Pre-existing Condition Insurance Plan Coverage is Available Now

On March 13, 2010, President Obama signed the Patient Protection and Affordable Care Act (“PPACA”) into law. There has been much written about the PPACA (a/k/a “Obamacare”), mostly about the requirement that everyone obtain health insurance or face a penalty. There are, however, a number of provisions in the PPACA that have not received much publicity, but may benefit a large number of people.

One such provision is the Pre-Existing Condition Insurance Plan (“PCIP”). The PCIP program provides a means for individuals with pre-existing medical conditions to obtain health insurance when they are not able to do so through a private insurance company. Unlike some provisions under PPACA, PCIP coverage is effective now. To qualify for PCIP coverage, an individual must:

1. be uninsured for a period of six months, and

2. have a pre-existing condition or have been denied coverage because of a pre-existing condition.

Individuals who currently have healthcare coverage through an employer, medicare, medicaid, or otherwise, are not eligible for PCIP coverage.

The monthly premium amount depends on the insured’s age, state of residence, and which plan options are selected. For example, the cost for PCIP coverage for a Florida resident, age 55 will be between $626 and $842 a month, depending on the type of plan selected. In addition to the monthly premium, the insured is subject to a deductible between $1,000 and $3,000, as well as a $25 co-payment for doctors visits, and a 20% co-payment for any other covered benefits. The good news, however, is that the maximum out-of-pocket cost to the insured is $5,950 for 2011 (exclusive of premium payments).

Everyone should review the healthcare options currently available under the PPACA, whether for yourself, a relative, or a client.