It’s just about 6 months since the first pre-existing condition insurance plans (PCIPs) started getting up and running, so over here at MyHealthCafe.com, we decided to take a look at what we’ve learned about the PCIPs since they started opening for enrollment.
The PCIPs were one of the most-hyped elements of President Obama’s healthcare reform and promised the possibility of health insurance for Americans with pre-existing conditions who previously had not been able to get affordable health insurance in the market, if they’d been able to get any health insurance at all. The PCIPs are a temporary measure which will continue until 2014, when health insurance must be offered to all Americans regardless of pre-existing conditions. Currently, Americans with pre-existing conditions are often denied health insurance coverage or are only offered health insurance which is prohibitively expensive.
The PCIPs are available to Americans who have been without health insurance for six months or more, and are designed to provide affordable health insurance benefits to those with pre-existing conditions. The interim health insurance pools are limited to charging standard individual health insurance rates in the region, cap out-of-pocket expenses for members, and will provide immediate coverage for members’ pre-existing conditions instead of requiring a waiting period.
Well, that’s all well and good, but what have we learned in the six months since the PCIPs first got up and running about how they really work? Well, we’ve learned a lot:
PCIPs May Be Relatively Affordable, But They’re Still Not Cheap. It may all be relatively, but the PCIPs only provide relativelyaffordable health insurance, which considering that many folks with pre-existing conditions couldn’t get anyhealth insurance before, isn’t saying much. Health insurance premiums are still likely to run between at least $300 and $500 a month, and in Connecticut, PCIP health insurance premiums can run as high as $890 a month. PCIPs may be providing relatively affordable health insurance, but cheap it’s not.
PCIPs Are Providing Some Choice of Health Insurance. A number of PCIPs are providing some choice of benefits and premiums to members so they can find the level of benefits they need at the price they can most afford. For example, Nevada’s PCIP offers three separate health insurance options: a standard plan, an extended plan, and a plan with a health savings account (HSA). The three plan options offer different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. Any PCIP plan option must provide preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis.
Yes, You Really Need to Have Been Uninsured For Six Months. Yes, we know it’s scary, and we normally would not advise going without health insurance, but if you want to apply for a PCIP, you’re going to have to go “naked” without health insurance for six months. In other words, even if you are on health insurance through COBRA and it’s about to run out, you will not qualify for a PCIP until you’ve been without health insurance for six months.
You May Not Be Required to Show a Health Insurance Denial, Though. Although PCIPs originally required proof of a rejected health insurance applicaiton, they’ve become much more lenient on the requirement. Some pre-existing conditions (asthma, diabetes, cancer, etc.) may automatically qualify you for some state PCIPs if you have a doctor’s note. Contact your state PCIP’s office for more information.
PCIPs are enrolling members on a first-come, first-served basis, so if you are at all interested in applying for a PCIP, we advise you to apply even if you are unsure if you qualify. More information on all of the state PCIPs is available at HealthCare.gov.
Are you planning on applying to a PCIP ? Tell us about it!
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