Understanding PCIP Coverage in 2013

PCIP or Pre-Existing Condition Insurance Plan has been created in the run-up to the exchanges so that people who have been left uninsured due to existing medical conditions have some form of coverage until the exchanges start selling health insurance. PCIP refers to a time-based coverage option where people diagnosed with a pre-existing condition and uninsured for at least six months can seek coverage. These essentially high-risk individuals are being covered by the federal government.

From February 16, 2013 applications for the federally-run PCIP have been suspended. This is because new enrollment applications have been put on hold until further notice. Some of the state-based PCIPs can still accept enrollment applications but these too will be soon stopped. PCIP is presently providing coverage to nearly 100,000 people across the nation.

PCIP refusal of new applications in 2013 is quite expected. It was always a temporary program for those who were forced out of the existing health insurance marketplace.  The PCIP has had limited funding that is due to decrease as the exchanges arrive. PCIP enrollees have traditionally been people with severe illnesses, requiring extensive medical care. People who are confused about how the PCIP program provides coverage can read the details listed at this link:

http://www.cciio.cms.gov/resources/files/pcip_annual_report_01312013.pdf

In the near future, new PCIP enrollee coinsurance and out-of-pocket costs will be effective. PCIP has been providing drug refills for prescription medications. This has continued into 2013. More relaxations are being made and now PCIP will cover generic and formulary prescription drugs beyond the first two-time limit that was applicable until now. However, some form of coinsurance will now be applicable, i.e. beyond the first two refills. PCIP offers standard benefits across people without much differentiation across different types of plans. For instance, the Standard Plan has a fixed, minimum annual deductible for medical services and a separate drug deductible. To become eligible for PCIP, it is vital to have a health assessment done. This should be completed within a stipulated period so that the health requirements can be properly detailed. The assessment is not demanding. It includes an online questionnaire that helps to identify the health risks and other requirements for successfully transitioning to PCIP coverage.