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The New Health Care Law

AARP Webinar Q-and-A: What You Need to Know About the New Health Care Law

The following questions are among those asked during AARP’s webinar series about the new health care law.

Participants were especially curious about the new law and coverage for young adults, insurance for people with pre-existing conditions, help for the uninsured and those paying high premiums for COBRA, and about a new, long-term care insurance program called CLASS.

For Medicare-related questions asked during the webinars, see AARP Webinar Q-and-A: What the New Health Care Law Means for People With Medicare. For more information about the new, "high-risk pools" for people with pre-existing conditions, see AARP Webinar Q-and-A: Temporary Insurance for People With Pre-existing Conditions.

The Law and Pre-existing Conditions

Q: When will insurance plans be required to cover people with pre-existing conditions?

A: As of Sept. 23, 2010, insurance companies can’t refuse to sell insurance to children with pre-existing condition. In 2014, all insurance plans will be required to provide coverage to adults with pre-existing conditions.  

Q: What is the Pre-Existing Condition Insurance Plan?

A: The Pre-Existing Condition Insurance Plan (PCIP) was created as part of the nation's new health insurance law, the Affordable Care Act. The PCIP program was designed to make health insurance available to you if you’ve been denied coverage by private insurance companies because of a pre-existing condition. PCIP provides a new health coverage option if you are a U.S. citizen (or are otherwise residing here legally) and have been uninsured for at least six months, have a pre-existing condition or have been denied health coverage because of your health condition. PCIP is a transitional program until 2014.

Q: Who is eligible for coverage through PCIP?


A: Eligible individuals must:

  • Be a U.S. citizen or a legal resident
  • Have a pre-existing medical condition
  • Have not have been covered under creditable health coverage — as defined by Section 201(c)(1) of the Public Health Service Act — for the previous six months before applying for coverage. Persons currently covered by a health plan, including employer plans, COBRA, Tricare, Medicare, Medicaid and existing high-risk pool programs, are not eligible for PCIP.

 

Q: Is PCIP available now or in 2014?

A: PCIP is available in most states now.

Q: How do I find out about pre-existing conditions and what they are?

A: A wide variety of health conditions have been used by insurance companies as reasons to deny coverage. Different states may use different methods of determining whether you have a pre-existing condition and whether you have been denied insurance coverage. If you live in a state that guarantees insurance coverage, the state may consider you to have been denied coverage if you were offered coverage at an unreasonable price. Go to HealthCare.gov to learn more about the eligibility requirements in your state.  
 
Q: The temporary PCIP will be awarded on a "first come, first served" basis. What does that mean?

A: Congress appropriated $5 billion to fund the temporary PCIP through December 2013. About 5 million to 7 million Americans are estimated to lack health insurance and have a pre-existing condition. While only a fraction of those who need coverage are expected to enroll in the program, there’s a range of estimates about how large that fraction will be. Therefore, the federal funding allotted for the new program may not be enough to help all individuals who are eligible to receive temporary insurance coverage. But those individuals who do get temporary coverage through PCIP in their state will be able to keep their coverage (as long as they pay their premiums) until 2014, which is when everyone with a pre-existing condition will be able to access coverage through state-based insurance exchanges.

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