HHS Enables Patients with Pre-existing Conditions to Obtain Health Insurance

July 19, 2011, 8:56 AM

The United States Department of Health and Human Services (HHS) announced new steps last week to significantly lower premiums for the Pre-Existing Condition Insurance Plan (PCIP) in most states. Under the proposed steps, eligibility standards for patients with pre-existing conditions will ease in 23 states and the District of Columbia. PCIP premiums will drop by as much as 40 percent in 18 states. In Virginia, PCIP rates will decrease by 40.3 percent. The rate decreases will bring PCIP premiums closer in line with states individual insurance markets.

HHS believes that the proposed steps will make it easier to enroll in the PCIP. As of July 1, 2011, those applying for PCIP coverage will no longer have to wait for a letter of denial from an insurance company. Applicants can simply present a letter from a doctor, physician assistant, or nurse practitioner from the last 12 months stating that they had or have an illness or medical condition.

Between November 2010 and March 2011, PCIP enrollment spiked 129 percent to approximately 18,000 people. To further bolster enrollment, HHS plans to pay insurance brokers and agents for connecting eligible individuals with the PCIP. Several states have experimented with such a program with good results.

Congress enacted the PCIP under the Affordable Care Act as a federally-administered temporary program to help uninsured Americans with pre-existing conditions obtain affordable health coverage. Beginning in 2014, health insurance companies may not deny coverage to anyone with a pre-existing condition. According to the HHS, PCIP provides primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventative health and maternity care. For further information, click here and for fact sheets, click here. --Aaron J. Ambrose & Christopher L. McLean