Think of someone with a pre-existing condition who cannot get an individual policy or coverage under group health insurance.
Think of someone whose COBRA coverage has run out.
How about someone who doesn’t qualify for Social Security? Or someone 65 or older who doesn’t qualify for Medicare? Even a disabled person under age 65 who can’t get Medicare because he or she hasn’t been disabled long enough.
And really, a person’s age doesn’t matter at all. Or a person’s work history: even a person who’s starting a new business and who can’t get insurance because of a pre-existing health problem and doesn’t have enough employees yet to get a group policy.
What matters is they can’t get health insurance coverage.
Here’s the antidote: the “Pre-Existing Condition Insurance Program” (“PCIP” for short).
PCIP is not picky on what your pre-existing health issue might be. Virtually none will affect coverage, not even ones which you’d think would be insignificant. For example, if an insurance company denied you coverage because you take medicine for cholesterol or high blood pressure, well, you’ll qualify for PCIP coverage.
It gets better: PCIP insurance has no limit on benefits, unlike most health insurance plans which do have a max.
What this means: someone with cancer discovers that his or her health insurance provides a maximum lifetime benefit of $200,000. And that max will be reached in a matter of months.
Under PCIP, this won’t happen.
Isn’t this amazing? What’s really amazing is that this is federal law, and what’s really, really stunning: It was created under the Obama healthcare statute (technical name: the “Affordable Care Act”) with support from both Democrats and Republicans.
OK, what’s the catch?
Well, to qualify for PCIP, you must be flat out-of-luck, with no insurance benefits of any kind for at least six months. You also can’t be eligible to get an individual or group policy, and you cannot qualify for Medicare or Medicaid.
In addition, you must have been turned down for coverage because of your health situation.
“Well,” you say, “PCIP covers next to nothing, right?”
Wrong. PCIP covers primary care and specialty care. Prescription drugs. Hospitalization. Pregnancy and maternity. Mental health. A skilled nursing care facility. Durable medical products. Even hospice. The list goes on.
The coverage varies from state to state. Use the dropdown menu on the PCIP website to view the Georgia coverage.
There are even three levels of coverage you can choose. The premiums depend on your age: in Georgia, the “standard plan” premium ranges from $147 (for ages 00-18) to $470 (if you’re 55 or older).
The politics: This program will expire Jan. 1, 2014, when a new insurance pool is supposed to go into effect in every state (except those opting out, I guess).
This is a quick overview of a virtually-unknown law. If you have questions, contact me.