Insurance and SSI

Insurance

Pre-Existing Condition Health Care Plan: Click here

There is now an option for those unable to get insurance due to a pre-existing condition. The Pre-Existing Condition Insurance Plan (PCIP) was created in March 2010 as part of President Obama’s Affordable Care Act – the new health care law. This plan makes health insurance available to you if you have previously been denied coverage due to a pre-existing condition. The plan is administered by either the U.S. Department of Health and Human Services or by your state. Click here to find out how the plan works in your state or call the PCIP Call Center toll-free at 1-866-717-5826 from 8 a.m. to 11 p.m. Eastern time.

To qualify you must have been without coverage for a minimum of six months, have a pre-existing condition or have been denied coverage because of a pre-existing condition, and be a citizen or legal resident of the US. This program was created to help those unable to obtain insurance until 2014 when the affordable health choices take place. Eligibility is not based on income and you will not be charged a higher rate due to your medical condition.

Further changes to PCIP were initiated in July 2011 to make it easier for people to get insurance. These include:

• Steps were taken to reduce the premiums as much as 40% to bring them in line with each State’s individual insurance market.
• Applicants no longer have to wait for a denial letter from an insurance company. As of July 1, they can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness.

For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit www.pcip.gov.  

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Additional information about insurance is available at these resources:

Americans with Disabilities Act
Information and technical assistance on the American Disabilities Act

Patient Advocate Foundation
Information and education to assist patients with access to care, medical debt, and job retention issues related to their illness, including co-pay assistance

America's Health Insurance Plans
National trade association representing the health insurance industry

A Consumer's Glossary of Insurance Terms
A-Z glossary of insurance-related terms

National Coalition on Health Care
Working group made up of 80 organizations whose aim is to achieve comprehensive health system reform and improvement of health care

Risk Pools: Where To Turn If You're Medically Uninsurable
State-sponsored programs to help people with a history of medical problems to purchase coverage

Healthinsurance.org
Consumer information on affordable health and medical coverage

Chronic Disease Fund
Help for chronically ill patients to obtain necessary medications

HealthWell Foundation
Assistance with co-payments and premiums

Patient Access Network Foundation
A nonprofit 501(c)(3) organization dedicated to supporting the needs of patients that cannot access the treatments they need due to out-of-pocket health care costs

Patient Services Inc.
A nonprofit that assists patient with chronic illnesses in meeting their co-pays and premiums

Social Security

On 7/14/11, the Social Security Administration added seven congenital heart diagnoses to its Compassionate Allowance listings. Two groups of patients are targeted:

All Single Ventricle Patients: These are patients who have only one working pumping chamber in their heart. It includes anyone who underwent a Fontan procedure. Listed diagnoses are:

• Hypoplastic Left Heart Syndrome
• Aortic Atresia
• Mitral Valve Atresia
• Pulmonary Atresia
• Tricuspid Atresia
• Single Ventricle (not covered above)

All Eisenmenger Syndrome Patients: “Eisenmenger Syndrome” refers to a group of problems that can develop in patients born with many kinds of heart defects. It develops when defects are not fully repaired and cyanosis ("blueness") lasts over time. Symptoms include:

• Chronic low oxygen levels
• Blue lips, clubbing of fingers
• Pulmonary hypertension
• Problems with clotting

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Additional information about social security and supplemental security income (SSI) is available at these resources:

SSI Booklet
Online booklet with information about Supplemental Security Income (SSI)

Local/Regional Social Security Administration Offices
Information about Regional Social Security Offices

What You Need to Know when You Get SSI
An explanation of your responsibilities and rights if you receive SSI

SSI Appeals Information
An explanation about what to do if you don’t agree with the decision made on a Social Security or SSI claim

What You Need to Know: Reviewing Your Disability
Answers to some questions about Social Security disability reviews

US Equal Employment Opportunity Commission
Information about laws that protect US citizens from discrimination in the workforce