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PCIPs

The Affordable Care Act (ACA) mandated that every state create or maintain a Pre-Existing Condition Insurance Plan (or PCIP), to make health insurance available to people who have had a problem getting insurance due to a pre-existing condition.

 

PCIPs are similar in concept, to high-risk insurance pools - created to serve “medically uninsurable” patients who have pre-existing health conditions that made obtaining insurance very costly, or impossible.

 

 

Background

 

 

The ACA created a number of new opportunities for patients in the US who did not have insurance to obtain it starting in 2014.

 

To help certain patients obtain coverage prior to 2014, Congress provided $5 billion in PCIP funding under the ACA.

 

States were given the option to create a state-administered PCIP or allow the federal government to serve those patients through the federally administered PCIP.

 

The PCIPs covered major medical and prescription drug expenses, but enrollees were responsible for paying premiums, deductibles, copayments, and coinsurance amounts.

 

28 states chose to develop their own state-run PCIP: Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhodes Island, South Dakota, Utah, Washington, and Wisconsin.

 

23 states and the District of Columbia opted to have HHS administer a Federally-run PCIP coverage to their constituents: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, 4Nevada, North Dakota, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia and Wyoming.

 

 

Open Enrollment 2013

 

 

 

The PCIPs were temporary, and established provide health coverage to individuals with pre-existing conditions starting in 2010, lasting until 2014. 

 

Starting in October of 2013, individuals without insurance coverage were given the ability buy insurance directly in their state Insurance Exchange. The ACA prohibits insurance companies from refusing to sell coverage or renew policies because of a person’s pre-existing condition.

 

On February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) suspended acceptance of new enrollment applications until further notice. The suspension also became effective in the state-based PCIPs on March 2. This was done to ensure that funds would be available to continuously cover people currently enrolled in PCIP through the remainder of 2013.

 

States were given the option to keep their state-run Pre-existing Condition Insurance Plan (PCIP) programs running after that time at their own funding and supervision.

 

 

Learn More:

 

PCIP Program– PCIP.gov

What Is PCIP? – PCIP.gov

Affordable Care Act & PCIP Coverage – PCIP.gov

PCIP Coverage After 2014 – PCIP.gov

 

 

Additional Resources:

 

 Pre-Existed Condition Insurance Plans – Healthcare Access Working Group

 

 

AAHIVM Advocacy:

 

Letter to HHS on PCIPs, May 8, 2013 - AAHIVM & Health Care Access Working Group

 

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