New Pre-Existing Condition Insurance Plan Begins

Karen Lee Richards Health Guide
  • As part of the health care bill that was signed into law last March, a new program – the Pre-Existing Condition Insurance Plan – was created to make health coverage available to you if you have been denied health insurance by private insurance companies because of a pre-existing condition.  The plan is supposed to cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. 

    This new plan went into effect July 1.  The specifics of the program will vary depending on what state you live in.  In 21 states, the U.S. Department of Health and Human Services will run the Pre-Existing Condition Insurance Plan.  The remaining 29 states have opted to run the program themselves. 

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    Who is eligibile?

    There are certain eligibility requirements that apply to everyone.  In order to qualify for this plan, you must:

    • Be a citizen or national of the United States or lawfully present in the United States.

    • Have been uninsured for at least the last six months.

    • Have had a problem getting insurance due to a pre-existing condition.

    Different states may use different methods of determining whether you have a pre-existing condition and whether you have been denied insurance coverage.  For example, 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.  So, you'll need to check on how to establish eligibility in your state.

    When does coverage start?

    If you live in a state where the DHHS is running the program, you can apply and enroll starting July 1, 2010.  If you apply and are approved for enrollment by July 15th, coverage will begin August 1.  Generally, a completed application received on or before the 15th of the month will go into effect on the first day of the next month. A completed application received after  the 15th of the month will go into effect on the first day of the following month.

    How much do the premiums cost?

    The premiums will vary by state.  Premiums are not based on income, so even though you can't be charged a higher premium because of a pre-existing condition, the premiums may still be somewhat expensive.  As an example, if you live in a state where DHHS is providing coverage, the premium for a 50-year-old enrollee may range between $320 and $570.  If you can't afford the premiums and have limited income and resources (assets), you may be eligible for the Medicaid program in your state.

    How do I apply?

    Go to the Web site's New Pre-Existing Condition Insurance Plan page and click on your state to find out how the program is being run in your state and how to apply.


Published On: July 07, 2010