A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government's projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.
The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)
Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government's statistics.
In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. He did say, however, that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.
A “significant number” of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.
To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can't comment on why this waiting period was made an essential part of the eligibility.
After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program be federally run, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.
Twenty-seven states run their own programs.
Patients can apply at the federal government's website (www.pcip.gov
In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.
At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program operated by the federal government. For standard coverage, individuals can expect to pay $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.
The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.
DHHS is trying to get the word out about the PCIP. When people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.