Door to Health Care Coverage Opens a Little Wider

It will now be easier to enroll in, and less costly to pay for, the national Pre-Existing Condition Insurance Plan (PCIP) under changes announced by the U.S. Department of Health and Human Services (HHS) on May 31. The PCIP program was developed under the Patient Protection and Affordable Care Act—the health care reform law—as a way to ensure the accessibility of health benefits for individuals who have had difficulty obtaining insurance coverage due to a preexisting medical condition.

New Rates

According to HHS, the premiums for the PCIP program will drop by up to 40 percent in 18 of the 23 states in which the insurance plan is administered by the federal government, bringing the rates in each of those states closer to those for coverage in their individual insurance markets. HHS noted that the costs for PCIP coverage in the other five states with federally administered PCIP programs, as well as in the District of Columbia, are already well aligned with insurance-market premiums.

HHS also sent letters to the 27 states that operate their own PCIP programs to notify them of the opportunity to adjust current insurance-market premiums.

Eligibility Standards

As of July 1, individuals applying for coverage through federally administered PCIP programs will no longer have to be denied other insurance due to their preexisting condition before becoming eligible for the new plan. Applicants must be U.S. citizens or legal residents, have been uninsured for at least six months, and be able to provide an authorized letter confirming their preexisting condition, disability, or illness.

Incentives

HHS will also begin paying agents and brokers for signing up individuals who are eligible for the program but have not enrolled. This incentive will begin in the fall.

Additionally, HHS has begun collaborating with local insurers to share information about the PCIP program in their state with individuals who find themselves denied health coverage due to a preexisting condition.

The benefits of the PCIP program include coverage for primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, and preventive health and maternity care.

PCIP coverage is designed to serve as a bridge to 2014, when the Affordable Care Act's ban on insurers refusing to cover adults with preexisting conditions goes into effect.

Additional information about the PCIP program, including plan rates and state-specific details, is posted at <www.pcip.gov>.