Pre-Existing Condition Insurance Plan To Offer Much Lower Premiums

WASHINGTON -- The government announced Tuesday that it will lower premiums and ease eligibility requirements for its fledgling health insurance program for people shut out from the private health insurance market because of pre-existing conditions. Premiums will fall by as much as 40 percent in some states.

The Pre-Existing Condition Insurance Plan, run by the Department of Health and Human Services in 23 states and by state governments in the rest, offers relatively affordable coverage for people who've been uninsured for at least six months because of conditions like diabetes or heart disease. The plan launched last summer as one of the first components of the health care reform signed into law by President Obama in March 2010.

"This program changes lives, and in many cases saves lives," HHS director Kathleen Sebelius said on a Tuesday conference call with reporters.

Yet only 18,000 Americans have signed up for the PCIP. Officials initially said it would reach hundreds of thousands by the time the program is phased out in 2014, when it will become illegal for insurance companies to discriminate against the sick.

To boost enrollment, Sebelius said monthly premiums, which vary by age and region, will drop in 17 of the states where HHS runs the program starting in July. In Alabama, Arizona, Delaware, Florida, Kentucky, and Virginia, premiums will plummet by 40 percent. Come July, people older than 55 who enroll in the Virginia PCIP's standard plan will have to pay $297 a month, a steep drop from the current $498 monthly premium.

Sebelius also said PCIP applicants will no longer have to brandish rejection letters from insurance companies to prove they have pre-existing conditions. Instead, a doctor's note will suffice.

It's not clear if any changes will occur in states where the federal government doesn't administer the program. Richard Popper, director of the HHS Office of Insurance Programs, noted that the HHS would be "issuing a guidance letter to all the 27 state-run PCIPs encouraging them to take a look at the premiums that they charge and the benefit packages, as well as the eligibility rules, allowing them to consider making adjustments similar to what we’re doing in the federally-run pool."

A spokeswoman for the California Managed Risk Medical Insurance Board, which administers the state's PCIP, told HuffPost that the state had not yet received the letter. With 1,543 enrollees, California boasts the nation's second-highest PCIP participation.

PCIP enrollee Suzanne Hannon of Fallston, Maryland, joined Sebelius on the conference call. Hannon said she lost her insurance when her husband turned 65 and became eligible for Medicare. She was 58.

"I applied many times to various insurance companies only to be denied. The last application I submitted was in September and I was turned down due to a high cholesterol level," Hannon said. Rejection letter in hand, Hannon applied for the PCIP in Maryland, and just in the nick of time.

"I was approved in November and I was diagnosed with cancer in December," she said. "Because I had insurance, at the first symptom I sought immediate medical care. Quickly I was treated with surgery, chemo, and radiation, ending with a good prognosis. Without the insurance I would not have sought treatment right away."

As many as 25 million Americans have pre-existing conditions and lack insurance. Costly premiums have been one explanation for the PCIP's sluggish enrollment numbers -- another has been the program's harsh requirement that applicants be uninsured for six months.

Popper said Tuesday that HHS can't change the six month waiting period because it's written into the health care reform law. "It’s in the statute, so we don’t have the authority to waive that," Popper said.

In another upcoming change, HHS will also start paying health insurance brokers this fall for connecting eligible applicants with the program.

HuffPost readers: Thinking of signing up for the PCIP? Too expensive? Can't wait six months with no insurance? Tell us about it -- email [e-mail]. Please include your phone number if you're willing to do an interview.

Comments

[Leslie Love]

03:42 PM on 07/12/2011

This is really great that NC medicare is going to have cheaper premiums. Does that apply to all Medicare providers? For instance, does it apply to http://lowcountrymedicare.com ?

[mikeemo1]

12:19 PM on 06/09/2011

if everyone and i mean everyone including the president had to pay the same amount for insurance maybe then and only then evryone would have insurance
healt insurance is given to the politicans who make the laws that require everyone else to pay seems to me that the health insurance companys are the ones running the politicans
put that in your pipe hillary rottenass cliton

[Awake-and-Sing]

02:11 PM on 06/01/2011

Imagine how much lower the premiums would be if the six month waiting period were removed and this program were opened to everyone.

Younger and healthier people would come rushing in to get away from their overpriced for-profit insurance.

The only ones weeping would be corporate CEOs and the right-wing politicians who depend on their campaign contributions.

