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.

Photo Credit: photoXpress.com


jane richmond
jane richmond8 years ago

So many people need this coverage and yet we have to listen to the naysayers.
Everyone should be entitled to health coverage.
The Constitution says LIfe, liberty and the pursuit of happiness without life you cannot have the other two.

william k.
william k.8 years ago

So sad that in a rich country like this that the greed and influence of a few people at the top can cause so much suffering and anguish for so many more people in the bottom 98%.

This is the stuff of revolution.

Ed G.
Ed G8 years ago

I am sure this will turn ugly if the repubs are successful overturning the health care reform.

Lisa R.
Lisa R8 years ago

Thank you for the information.

Edith B.
Edith B8 years ago

The new health care reforms are a start, and have been fought for valiantly. Surely, we will not sit by and let the GOP stop it from even getting started. Nothing our congress passes is ever perfect, that is why we have amendments.

Julie W.
Julie W8 years ago

James, tell that to someone working for minimum wage - which I believe is very low in the US. Some of them probably already wok for 'evil' companies - but don't necessarily get good health care.

Mary L.
Mary L8 years ago

Amazing. Now all some people need to do is figure out how to pay for it on top of rent, utilities, and maybe some groceries.

Sound Mind
Ronald E8 years ago

James P, please plug your brain in before you expose your intellect to the world.

Antonio Campos
Antonio Campos8 years ago

Raine W: "I still can't afford this, so I still don't have insurance. When is there going to be help for people who cannot afford things like this?"

In 2014 I believe, when everyone will be required to have some form of health insurance (his is the part that the insurance industry cried for and which democrats rightfully cry foul as a give-away to the insurance industry, but it is a lesser evil compared to allowing insurance companies to continue their death panels of dropping the sick at precisely the time they need it most).

For those who cannot afford health care once insurance companies are no longer allowed to drop the most sick, it will be subsidized based on a sliding scale based on need. This "socialized" health care, although a compromise, will put this 2nd world country of the United States of Corporations on better footing with every other western 1st world country that provides health care as a right for its citizens.

It's about time that this government of the people and for the people became exactly that (unless Republican and Tea Party attempts to repeal this health care are successful).

Charlene R.
Charlene Rush8 years ago

To James P.: Are you spewing one of those fabricated rants, that health insurance was not outrageous, in the first place?
If everyone could afford it, we wouldn't be having this continuing situation.

If you think that anyone is falling for your story of having to work for an EVIL company, in order to acquire better health insurance.......I have a plot of swamp land to sell you in Florida.

Do you labor, under the delusion that you are on this planet, to care only for yourself? I suspect you are not a Christian, because your rhetoric does not follow in the footsteps of Christ.

Apparently, you have a problem understanding the connection between politics and history. All scholars will explain to anyone, with a thinking brain, that the results of any administration, are not felt for years after they have left office. Consequently, your point is moot.

Assuming you are not a racist, the other conclusion to ascertain is, that you are a Tea Party Republican and want only the wealthy to be able to afford adequate insurance.
Your way of thinking, will continue the onslaught of Emergency Room patients, which costs all citizens more.