PCIP – FAQ

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A pre-existing condition is a condition, disability or illness (either physical or mental) that you have before you enrolled in a health plan.

Yes, every state has a plan that offers comprehensive health coverage for uninsured Americans with pre-existing conditions. The program name and other plan details vary depending on which state you live in and whether the program is run by the state or the Department of Health and Human Services. Check out the State Plans page to learn more about how the Pre-Existing Condition Insurance Plan works in your state.

If we get your complete application, including all supporting documents, on or before the 15th of the month, your coverage will start on the first day of the next month. If we get your complete application, including all supporting documents, after the 15th of the month and on or before the last day of the month, your coverage will start the first day of the second month, unless you choose to have your coverage start on the first day of the next month. If we approve your application, we will let you know how to choose an earlier effective date. Coverage always begins on the first day of the month.

You are not eligible unless you have been without health coverage for at least the last 6 months. For example, if you have Medicare or TRICARE, you shouldn’t apply. Also, if you have coverage provided by a state high risk pool or insurance coverage that may not cover a pre-existing medical condition, you shouldn’t apply. If you are uninsured and have been told that you may be eligible for other coverage programs like Medicaid and the Children’s Health Insurance Program, you should check out those programs first, as they may better meet your needs. If you have job-based coverage, or individual insurance coverage, you aren’t eligible to apply.

No, even if your COBRA or other continuation of coverage is about to run out, you won’t be eligible until you have been without health coverage for at least the last 6 months, and meet other eligibility criteria.

No. To be eligible for the Pre-Existing Condition Insurance Plan, you must have been without other health coverage for at least 6 months from the date of application.

The Pre-Existing Condition Insurance Plan will have provider networks that include a full range of services and specialists. You can search for participating providers at www.PCIPlan.com.

If you are eligible for the Pre-Existing Condition Insurance Plan, you pay a monthly premium for your coverage and other cost-sharing. To see the premium rates for your state, go to State Plans.

If you have limited income and resources, you may be eligible for the Medicaid program in your state. If you are seeking insurance coverage for your child, go to www.insurekidsnow.gov to learn more about children’s health insurance in your state.

The Pre-Existing Condition Insurance Plan is a transitional program that provides health coverage to people with pre-existing conditions. This program is available until 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange. An Exchange will provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. In addition, starting in 2014, it will be against the law for an insurance company to discriminate against you based on a pre-existing condition. If you are enrolled in PCIP, we will provide additional information about how your Pre-Existing Condition Insurance Plan coverage will change and how you can take advantage of the new coverage options available in 2014.

The Affordable Care Act remains the law of the land and we are continuing to carefully and effectively implement this law to improve the health of all Americans. The Affordable Care Act created the Pre-Existing Condition Insurance Plan, which is available to people who are U.S. citizens or residing here legally, have a pre-existing condition or have been denied health coverage because of their health condition, and have been without health coverage for at least 6 months. This program will be available until 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange. An Exchange will provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. In addition, starting in 2014, it will be against the law for an insurance company to discriminate against you based on a pre-existing condition. We recognize how important the Pre-Existing Condition Insurance Plan is to you and will let you know if there are any changes that could affect your coverage.

If you are a current PCIP enrollee, you will receive a letter in the mail stating the amount of your new premium at the beginning of June 2011. This letter will include the new premium amount effective July 1, 2011 and explain what to do if you have paid future months’ premiums and need a credit adjustment. To see the premium for your state effective July 1, 2011, go to State Plans and click on your state of residence.

No. PCIP enrollees will continue to have a choice of three plan options – the Standard Plan, the Extended Plan, and the HSA Plan. Your benefits will remain the same. There will also be no changes to your out-of-pocket costs, such as deductibles, co-pays, and coinsurance.

No. Current enrollees will not be able to switch plans at this time. However, if you live in a State where the premiums were reduced, you will see a decrease in premiums no matter what plan you are enrolled in.

If you paid your premiums for future months and your premiums will decrease as of July 1, 2011, PCIP will credit any overpayments towards your future premiums.

The PCIP program revised its premiums by considering current individual market premiums in each state in order to best serve those eligible for the PCIP program. This resulted in a premium reduction in some states where the federally-administered PCIP operates. As was the case before, premiums vary depending on the state you live. For example, the premium for a 50-year-old enrollee may range between $214 and $559. The previous 2011 premiums for a 50-year-old enrollee ranged between $320 and $570.

Premiums vary depending on the state where you live. This change takes into account the premiums currently charged by individual market insurers for similar benefits in each state, which generally varies from state to state.