For some people, the challenge of obtaining health coverage for chronic medical conditions may have gotten easier. As part of health care reform legislation enacted in March 2010, the U.S. Department of Health and Human Services (HHS) has established a temporary federal health insurance program designed to provide medical coverage to people unable to obtain health insurance. As of July 1, 2010, in at least 21 states, individuals were able to begin applying for medical coverage under the Pre-Existing Condition Insurance Plan (PCIP).
PCIP to Cover Uninsured
PCIP will offer coverage to people who haven't had health insurance for at least six months and have been unable to obtain a policy because of an ongoing medical condition, HHS said. “Health coverage for Americans with pre-existing conditions has historically been unobtainable or failed to cover the very conditions for which they need medical care,” says Jay Angoff, director of the Office of Consumer Information and Insurance Oversight.
Existing Chronic Care Coverage
Some conditions insurers regard as "pre-existing" conditions include obesity, high blood pressure, diabetes, mental health and cardiovascular disease. Group health plans can exclude coverage for these medical conditions for new enrollees for up to 18 months. In the individual insurance market, a health plan can refuse coverage to someone with a chronic condition. Thirty-three states provide coverage to medically uninsurable people through high-risk pools, and 12 require all health insurers to issue individual policies regardless of health status.
PCIP Benefits
PCIP will provide primary and specialty care, hospital care and prescription drug coverage, HHS said. Eligibility for the plan isn’t based on income, and the program won’t charge a higher premium because of a medical condition. Plan administrators will set premiums based on the rates of standard individual health insurance premiums for major medical and prescription drug coverage in the enrollee’s state, according to HHS. Federal subsidies will cover at least 65 percent of the premium, making the cost of these health plans lower than existing state high-risk pools, the Congressional Budget Office says.
Transitional Program
A transitional program, PCIP will run until 2014, when provisions of the Patient Protection and Affordable Care Act (PPACA) ban insurers from delaying or denying coverage for pre-existing conditions. At that time, health care exchanges designed to offer individuals and small businesses affordable private insurance options are scheduled to begin providing coverage. PPACA has appropriated $5 billion in federal funding to support PCIP. At this funding level, the program could subsidize premiums for as many as 200,000 individuals between 2011 and 2013, according to the Congressional Budget Office.
Program Administration
While 21 states have elected to have HHS administer their plan, the remaining 29 and the District of Columbia will run their own programs. As of July 1, 2010, individuals were able to begin applying for PCIP in the states where HHS will operate the program. Some states running their own PCIPs may not begin enrollment until the end of August 2010, according to HHS. Even as PPACA establishes eligibility, state programs can vary on cost, benefits and determination of pre-existing conditions.
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