[SisterAnn]

03:29 PM on 06/01/2011

Other countries pay at least 40% less than we do with better results.

[Awake-and-Sing]

03:49 PM on 06/01/2011

Exactly!

I've lived abroad and seen how these systems work well and how the right-wing fearmongering is just an attempt to preserve the profits of corporate campaign contributors.

[timhere]

01:24 PM on 06/01/2011

If the government is going to cover all the high risk people it just makes sense for them to cover everybody. The government covers the sick and the elderly; meanwhile the insurance companies cover those who don't use medical services often. That is a scam, the result of a government owned by corporations.

[Awake-and-Sing]

02:24 PM on 06/01/2011

I agree. Two simple amendments to this that could be passed via budget reconciliation:

- Allow anyone to sign up for it
- Remove the 6 month wait

Then we have our public option. Younger and healthier people would rush to join in to escape their overpriced for-profit insurance, lowering premiums even further.

[SisterAnn]

03:53 PM on 06/01/2011

Do they use cigarette taxes to pay for chip? I always thought Chip was just for children, but I guess not.

[SisterAnn]

03:44 PM on 06/01/2011

My insurance companie dropped me after I became sick, so I signed up for high risk. It was going to cost about $1100 a month. I was afraid I would end up in the hospital and was tempted to take it. Then the insurance that canceled me reinstated my insurance. They had changed the coverage. It had a high deductible and no prescription coverage. They called it catastrophe insurance. I liked about 5 months being eligible to get Medicare. I went ahead and took the catastrophe until then. I paid for my prescriptions myself.

They did need to lower the cost of high risk insurance. I wonder how they will pay for it.

If I were running the country, some in the health field would do some of the work for high risk people for costs only. That is their price for getting to live the American High life.

That will drive some on here nuts.

[annie s]

09:21 AM on 06/01/2011

Bravo. Florida currently charges $773 per month. Now shorten the "uninsured" time limit from 6 months to 3 and you have a successful program.

[gaydood]

09:30 AM on 06/01/2011

when i look its $118 to $390 per month

https://www.pcip.gov/StatePlans.html

[annie s]

09:46 AM on 06/01/2011

Wow. I just looked and you're right. That's fantastic.

[Awake-and-Sing]

02:11 PM on 06/01/2011

Shorten the "uninsured" time limit to zero, open the program to everyone, and you have a public option as an even more successful program.

[JPMac]

09:10 AM on 06/01/2011

What a great idea, I think the private insurance are going to start offering car insurance a lower rate plans to people who have been pulled over for drunk driving just to get more of them on the rolls!!! This idea is just the being of the end!! Lowering the cost of insurance to the people that will cost the progam the most is just economiclly unsustainable, but politically popular!!

[gaydood]

09:31 AM on 06/01/2011

not everyone with pre existing is sick ! what a strange post

[Seer Clearly]

10:34 AM on 06/01/2011

I'm actually beginning to wonder if these posters are mentally ill. Being sick or having a preexisting condition is not a choice like drunk driving. By this JPMac's "logic" health coverage should only be available to young, healthy people. Why not just put everyone who has a preexisting condition in a gas chamber and get it over with?

[Deaninphilly]

08:05 AM on 06/01/2011

One of the reasons that it has been sluggish with enrollment is because the plans stink. You not only pay the monthly premium each month but most things are not a "copay", you pay a percentage usually around 20%.

Even with this insurance I would stand to still have to spend close to $1500 a month after paying the premium.

[gaydood]

08:17 AM on 06/01/2011

are you ill?

[gaydood]

09:33 AM on 06/01/2011

are you in PA?

Premium: $283.20 per month
Deductible: $1,000 in-network
Out of Pocket Limit: $5,000 in-network

[annie s]

09:24 AM on 06/01/2011

A co-pay of 20% based on usual and customary fees is better than no insurance at all. And just so you know, many doctors and hospitals are willing to negotiate the 20% or at least allow small affordable monthly payments

[Danilo Gurovich]

11:59 PM on 05/31/2011

Funny place you're going to find opposition to this is from business, the same people that this is supposed to benefit.

Why? Because a lot of people take low-paying crappy jobs with crappy bosses because they are petrified of losing their insurance. As long as employers provide insurance and you have no coverage for pre-exisiting conditions any other way, you have to take what you can get.

[dkinton49]

02:06 AM on 06/01/2011

Your logic is terrible! You say, "Because a lot of people take low-paying crappy jobs with crappy bosses because they are petrified of losing their insurance." This sentence makes absolutely no sense. Can you explain it?

