Printer Friendly and PDF

PCIPs Enrollment Now Easier, Less Expensive

June 1, 2011

On May 31, 2011, the Department of Health and Human Services announced that it was making changes to the federally administered Pre-existing Condition Insurance Plans (PCIPs) in 23 states and the District of Columbia.  The other 27 states administer their own plans and will have the opportunity to make comparable changes. The PCIP is a bridge for patients who would otherwise be denied insurance to obtain coverage until 2014, when private plans will be prohibited from denying coverage based on pre-existing conditions.

Participation in the PCIP has been significantly lower than expected.  To increase enrollment, the government has occasionally modified rates and requirements.  Theselatest changes will make it even easier for people with pre-existing conditions to obtain health insurance coverage. 

In 18 federally administered plans, premiums will be lowered by as much as 40% to bring costs more in line with the private individual insurance market.  In the remaining six states, premiums are already on par with the private market.  Moreover, starting July 1, 2011, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have, or at any time in the past had, a medical condition, disability or illness. Applicants will no longer have to wait for an insurance company to send them a denial letter.  

This option became available to children under age 19 in February 2011; it is being extended to all applicants regardless of age. Applicants will still need to meet other eligibility criteria, including that they are U.S. citizens or residing in the U.S. legally and that they have been without health coverage for six months. 

More information on the PCIP can be found at: