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The New Health Care Law

AARP Webinar Q-and-A: Temporary Insurance for People With Pre-existing Conditions

The following questions were asked during AARP’s webinar series about the new health care law. Additional information about the Pre-existing Condition Insurance Plan, including instructions on how you can apply, is available at Healthcare.gov.

Overview

Q:  What is a pre-existing condition?
A:  A pre-existing condition is a disability or illness (either physical or mental) that you have before you enrolled in a health plan. A wide variety of health conditions have been used by insurance companies as a reason 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 due to that condition. If you live in a state that guarantees insurance coverage, you may be considered to have been denied coverage if you were offered insurance at an unreasonable price.

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 have 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 residing here legally, and have been uninsured for at least six months, have a pre-existing condition and have been denied health coverage because of your health condition. PCIP is a transitional program until 2014.

Q: What happens when the PCIPs end in 2014?
A:  PCIP is a "transitional" program because on Jan. 1, 2014, health insurance companies will be prohibited from denying coverage due to a pre-existing condition. PCIP is a bridge until 2014 for people who have been denied coverage by health insurance companies. In 2014, PCIP enrollees will be able to acquire health care coverage through new state-based health care exchanges.

Q: Is PCIP available now?  
A: PCIP is available in most states now. Whether the state or the federal government runs the program depends on the state. Also, the program name and design may vary depending on which state you live in. To learn more about eligibility, how to apply and what benefits are available in your state, visit the provisions page at Healthcare.gov.  

Eligibility

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 
  • 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


People now covered by a health plan, including employer plans, COBRA, TRICARE, Medicare, Medicaid and existing high-risk pool programs, are not eligible for PCIP. Even if you have a pre-existing condition, and your COBRA or other continuation of coverage is about to run out, you won't meet the requirement to be uninsured for the last six months. More about eligibility here.

If you are uninsured and have been told that you may be eligible for coverage through programs such as Medicaid and the Children’s Health Insurance Program, you should check out those programs first, as they may better meet your needs. If you have job-based coverage, or individual insurance coverage, you aren’t eligible to apply.

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