[annie mac]

03:28 AM on 06/01/2011

It's well known that many people are in "job lock" because just about the only way they can find decent and halfways affordable insurance for themselves and their families is through their employer. So, they feel trapped in jobs that they are unhappy with, for the sake of the insurance.

It's anticipated that healthcare reform will boost job mobility - in fact it's a key concern - so that people feel free to pursue better opportunities. They will be able to do this because even small businesses will be able to offer good value plans, or they can source them themselves if the plan of their chosen new employer is too costly, or simply not competitive with alternatives.

[SisterAnn]

06:35 AM on 06/01/2011

Just change 'take' to 'keep' in that sentence and it makes sense.

You learn after awhile what people mean even if they use the wrong word.

I have done that before, myself.

Besides, it gave you the opportunity to act superior.

[FatFeline]

11:53 PM on 05/31/2011

Let's not forget this is being paid for with the $500 billion taken from Medicare.

[annie mac]

03:16 AM on 06/01/2011

$500 billion has not been taken from Medicare.

That is, $500 billion is a Medicare SAVING, achieved by no longer paying subsidies to private health insurance companies participating in Medicare Advantage. These subsidies go directly into private insurance companies coffers, as a sort of participant's kickback, and do not contribute to actual health care in any way. It;s money for nothing.

In other words, $500 billion has been taken from private insurance companies.

[FatFeline]

04:14 AM on 06/01/2011

You have not idea what you are talking about. You have been listening to Obama propaganda. Ask someone who had Medicare Advantage.

I have Medicare Advantage. I get lots of health care benefits from it. That $500 Billion takes away from benefits that I tens of thousands of other are getting. My lowered co-pays, extended hospital stays, added drug cost benefits, etc are very real.

[jagcapt007]

03:46 AM on 06/02/2011

you are a liar. The number one advantage of medicare advantage plans are they paid for diabetic testing for Seniors. They have already been told (Medicare) they need test 67% less (type two) to save ($200.00) monthly that nasty advantage plan benefit paid for their supplies.



We already have deaths from a semi conscience driver who said straight out, she was clueless what her blood sugar was before she got behind the wheel of her vehicle. She was normal yesterday.


My state wants her license, and I can't disclose my fees. Her blood sugar in the hospital was 43. In the real world that makes a 1.0 drunk actually appear sober. It going to be great having all those Seniors on the road oblivious to traffic and pedestrians.



The greatest gifts of deadbeats is all those that paid a lifetime towards their insurance must now give them up, so single moms and minorities can have their's for free.


A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs


Those poor little moms get health care for breeding, and the seniors get told to fend for themselves. Life is great for progressive elite's; So many more victims to bring to the genocide's

[rotorhead1871]

11:49 PM on 05/31/2011

has this chick paid her taxes yet?

[Beckel411]

11:19 PM on 05/31/2011

More food for thought:

Thousands of people file for bankruptcy because of medical bills. They go bankrupt, the medical bills are wiped out, the doctors, hospitals, labs, etc. don't get paid.

That could never happen to an insurance company -- they've got you over a barrel cuz if you don't pay upfront, you don't have insurance.

I think insurance companies are the biggest scourge on the face of the earth.

[pistol13]

11:01 PM on 05/31/2011

I still want to know why all insurance companies cannot sell health insurance in any state. That is known as competition and competition drives down prices. Has anyone ever gotten an answer to that question or do your people in Congress, Dems and Repubs alike, ignore you.

[Beckel411]

11:22 PM on 05/31/2011

Because different states have different laws. I live in Ohio. If I buy a policy from a company in Georgia, does that policy have to abide by Ohio laws or by Georgia laws?

If the answer is Georgia laws, how do my medical providers know what things my insurance must cover (Pap smear, HIV testing, the tests on newborn babies, etc.) without having to do major research?

[jagcapt007]

01:15 PM on 06/02/2011

You must be one of those special people I always read about. If you commit a crime in NY, that state prosecute you,, not your home state.

I purchased $25,000 of equipment from California, and was required to pay a special California tax for those products. Something malfunctioned with some of those products, and I informed that global vendor under California law I have certain rights, not afforded me in my State. They proudly told me I was wrong.

Upon filing papers with that tax number, all malfunctioning products were replaced free of charge under the law.

