Pre-Existing Condition Insurance Plan under-promoted, under-enrolled


    The Pre-Existing Condition Insurance Plan, as of Nov. 1, 2010, only had 75 people enrolled in Virginia.  This is unsat.  When the RAM people do a free clinic in Virginia, people line up for days and nights to try to get in.  Surely there must be a greater need in Virginia than 75 folks.…

    The Pre-Existing Insurance Plan was part of the health care reform bill, and is a program that has been available since July 1, 2010 in Virginia.

    What can be done to get people who are eligible in Virginia signed up for this program?

    As recently as April, the chief actuary for Medicare and Medicaid estimated that 375,000 people would enroll in the risk pools this year.…

    Nationwide, the PCIP only has about 8000 people signed up.…

    The federal government is trying to lower the premiums for the PCIP in order to get more enrollees.


    “The Pre-Existing Condition Insurance Plan, run by the federal government in 23 states and state governments in the rest of the country, is for people who have been uninsured for at least six months due to pre-existing conditions like cancer, diabetes, and heart disease.

    “There are millions of such people, but officials with the Department of Health and Human Services initially said they expected the program to reach 350,000 over the next three years.”

    This program can be a godsend for people who are eligible.

    “For Gillian Sender, the new plan has been an enormous relief. Uninsured since December when she left her job in newspaper advertising sales, Sender, 52, started feeling fatigued and bloated over the summer. She went to a community health center near her home in Milwaukee to get it checked out in July and was referred to a gynecologic surgeon, who told her she had uterine cancer.

    “That week, as she grappled with her diagnosis and panicked about how she would pay for her upcoming hysterectomy, chemotherapy and radiation, family members told her about the new options for people with preexisting conditions. Sender immediately signed up for a plan with a $3,500 deductible, for which she pays $288 monthly.

    “Although the plan’s Aug. 1 start date meant she had to pay for her surgery, she’s covered for the chemotherapy and radiation. “I was more terrified of not having insurance than the diagnosis itself,” says Sender. “It’s definitely affordable, and the coverage is fabulous.””…

    I’d hate to think that the Virginia governor is not promoting this plan for partisan reasons.

    Having health insurance matters.

    Recent figures show that more than 1 in 4 adults 18-64 years old-about 50 million people-had no health insurance for at least part of the past year. Over the past several years, the number of adults 18-64 years old without health insurance for at least part of the year has increased by an average of 1.1 million people each year, and middle-income people account for half of that increase.

    Although poverty and lack of insurance are linked, about 1 in 3, or 32%, of middle-income adults aged 18-64 years went without health insurance during some part of 2009. People in all income brackets have been affected, including about 10 million adults in middle-income households and 12 million adults living in poverty according to data from the 2009 National Health Interview Survey.

    As a result, millions of Americans have limited access to needed clinical care, including prevention services, because they lack health insurance and are not seeking medical care because of financial concerns.1,2 Missing or delaying health care can lead to poorer health and potentially to greater long-term medical expenditures.3,4

    Not having insurance has a greater impact among those adults who need health care the most. Delays in receiving health care can lead to poorer health and higher medical costs over time, especially for those individuals who already have health issues, including the approximately 40% of the U.S. population with one or more chronic diseases.5 About 60% of adults ages 18-64 with a disability who had recent gaps in the past 12 months in their insurance skipped or delayed care as well.…

    What’s Pennsylvania’s secret sauce for getting people to enroll?

    “I think there are three reasons that Pennsylvania is doing so well,” said Insurance Department spokeswoman Melissa Fox. “First, our premium is more affordable than other states’ [because] it is community rated — spreading the risk among a large group — and not rated by age or condition.”

    Second, she said, Pennsylvania’s list of eligible pre-existing conditions is more comprehensive than other states’, and third, Pennsylvania’s application is online only, which speeds the enrollment process.

    Pennsylvania, which began taking applications Aug. 5 and offering coverage in September, also publicized the program via radio and Internet ads.

    Read more:…

    Here are some details regarding the Virginia version of the PCIP:

    Pre-Existing Condition Insurance Plan: Virginia

    PCIP 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, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods.

    The monthly premiums for your state are:

    Age 00-34  35-44  45-54   55+

        $289  $347   $443   $616

    In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year. However, your out-of-pocket costs may be higher if you go outside the plan’s network.


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