Pre-Existing Condition Insurance Plans (PCIPs) Available under Health Reform Law to Help Those With Pre-existing Conditions

While lawsuits and Republicans in Congress are seeking to overturn The Affordable Care Act of 2010, the Department of Health and Human Services (HHS) is continuing to institute many of the law’s provisions in an effort to provide low-cost health care to everyone.

One provision that you may not be aware of is the establishment of Pre-Existing Condition Insurance Plans (PCIPs). These plans established under the Health Reform Law, are now available in all 50 states, to help people who are denied private insurance coverage based on pre-existing conditions. These PCIP Plans are intended to cover those with pre-existing conditions between now and 2014, when the Health Reform Law will make it illegal for private insurance companies to deny coverage based on pre-existing conditions.

The Affordable Care Act of 2010 allocated $5 billion to develop the PCIPs to cover 6 million potentially eligible adults. So far, only a little more than 8,000 people have enrolled, according to figures released last month by HHS.

“That’s probably due to a few factors,” says Marty Rosen, executive vice president of Health Advocates, according to a report by Health Advocates is an advocacy group that helps people and employers find affordable healthcare options. “One is how well promoted they’ve been,” he says — and most states have fallen short on that, considering that they had just 90 days after the healthcare bill went into effect to get the PCIPs up and running. “And secondly, it’s still costly.  “But in spite of that cost, he says, this new health-insurance option really is valuable to a certain segment of the population. “If you have an active major medical problem, this could be hugely significant.”

Reaching those people was the whole point of these provisions, according to Jean Hall, PhD, associate research professor at the University of Kansas. Hall wrote an extensive report on PCIPs, entitled: “Realizing Health Reform’s Potential: Pre-Existing Condition Insurance Plans Created by the Affordable Care Act of 2010,” for The Commonwealth Fund, a nonprofit organization dedicated to improving access to health care.

“They really just level the playing field for the individual market,” she explained to By law, the plans must be set at standard market rates, which means that people with pre-existing conditions will be able to get plans at prices on a par with what healthy people pay in the individual insurance market. “They’re still going to be expensive, but it’s better than what people [with pre-existing conditions] would have to pay if they had to buy from private companies.”

Here are some details on PCIP’s:

The plans went into effect in July, 2010. They operate in all 50 states, but each state operates them somewhat differently. In 23 states, PCIPs are administered by the federal government. The federal government contracted the job out to the Government Employees Health Association (GEHA), which operates health insurance plans for all federal employees. The benefit levels are the same for all states being operated by the federal government. The other 27 states and the District of Columbia chose to administer their plans themselves, and therefore, in these states, costs, benefits, and eligibility requirements vary state to state.

All PCIP plans, however, are required to adhere to a few basic rules:

• To be eligible, you have to have a pre-existing condition, and must have been uninsured for at least six months. In most cases, you’re required to provide written proof of being denied coverage and other documentation showing that you have a pre-existing condition.

• The costs for the plans must be equivalent to the standard market rates for healthy individuals in the states in which they’re operated. The rates cannot vary based on gender.

• Annual out-of-pocket costs are capped at $5,950, although some states set lower limits.

• Only U.S. residents are eligible for the PCIP plans.

To find out more about PCIP’s in general, and PCIPs in your state, go to

Read more introductory background information about PCIPs on The Low-Cost Health Care Option You Never Heard Of; A new but relatively unknown provision of the healthcare bill makes it easier to get insured with a pre-existing condition.

For lighter, repeat coverage with background videos on Health Reform, see also » Pre-Existing Condition Insurance Plans PCIPs Help Those With Pre-existing Conditions – ABC News.

For more on the status of Health Care Reform and lawsuits seeking to overturn the Affordable Care Act of 2010, see our reporting on News On Health Care Reform –


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