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You can't be denied health coverage

HeartofSoul's picture
Posts: 732
Joined: Dec 2009


You can't be denied health coverage

States and the federal government now offer temporary insurance to buyers who have been denied insurance because of pre-existing conditions.
If you've been denied health insurance coverage because of a pre-existing condition, you can now get temporary coverage through a program set up by the states and the federal government.

The new Pre-existing Condition Insurance Plan will provide health insurance for those who have been without coverage for at least six months, who have a health condition that has kept them from getting medical coverage, and who are U.S. citizens or who reside legally in the United States.

Created under the federal Affordable Care Act and developed by the U.S. Department of Health and Human Services, the plan covers a broad range of health benefits, including primary and specialty care, hospital care and prescription drugs. It does not base premiums on income and does not charge higher premiums because of medical conditions.

Those who participate will pay rates no higher than the standard individual health insurance premium in their state. The insurance covers major medical and prescription costs, with some out-of-pocket expenses, such as deductibles. The plan is funded with $5 billion from the Affordable Care Act.
The PCIP program will be available until 2014, when a new and competitive insurance exchange is scheduled to be in place.

States are in control
States have the option of running their own plans or having them administered by HHS. The federal government will run plans in 21 states, while 29 states and the District of Columbia will run their own plans.

According to HHS, this arrangement gives the states flexibility in how to run their PCIPs, because state programs can vary on cost, benefits and determination of pre-existing conditions. State funding is based on the same allocation formula as the Children's Health Insurance Program, but unlike CHIP there is no requirement for states to match federal dollars, and the federal government will cover the entire cost of the pre-existing condition plan.

To apply for the pre-existing condition insurance plan, go to HealthCare.gov. Those living in a state where HHS is administering the plan will be linked directly to the federal application page, where applications are available for download. You must complete the application and supply a copy of a letter dated within six months of the application from an insurer or health plan showing denial of coverage because of a pre-existing condition.
If you live in a state running its own plan, you'll find information on your state's HealthCare.gov page.

Premiums vary from state to state
While the plans are meant to provide affordable health insurance, premiums will vary by state. For example, New York runs its own plan, and premiums there are expected to range from $400 to $600 per month. In California, also running its own plan, the monthly premium is $575 for a monthly subscriber in San Francisco, with a $1,500 deductible and $2,500 out-of-pocket limit.

If HHS runs the plan, premiums will range from $320 to $570 a month for a 50-year-old enrollee, depending on state. But prices can go as high as $600 in Texas and $675 in Florida and Massachusetts for a 50-year-old.

The plan is not available for those with COBRA or any existing health insurance.
Those who can't afford the premiums will be directed to Medicaid.
You may also call 866-717-5826 for pre-existing insurance plan information, Monday through Friday, 8 a.m. to 11 p.m. ET.

Pre-existing condition insurance plans
The following states will run their own plans: Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia and Wisconsin. The District of Columbia will also run its own plan.
HHS will run the plan in these states: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia and Wyoming.

This article was reported by Laurie Ledgard for Insure.com.
Published Aug. 19, 2010

terato's picture
Posts: 383
Joined: Apr 2002

Illinois, and probably other states, have only enough Federal subsidies for a limited number of applicants, so interested patients should apply early to avoid having to settle for the state's own CHIP (Comprehensive Health Insurance Plan), which has higher premiums and deductibles.

Here is the website detailing eligibility and state limitations:

Fact Sheet – Temporary High Risk Pool Program

The creation of a high risk pool program was proposed by Congressional Republicans and included in the historic new health reform law to help provide affordable health insurance coverage to people who are uninsured because of pre-existing conditions. States may choose whether and how they participate in the program, which is funded entirely by the Federal government. Background on the temporary high risk pool program is below.

In order to receive insurance through the temporary high risk pool program, an individual must meet the criteria established in the law. Eligible individuals must:

* Be a citizen or national of the United States or lawfully present in the United States;
* Not have been covered under creditable coverage (as defined in Section 2701(c)(1) of the Public Health Service Act) for the previous 6 months before applying for coverage; and
* Have a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary...


Hopefully, this will be unnecessary in 2014!


wercancerfree's picture
Posts: 7
Joined: Oct 2010

In Michigan they want over $700 a month for this policy. "Affordable Insurance" it is not when you are unemployed and living off social security. I thought this was supposed to be "affordable".

Posts: 188
Joined: Apr 2010

a period of 6 months that you have to be 100% uninsured before you qualify. http://www.healthcare.gov/
In Texas, if your cancer diagnoses if 4 years ago or longer, it is no longer considered a pre-existing condition. It does not matter if you are still under treatment, its diagnoses date.

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