ColumnsHealth & Wellness

Obamacare Now Protects 50,000 Americans with Pre-existing Conditions

by Healthy Living News

The new health care law’s Pre-Existing Condition Insurance Plan (PCIP) program is providing insurance to 50,000 people with pre-existing conditions. According to a new report, PCIP is helping to fill a void in the insurance market for people with pre-existing conditions who are denied health coverage.

“For too long, Americans with pre-existing conditions were locked out of the health care system and their health suffered,” said HHS Secretary Kathleen Sebelius. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”

Under the Affordable Care Act, or Obamacare, in 2014, insurers will be prohibited from denying coverage to any American with a pre-existing condition. Until then, the PCIP program will provide affordable insurance coverage.

PCIP is helping individuals like: Gail O’Brien of New Hampshire who is now getting help with non-Hodgkin’s lymphoma treatments and is responding very well. Or James Howard of Texas, who is grateful for the coverage the PCIP program is providing to treat cancer and says that without it, he would not have been able to continue receiving care.

In many cases, PCIP participants have been diagnosed with serious health care conditions such as HIV/AIDS, cancer, heart disease, bone diseases and hemophilia. Under the new law, PCIP enrollees are receiving health services for their conditions on the first day their insurance coverage begins.

People who enroll in the PCIP program are not charged a higher premium because of their medical condition. Program participants pay comparable premium rates to healthy people. By law, premiums may vary only on the basis of age, geographic area and tobacco use.=

PCIP provides coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, nursing care, preventive health and maternity care. The program is available to U.S. citizens and legal residents (regardless of income) who have been without insurance coverage for at least six months, and have a pre-existing condition, or have been denied insurance coverage because of a health condition.

For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit Or call toll-free 1-866-717-5826 (TTY 1-866-561-1604).

About the New Pre-Existing Condition Insurance Plan

The Affordable Care Act created the Pre-Existing Condition Insurance Plan (PCIP) program to make health insurance available to millions of Americans denied coverage by private insurance companies because of a pre-existing condition. Coverage for people living with such conditions as diabetes, asthma, cancer, and HIV/AIDS has often been priced out of the reach of most Americans who buy their own insurance, and this has resulted in a denial of coverage for millions. The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage at a reasonable cost.

The PCIP program, which is administered by either your State or the Federal government, will provide a new option for you have been uninsured for at least six months, have a pre-existing condition, and have been unable to obtain health coverage because of your health condition.


What Does the PCIP Mean For You?

The PCIP program may be able to help you, if you’ve been locked out of the insurance market, with a temporary program that will be in place until 2014. In 2014, all Americans will have access to affordable health insurance choices, either through their employer, or through a new competitive marketplace called an Exchange, where insurance companies will no longer be allowed to discriminate based on your medical condition.

The PCIP will be available in every state—but the program will vary depending on your state. Many States run programs – often called “high risk pools” – to offer insurance to people who have a pre-existing condition.

The program:

  • Will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to you, even to treat a pre-existing condition.
  • Won’t charge you a higher premium just because of your medical condition.
  • Doesn’t base eligibility on income.


Different States may use different methods of determining whether you have a pre-existing condition and whether you have been denied insurance coverage. Specifically, a PCIP may determine that you have a pre-existing condition based on providing documented evidence that you meet any one or more of the following criteria:

  •  An insurer has refused, or has provided clear indication that it would refuse, to issue you coverage based on your health;
  • You been offered individual coverage but only with a rider that excludes coverage of benefits associated with your pre-existing condition; or
  • You have a medical or health condition specified by the State and approved by the Secretary of HHS.
  • You satisfy another test applied by a State with the approval of HHS.

These criteria vary by State, so you need to check on how to establish eligibility in your state. For a list of State programs go to, the comprehensive website and portal for the Affordable Care Act.

The PCIP program will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even to treat a pre-existing condition. The regulation specifies the required benefits that all PCIPs must cover. Required benefits include:

  • Hospital inpatient services
  • Hospital outpatient services
  • Mental health and substance abuse services
  • Professional services for the diagnosis or treatment of injury, illness, or condition
  • Non-custodial skilled nursing services
  • Home health services
  • Durable medical equipment and supplies
  • Diagnostic x-rays and laboratory tests
  • Physical therapy services (occupational therapy, physical therapy, speech therapy)
  • Hospice care
  • Emergency services, and ambulance services
  • Prescription drugs
  • Preventive care
  • Maternity care

Premium Rates:
Premiums will vary depending on the State in which you live. (But, as an example, if you live in a State where the U.S. Department of Health and Human Services provides coverage, the premium for a 50 year old enrollee may range between $320 and $680). For an estimated premium range for your State, please visit,

Source: HealthCare.Gov

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