Fact Sheet: The Health Care Law and Temporary Insurance for People With Pre-existing Conditions

by: Education & Outreach | from: AARP | Updated 2011

En español | An important provision in the health care law provides funding to offer temporary health insurance to people who cannot access health insurance through other means.

This provision, officially known as the Pre-existing Condition Insurance Plan (PCIP), is a first step in helping people with pre-existing health conditions get the insurance coverage they need. This temporary program will operate until Jan. 1, 2014, when individuals will be able to buy health insurance through state-based purchasing pools called exchanges.

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In some states, the PCIP is operated by the state itself. In states that chose not to take on this role, the plan is run by the U.S. Department of Health and Human Services. Twenty-three states have asked the federal government to run their PCIPs. The remaining states have chosen to run their own plans.

This program is funded entirely by the federal government. The health care law allocated money for the program nationwide. Funding will be used to cover the costs of running the program.

Who is eligible?

To be eligible for PCIP, you must have been uninsured for six months, have a pre-existing condition and have been denied coverage because of your health condition. You must also be a U.S. citizen or national, or be lawfully present in the United States. If you have any insurance now, you are not eligible. This includes coverage you have through employer plans, Medicare, Medicaid, COBRA and existing high-risk pool programs run by your state.

What benefits are covered?

PCIP covers a range of benefits, including primary and specialty care, hospital care and prescription drugs. All of these health plans are required to cover pre-existing medical conditions, and they will have networks of health care providers that include a full range of services and specialists.

What is the cost?

Premiums are determined by a number of factors, such as your age and the state where you live. Yearly out-of-pocket costs will be limited to $5,950 for individuals, not including premiums.

When can you apply for this type of health insurance?

Every state is now accepting applications for PCIP. Individuals will be accepted on a first-come, first-served basis. Coverage under this program will end Jan. 1, 2014, when individuals will be able to buy insurance through state-based exchanges.

For more information on the PCIP in your state and get an application for this temporary insurance coverage, visit PCIP.gov or call 866-717-5826.