Many Uninsured Individuals with Pre-Existing Conditions Will Find It Easier to Obtain Coverage

Individuals with pre-existing conditions who have been uninsured for six months may now find it easier to obtain coverage through the Pre-Existing Condition Insurance Plan (PCIP).  PCIP was created by the Affordable Care Act to provide interim coverage until the Health Insurance Exchanges are up and running in 2014. Twenty-seven states administer their own PCIP. PCIP is administered by the Department of Health and Human Services (HHS) in the other 23 states and in the District of Columbia.

HHS announced on May 31, 2011, that premiums would be reduced by as much as 40% in 18 of the 23 states in which the federal government administers PCIP.[1]  Further, starting in July, applicants in the states where PCIP is administered by HHS will no longer have to establish that they have been turned down for health insurance coverage by an insurance company.  They will only have to provide a letter from a doctor, physician assistant, or nurse practitioner verifying that they have or have had a medical condition, disability or illness that qualifies them for PCIP.  The letter must be dated within 12 months of the application.

Coverage under PCIP is available to individuals who are citizens or who are living in the United States legally, who have pre-existing conditions, and who have been uninsured for at least the last 6 months.  Eligibility is not based on income.  PCIP covers hospital care, primary and specialty care, and prescription drugs, even for pre-existing conditions coverage.

Information about applying for PCIP is available at http://www.healthcare.gov/law/provisions/preexisting/federal/index.html.


[1] Go to http://www.healthcare.gov/news/factsheets/pcip05312011a.html for information about the reduction in premium amounts in the states in which HHS administers PCIP.