IN my state we don't respect other state laws, however we will always enforce contract law. We don't respect GAY Marriage in my State, We absolutely respect Gay marriage from other states if you move here legally married else where.

It takes no major research to obtain state laws. They All are required to publish their laws free on web sites via Federal law


I do business worldwide, Every Nation requires under their laws I leave a contact number. Once they call that number, and file a complaint in writing, I am legally responsible to comply

[Beckel411]

11:30 PM on 05/31/2011

P.S. If insurance companies have to compete for your business and it drives down prices, the important question is, HOW does it drive down prices?

The only possible way an insurance company can reduce their costs, aside from only insuring the people who won't make claims, is to pay less for health care for their clients.

How can insurance companies pay less for health care?

Don't you see that insurance companies don't produce a product? They don't provide anything really. They just shuffle some of the money that people pay them out to some of the people who need it.

Taking a handsome cut for themselves first, of course.

[Seer Clearly]

10:42 AM on 06/01/2011

They lower premiums by denying service with Death Panels. Clearly, not by paying their executives less or becoming more efficient. Essentially they are bureaucracies that have the power to charge for shuffling papers and denying services. Just like the government of communist Russia was. We need a revolution here.... Agains the insurance companies that hold our lives hostage. Single payer is the solution.

[jagcapt007]

12:51 AM on 06/03/2011

Yet I know you believed Obama when he demanded we can now insure 47,000,000 more American and save trillions.

Any Professional that actually owned a business knows how to bring down the cost of any product quickly. Pay cash upfront.

When I had my first child I had two options. I could pay $650 cash in advance or $2100 Plus after delivery. I chose cash in advance and refused to pay the phone bill, because I had a receipt going into that Hospital .. PAID IN FULL.



LMAO @ insurance companies don't produce a product. I don't know how to break this too you Beck but the insurance company that I help support last year contributed 2 billion dollars just to our state hospitals alone.


As we speak I had two clients with similar problems that I represented. One paid me 250K upfront, the other paid me 950k 3 years later. They both got the same settlements, and services.

The ladder half was actually furious her check came through me, and not reversed, that she would have to pay me.

Welcome to the real world of finance and politics. Those who pay thier bills in advance get discounts. Those that are late get screwed.

Deadbeats always get treaded oddly because everyone just wants them GONE

[Teacher Trish]

10:57 PM on 05/31/2011

It seems to me if people could sign up for this earlier (than the six months) they could pay more premiums thus saving the government some money.

[SisterAnn]

06:49 AM on 06/01/2011

This 6 months of no insurance is probably caused by the republicans not wanting the government to 'compete' with private insurance.

[Awake-and-Sing]

02:21 PM on 06/01/2011

If there was no waiting period, and it was open to everyone, it would be the "public option" and it would save even more money and have even lower premiums because younger and healthier people would rush to it to escape their overpriced for-profit insurance.

[Teacher Trish]

07:08 PM on 06/01/2011

Yeah, I guess that would make too much sense!

[Lorianne]

10:38 PM on 05/31/2011

ObamaCare’s Disastrous New Long-Term Care Entitlement ____ http://reason.com/archives/2011/05/27/obamacares-disastrous-new-long

[Danilo Gurovich]

11:52 PM on 05/31/2011

oh boy! I'll bet you wrote the article?

Wait. How about RepubliCare? If you aint' rich, we don't care.

[Tessie]

08:58 PM on 06/01/2011

Anyone who wants care--no they don't have to pay, it's all freeeee! We'll just print more money, spend more of other peoples money, and implement lower care and higher costs for everybody hooray! We'll all be equal.

[oceana6695]

12:41 AM on 06/02/2011

I don't trust blogs

[Lorianne]

10:38 PM on 05/31/2011

Pelosi’s District Gets 20% of Latest ObamaCare Waivers http://www.commentarymagazine.com/2011/05/18/pelosi-district-gives-20-percent-of-obamacare-waiver/ _________________

[Danilo Gurovich]

11:53 PM on 05/31/2011

RepubliCare -- where life is precious from conception to birth. After that, you're on your own.

[solvseus]

01:17 AM on 06/01/2011

You're late to the party. This was debunked awhile ago. Enjoy:

http://www.huffingtonpost.com/2011/05/17/nancy-pelosi-health-care-waivers_n_863252.html

Long story short, she had nothing to do with it, and they got the waivers because their coverage is BETTER than what the new law proposes and conflicts with.