40% Premium Decreases for PCIP Programs in Some States

40% Premium Decreases for PCIP Programs in Some States

Last week on May 31, 2011, the U.S. Department of Health and Human Services (HHS) announced new steps to reduce premiums and make it easier for Americans to enroll in the new federally-administrated Pre-Existing Insurance Plan (PCIP) program. The PCIP was created under the Affordable Care Act (ACA) to guarantee people with pre-existing conditions access to health insurance in the next 3 years. In 2014, thanks to the ACA, insurers will no longer be allowed to deny coverage to people with any pre-existing condition, such as cancer, diabetes, and heart disease.

The PCIP is federally-administered in 23 states and the District of Columbia. The remaining states, including California operate their own PCIP programs using federal funds provided by the ACA.

The changes announced by HHS include the following:

  • Premiums will drop as much as 40% in 17 states and the District of Columbia.  These premium decreases help bring PCIP premiums closer to the rates in each state’s individual insurance market; in the 6 states where PCIP premiums were already well-aligned with state premiums, premiums will remain the same. As California administers their own PCIP program, they are currently assessing how their rates compare with the state’s insurance market. If the rates are comparable, they will likely stay the same. If not, the premium rates may also decrease later this summer.
  • Eligibility standards will be eased in all 23 states and the District of Columbia where PCIP is federally-administered to ensure more Americans with pre-existing conditions have access to affordable health insurance. Starting July 1, 2011, people applying for coverage will simply be able to 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.  Applicants will no longer have to wait on an insurance company to send them a denial letter.  Applicants will still need to meet other eligibility criteria, including that they are U.S. citizens or residing in the U.S. legally and that they have been without health coverage for 6 months. California’s PCIP program will announce later this summer if they will have any such changes in their eligibility standards.

More About the Pre-Existing Condition Insurance Plan

PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care.  It limits annual out-of-pocket spending and does not carve out benefits the people need.

Premiums will vary depending on the state you live in, what region in your state and what plan you choose.  For example, in California, the monthly premium for a 50 year old enrollee ranges between $445 and $499, depending on the region one lives in. For an estimated premium range for other age groups in California, see the FAQ section of the California PCIP website.  If you live in another state, visit: www.HealthCare.gov/law/provisions/preexisting.

For more information on California’s PCIP,  including eligibility and plan benefits, as well as information on how to apply, see California’s PCIP website or call 877-428-5060 Monday-Friday, 8 a.m. to 8 p.m. or, on Saturday, 8 a.m. to 5 p.m. You can also read our news article on California’s PCIP.

In addition, you can visit the federal PCIP website for eligibility and benefit info on this program in all 50 states.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.