High-Risk Insurance Pool Enrollment Climbing: Are You Eligible?
Are you uninsured with a pre-existing health condition? The new high risk-pools may be an option for you.
The Pre-Existing Condition Insurance Plan (PCIP), as part of The Affordable Care Act, is set up to help Americans with pre-existing conditions who have been denied health coverage or priced out of the market.
PCIP is a temporary program, designed as a “bridge” to 2014, when insurers will be prohibited from charging more or denying coverage based on health status. The PCIP program is administered by either state or federal government. Twenty-three states and the District of Columbia have elected to have their PCIP program administered by the federal government, and 27 states are running their own programs.
You are eligible for PCIP if:
- You are a citizen or national of the United States or residing in the U.S. legally.
- Have been uninsured for at least the last six months. If you currently have insurance coverage that doesn’t cover your medical condition or are enrolled in a state high risk pool, you are not eligible for the Pre-Existing Condition Insurance Plan.
- Have a pre-existing condition or have been denied coverage because of your health condition.
If you meet these requirements, PCIP:
- Covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to you, even to treat a pre-existing condition.
- Doesn’t charge you a higher premium just because of your medical condition.
- Doesn’t base eligibility on income.
Enrollment began on July 1 for the federal program. As of February 1, 12,437 people have enrolled, according to the U.S. Department of Health & Human Services (HHS).
“This program has helped thousands of people that desperately need coverage and we are excited to see Pre-existing Condition Insurance Plan enrollment is ramping up, in much of the way enrollment in the Children’s Health Insurance Program (CHIP) did in the 1990’s, as more people learn about the new insurance options available,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight (CCIIO), which operates the program. “We are working every day to get the word out about this program, to find people who have been abandoned by the health insurance industry to get them the coverage they have been denied for so long.”
Americans are still coming to grips with the Affordable Care Act. False information has left many confused and unaware of some of the benefits even as they kick in.
HHS is working to get the word out to consumers. Visit PCIP.gov for more information on how the plan works in each state, including eligibility and how to apply.
While some headlines call attention to the fact that enrollment is lagging behind predictions, that shouldn’t be taken as a failure or a victory for health care reform opponents. It doesn’t mean folks don’t want health insurance. It means there are serious issues with PCIP eligibility.
- Many people with pre-existing conditions who have been without health insurance for a long period of time are simply not able to afford the premiums of the high-risk pools.
- Six-month waiting period. Even though the premiums and coverage may be better in the high-risk pools than in some individual plans, people in the individual market who are fighting health problems cannot make the change. It is literally a matter of life and death.
- If you currently have an insurance plan that doesn’t cover your medical condition or are enrolled in a state high risk pool, you are not eligible. Small comfort if you are fighting for your life.
PCIP is certainly not the answer for everybody, but it is a bridge to 2014 for those who qualify and can afford it.
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