If you have been turned down for health insurance because of a pre-existing condition, you may have another option. You may be eligible for the Pre-Existing Condition Insurance Plan, a new program created under the Affordable Care Act.Currently in most states, private health insurance companies can refuse to insure you if you have a pre-existing condition.
Available since July 2010, the Pre-Existing Condition Insurance Plan (PCIP) provides a health coverage option for children and adults in all 50 states and the District of Columbia who have been locked out of the health insurance market because of a pre-existing condition.
The absence of affordable health insurance can wreak havoc. An untreated medical condition may prevent people from working and frequently disrupts their relationships with friends and family. It can cost people their livelihood -- and in some cases their lives.
The transitional PCIP program will continue until 2014 when Americans, regardless of their health status, will have access to affordable health insurance because insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes and asthma.
Under PCIP, you'll be insured for a wide range of benefits including physician's services, hospital care, prescription drugs and treatment for your pre-existing condition.
You won't be charged a higher premium because of your medical condition and your eligibility isn't based on your income. Like standard health insurance plans, you'll be required to pay a monthly premium, a deductible and some cost-sharing expenses.
The maximum out-of-pocket cost for enrollees in the Nebraska PCIP program who go to in-network providers and are enrolled in the Standard or Extended plan options has been reduced from almost $6,000 in 2011 to $4,000 in 2012.
And, although the maximum out-of-pocket cost for going to out-of-network providers is still $7,000, enrollees will not have to meet these out-of-pocket limits separately.
In 2012, out-of-pocket costs for services received both in and out of network will be combined, so that the most enrollees will pay of pocket is $7,000. In 2011, enrollees had to meet the maximum limits for in and out-of-network services separately.
After the out-of-pocket limits are reached, either $4,000 for in-network services or at the most $7,000, for both in and out- of-network costs, the PCIP plan will pay the rest of your costs until the end of the year. This means comprehensive health insurance without financial ruin.
Since July 1, Nebraskans enrolled in PCIP will pay 20.5 percent less in monthly premiums than they were paying and people applying for the PCIP program will no longer have to wait on an insurance company to send them a denial letter. Applicants can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past had a medical condition, disability, or illness. These reduced premiums and new eligibility standards make it easier for Nebraskans to get the health insurance coverage they so desperately need.
Applicants will still need to meet other criteria, including proving that they are U.S. citizens or legal residents and that they have been uninsured for at least six months.
Nebraskans enrolled in PCIP have access to a provider network that includes approximately 6,800 physicians, 460 pharmacies and 73 hospitals throughout the state.
PCIP is already changing the lives of Americans who don't have health coverage and need medical care. James H., who lives in Texas, was diagnosed with brain cancer in 2010. Shortly after his diagnosis, James' insurance company rescinded his insurance coverage, claiming that his cancer was a pre-existing condition. James knew that his lack of coverage was a death sentence. Fortunately, he was able to join PCIP in Texas and is now receiving the treatment he needs.
For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit www.pcip.gov and click on “Find Your State.” Then, select Nebraska from a map of the United States or from the drop-down menu. The PCIP Call Center is open from 7 a.m. to 10 p.m. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).
If you or anyone you know has a pre-existing condition, be sure to tell them about this critical program. For many, these plans provide access to life saving treatments. It’s vital that we continue to find those who are eligible and get them covered.
Nanette Foster Reilly is a Consortium Regional Administrator for the Centers for Medicare & Medicaid Services and works out of the Kansas City Regional Office.