The U.S. Department of Health and Human Services (HHS) announced July 1 the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that offers coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.

The PCIP will provide a new health coverage option for Americans who have been uninsured for at least six months, have been unable to get health coverage because of a medical condition, and are a U.S. citizen or are residing in the United States legally.

Created under the Affordable Care Act, the PCIP is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions.

The Affordable Care Act provides $5 billion in federal funding to support PCIPs in every state. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs. The national PCIP began accepting applicants July 1 in the 21 states where HHS is operating the program. All states which are operating their own PCIPs will begin enrollment by the end of the summer, if they have not already begun to do so.

The PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. Eligibility is not based on income and a higher premium is not charged because of a medical condition. Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.

Like the Children’s Health Insurance Program (CHIP), the PCIP provides states flexibility in how they run their program as long as basic requirements are met. Federal law establishes general eligibility, but state programs can vary on cost, benefits, and determination of pre-existing conditions. Funding for states is based on the same allocation formula as CHIP, and it will be reallocated if unspent by the states. Unlike CHIP, there is not a state matching requirement and the federal government will cover the entire cost of the plan.

HHS’ new consumer website (www.HealthCare.gov) provides information about how the plan is administered in each state. An informational pamphlet on the PCIP also is available on this website.

5 Responses to “New Pre-existing Condition Insurance Plan in Operation”

1. Ruby Says:
   July 8th, 2010 at 10:11 am

   will this help if we were able to get insurance but at such a high price that we need to use our savings every month to pay it. I had Cobra coverage for Kaiser until April 2010. When it ended our monthly payment went to $1500 per month for myself and spouse due to preexisting conditions. We want to keep Kaiser. Any suggestions?

2. Gloria Says:
   July 19th, 2010 at 6:39 pm

   It’s about time that insurance companies are no longer allowed to discriminate! My son is type 1 diabetic and could not find a job that offered health insurance, and could not get insurance on his own. As a result he was unable to get preventive care which left the only alternative of going to the emergency room when close to diabetic ketoacidosis, or other health issues. Finally, after 11 years he has a job that offers health insurance. Unfortunately, the damage has already been done. He now has diabetic retinopathy, neuropathy, and gum disease. He’s only 29 years old. All I can say is “Shame on you Insurance companyies” for discriminating against my son. I only hope that it truly is affordable and not like COBRA which charges a minimum of $500 a month (and unable to file a claim for 12 months!) …and when you’re working a minimum wage job, living on your own, and having to pay $250.00 a month for medical supplies – WHO can afford that!

3. Eleanora Reeves CPC-A Says:
   July 22nd, 2010 at 9:54 am

   I am interested more in this , I have a husband who is legally blind, he has RP and we are finding out also that insurance companies will NOT insure him due to this being a pre-existing condition. I pray that we can and will now be eligible for insurance to cover things that the VA will not cover. I am also glad to hear that this will not be based on income, and that a higher premimun will not be required. Thanks for the info.

4. Joan McSherry Says:
   September 6th, 2010 at 12:01 pm

   I am interested i n learning more….why do people have to wait for 6 months….when they need insurance now. Should be a waiting period of 1-2 months tops.

5. Dean Says:
   September 17th, 2010 at 5:48 am

   My wife is enrolled in the progam. She has a stent in her heart and was rejected by BCBS so PCIP was are only option..In my opinion, it is not inexpensive, $438.00 a month with a $2500-$3000 deductable before it will pay for anything other than a yearly physical. In round figures, thats about $8000.00 a year before any benefits kick in, then you can get a co-pay of $25.00 on doctor visits if you can find a doctor that’s in the program..All in all, it was a disapointment to us. That said, if you currently are getting hit with 10s of thousands of dollars in med bills, it could be a blessing to you..

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