusion Medigap & Obama Care
Mar 6, 2013

Will the pre-existing condition exclusion remain after Obamacare goes into effect for disabled people on Medicare under the age of 65? I live in Florida and am unable to purchase Medigap insurance. Ryan White stopped covering all physician and Rx copays that are less than $9 per Rx in my area. I am finding it increasingly difficult to pay these expenses as I take 22 meds and see the doctor often. I am afraid of Medicare Advantage HMO's because the co-pays and uncovered expenses seem endless.

Response from Mr. Chambers

Unfortunately, Medigap policies are exempt from ACA (Obamacare): "Retiree-only and "excepted health plans" such as dental plans, long-term care insurance, or Medigap, are exempt from the Affordable Care Act insurance reforms."(

Access to Medigap policies for disabled persons under age 65 is not addressed under federal law, so insurance carriers require medical underwriting and disabled persons are denied.

As a result many states have legislated an open enrollment period for people under 65 similar to that under federal Medicare law open enrollment for persons age 65 and older, but Florida is not one of them.

That, however, shouldn't affect your medication issues since Medigap plans do not cover medications. They are covered under Part D - Prescription Drug Plans. It sounds like the AIDS Drug Assistance Program (ADAP), state plans funded by the Ryan White Care Act, in Florida has had to cut back due to lack of funds.

A quick check of the Florida ADAP website shows that they have reduced the number of medications covered. Also, as of August, 2012, the last date reported, Florida ADAP had a waiting list of 518 people, and they have recently cut pilot programs and reduced copays.

I just read a statement from your governor stating the economic improvement in Florida has made it possible to spend money. He was speaking of expanding Medicaid under the Affordable Care Act, but hopefully, AIDS organizations are lobbying for more money from the state to supplement federal ADAP funds.

Good luck, Jacques

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