Got Questions?
1-800-299-2207
Student Login


Federal Preexisting Condition Coverage

                                                     

There is no doubt that just about every American is aware of the Patient Protection and Affordable Care Act (PPACA), otherwise referred to as "ObamaCare."  One of the primary pieces of the legislation is the requirement that all Americans and legal residents have medical coverage by 2014.  In that vein, effective in 2014, all applicants must be accepted by insurers, including those with preexisting conditions (pre-x)  that would normally render an individual as uninsurable. 

So... what to do with people who are unable to obtain health insurance coverage due to preexisting conditions who are rejected by insurers or who are only offered coverage at outrageous premium rates due to preexisting medical conditions BEFORE 2014?

Prior to the passage of the PPACA, uninsurable individuals had an almost impossible time understanding how they could secure coverage.  The idea of state-run pools to insure individuals who cannot get coverage due to preexisting conditions has been around for some time, however the structure, availability and premium rates for pool coverage varied widely among the states.  The premiums for pool coverage are as high as 125-150% of the average individual premium in a state.  As well, coverage in the pool plans was often quite minimal, often only meeting state-mandated coverage requirements on a minimum level.  Deductibles, coinsurance and co-pays are often high as well.

How many citizens are aware of the Pre-Existing Conditions Insurance Pool, or PCIP?  All states now have in place a mechanism for those previously unable to get coverage through the PCIP.  Depending on the state in which a person lives, the program may be state or federal in nature, and there are distinct differences in premium rates, coverage, deductibles and rules.  The map below provides the details for each state (provided by our friends at healthcare.gov). 

                             

Click on the map and it will link you to the HealthCare.gov map shown above.  It's interesting to note the differences in terms of the plans, costs and coverage between the states - they can be significant.  For example, take a look below at the differences between a few of the states:

California (State Pool)


Florida (Federal Pool)


Oregon (State Pool)

Illinois (State Pool)
                            

    Premium:                                $99 to $607 for a non-smoker, rates vary by region

   
Deductible:                             $1,000 and $2,000

    Out of Pocket Limit:               $4,350 for medical (including deductible), $1,600 for pharmacy, with

                                                   a maximum out-of-pocket limit of $5,950         


Arizona (Federal Pool)


So, how would one find out what is applicable in their state regarding the availability of plans, costs and other information?  Click HERE for a link!

Posted: 1/6/2012 9:23:43 AM by Gary Sternberg | with 0 comments


Trackback URL: http://www.proschools.com/trackback/a64bb3dd-dc4d-42e8-a812-db336297ae82/Federal-Preexisting-Condition-Coverage.aspx

Comments
Blog post currently doesn't have any comments.
Leave comment Subscribe



Enter security code:
 Security code
Subscribe FREE
right now!
Get the latest information on the insurance industry and licensing requirements delivered to your email inbox or favorite RSS feed reader as soon as it's published.