Premiums and eligibility standards for many federally run state-based pre-existing insurance pools will be cut, according to the Department of Health and Human Services (HHS). The changes will impact some- of the state-based insurance programs, which have attracted fewer enrollees than the Obama administration originally estimated. The plan will reduce Pre-Existing Condition Insurance Plan (PCIP) premiums between two percent and 40 percent in Washington, D.C., and in 17 of the 23 states where the federal government runs the program. Another 27 states run their programs by using federal funding through the Patient Protection and Affordable Care Act (ACA).
According to HHS, the changes will bring the premiums closer to the individual insurance market rates in each state. The change will not affect premiums in states where they are “well-aligned” with the individual insurance market premiums. “That means real savings for people across the country,” HHS Secretary Kathleen Sebelius said. “The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives. These changes will decrease costs and help insure more Americans.”
Changes include allowing adults — beginning July 1 — to qualify for the program if a physician, physician assistant or nurse practitioner provides a letter from the last year stating that the individual has had “a medical condition, disability or illness.” The change no longer requires that applicants provide an insurance company denial letter, although the programs will still require citizenship or legal residency and no health insurance coverage for the previous six months. PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care. It limits yearly out-of-pocket spending and does not carve out benefits the people need. Eligibility is not based on income and people who enroll are not charged a higher premium because of their medical condition.
According to the MyHealthCafe.com blog, the move is a good one. “Based on PCIP enrollment so far, it may not be an issue. California may have a budget to provide health insurance coverage for 20,000 in its PCIP, but so far only 513 Californians have enrolled in its PCIP. That is still more than the paltry 101 residents of Missouri who have enrolled for health insurance coverage in that state’s PCIP. In contrast, Pennsylvania, which is running its own PCIP and is limiting health insurance premiums to a comparably affordable $283 a month, has enrolled 1,657 in its PCIP, 1,000 more than any other PCIP in the nation. Overall, only 8,000 Americans have enrolled in a PCIP so far. Although Americans with pre-existing conditions were expected to stampede into the newly-formed PCIPs, applications for most of the PCIPs have only trickled in so far. It is astonishing to many who predicted that the PCIPs would be flooded with applications from Americans with pre-existing conditions who have been long-denied health insurance. Experts questioned whether the $5 billion dollars would be enough to cover the 375,000 expected to enroll until 2014,when all health insurers will be required to offer insurance regardless of pre-existing conditions.”
As an example, HHS said that a 50-year-old Floridian can now get comprehensive health coverage for as low as $270 per month. “This option became available to children under age 19 in February, and we are extending this pathway to all applicants regardless of age,” Sebelius said. “Applicants will no longer have to wait on an insurance company to send them a denial letter.”
“These changes will get more people covered,” said Steven Larsen, the director of the Center for Consumer Information and Insurance Oversight. “We’re encouraged by recent increases in enrollment and we’re excited to build on these efforts and reach even more people.”
Tags: Center for Consumer Information and Insurance Oversight, Department of Health and Human Services, insurance premiums, Kathleen Sebelius, MyHealthCafe.com, Obama administration, Patient Protection and Affordable Care Act, pre-existing medical conditions