Think you're locked out of affordable health insurance? Try PCIPs

By Barbara Marquand, Insure.com - Last updated: Aug. 3, 2011

If you've been without health insurance and have a medical condition, the federal government has some good news for you.

It's now easier -- and in many states cheaper -- to enroll in a federally administered health plan for uninsured people who have difficulty qualifying for coverage. Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan (PCIP) serves as a safety net until 2014. Starting that year, health insurance exchanges are expected to be in place, and applicants can’t be denied.

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Go to pcip.gov to find information about plans in your state.

In the meantime, it’s still very difficult to find affordable health insurance if you don’t have employer-sponsored coverage and have been diagnosed with a medical condition, such as cancer, asthma, diabetes or pregnancy. The PCIP provides coverage, regardless of your health.

Premiums for the plan have dropped by as much as 40 percent in 17 states and the District of Columbia, and eligibility standards have been eased in those areas plus six others.

The price cuts bring premiums closer to average rates in those states’ private individual health insurance markets, according to the U.S. Department of Health and Human Services.

Smoother PCIP enrollment

Under the easier enrollment procedure, you no longer have to provide a denial letter you received from an insurance company. You simply provide a letter from a doctor, physician assistant or nurse practitioner, dated within the last year, that states you have or have had a medical condition, disability or illness. Other enrollment rules still stand: You must be a U.S. citizen or legal resident and have been without health insurance for at least six months.

"These changes are a lifeline for people with health conditions who can't get health insurance," says Laura Goodhue, executive director of the Florida Community Health Action Information Network (CHAIN), a statewide consumer health care advocacy group.

Florida is among the states where premiums for the program dropped 40 percent.

Goodhue tells of one man who had complications from a back injury and couldn't afford individual health insurance coverage. He applied to the PCIP and now is fully covered. She says he and his family couldn't believe how quickly his application was processed.

Another acquaintance, a woman in her 20s with a serious lymphatic condition, also qualified, as well as two teachers at her child's preschool.

"These are working people, but their employers don't provide health coverage," she says.

Enlisting help from health insurance agents

Officials need to do a better job getting the word out about the PCIP, Goodhue says. About 25,000 people were enrolled in the plan nationwide as of May 31, according to the federal health officials.

"The problem is people don't know about this," Goodhue says. "They think health reform is happening only in the future."

She was happy to hear the federal government will start paying private insurance agents and brokers this fall who connect eligible people with the PCIP program. Federal health officials said several states have experimented with such payments and found they boosted enrollment. Officials are also working with insurers to notify people about the PCIP option when their health insurance applications are denied.

The PCIP provides comprehensive health insurance coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care.

The PCIP is in effect in all 50 states. Twenty-seven states run their own plans using federal money. The recent premium cuts and easing of eligibility requirements took place in the other 23 states, where the federal government administers the program.

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