The Federal Government is now offering a temporary healthcare plan to individuals with pre-existing conditions that have been uninsured as a result of their pre-existing condition/disability for at least 6 months. The plan is being offered as part of the Affordable Care Act that was signed into law in 2010. The Pre-Existing Condition Insurance Plan will be available until 2014 when health insurance exchanges are available that allow individuals with pre-existing conditions to purchase care.
According to Delaware Online, fewer than 40 Delawareans have enrolled in the plan thus far. Federal Officials have been visiting healthcare clinics in recent weeks to help promote the plan that an estimated 4 million people nationally are eligible for. According to HealthCare.gov, Delaware and 22 other states have opted to have the US Department of Health and Human Services administer the plan. For Delaware residents that means that you apply for coverage directly from the federal government.
It is important to note that there are criteria that must be met in order to be eligible to purchase the plan, and the monthly premiums can still be significant. To qualify you must:
- Be a citizen or national of the United States or lawfully present in the United States.
- Have been uninsured for at least the last six months before you apply.
- Have a pre-existing condition or have been denied coverage because of your health condition.
If you qualify (and can afford the premiums), the plan covers a broad range of benefits including primary care, hospital care, prescription medications, testing, and specialty care. Three types of plans are offered, the standard option, the extended option, and the HSA option. The difference between the plans are the monthly premium and the deductible before benefits begin. A detailed summary of the benefits is available from the Pre-Existing Condition Insurance Plan website.
The current monthly rates for the Pre-Existing Condition Insurance Plan for Delaware Residents are summarized below (please note that these rates may be adjusted in the future):
The standard and extended options both have separate deductibles for medical and prescription costs. Under the standard plan, the medical deductible for in-network care is $2,000 and the prescription deductible is $500. The extended plan has a $1,000 deductible for in-network care and a $250 deductible for prescription costs. The HSA option has a combined deductible of $2,500 for in-network medical and prescription costs. Copay and co-insurance benefits do not begin until after the calendar year deductible is spent. The maximum out-of-pocket medical costs under these plans is $5,950 for in-network care and $7,000 for out of network care.
Coverage under these plans begin based on when the application is completed. If your application is completed on or before the 15th of the month, coverage begins no later than the first day of the following month, if your application is completed after the 15th of the month, your coverage may not begin until the first day of the second calendar month after you apply.
To apply for benefits in States that the plan is administered by the US Department of Health and Human Services, you may complete and submit a paper application or apply online at https://www.pcip.gov/Apply.html. The following documentation is needed when applying for the federally administered program:
- Denial letter from an insurance company licensed in your state that is dated within the past 12 months, or a letter in the past 12 months from an insurance agent or broker that shows that you are not eligible for one or more health insurance plans because of your medical condition; or,
- Offer of individual insurance coverage within the past 12 months that you did not accept that has an exclusion for a pre-existing medical condition; or,
- If you are under 19 (or you live in Massachusetts or Vermont), an offer of individual insurance coverage within the last 12 months that show a premium that is at least twice as much as the Pre-Existing Condition Plan premium for the Standard Option in your State.