Preexisting Condition Insurance Plan (PCIP)

Good News About Health Insurance

Health reform happens! This summer, a new “Preexisting Condition Insurance Plan (PCIP)” went into effect, providing a real and immediate solution to one of the most pressing health-care conundrums — which is that people with “preexisting medical conditions” who lost their insurance or had none were unable to get health insurance. Helping these folks get coverage is huge. I checked in with federal Department of Health and Human Services (HHS) spokesperson Jessica Santillo to get information on the program — who’s eligible and what they need to do to get it started.

Do You Qualify?

This PCIP is an interim solution to tide people over until 2014, when health insurance “exchanges” (government-organized insurance providers) will offer this coverage, Santillo explained. It designates $5 billion in federal funds for a temporary “high-risk pool” to make health coverage available immediately to those who have been unable to obtain coverage for at least six months because of a preexisting condition. I’m glad to see it — waiting another three years for coverage is simply not a solution for people who are suffering today.

HHS is working with states and other partners to make sure eligible people are aware that they can enroll in this temporary, transitional program.

In order to qualify for PCIP, you must:

  • Be a citizen or legal resident of the US.
  • Have been uninsured for at least the last six months.
  • Have been unable to get health insurance due to a preexisting condition.

The coverage is not free, eligibility is not based on income, and people with preexisting conditions will not be charged higher rates for their health insurance coverage — rates in each state will be about the same as standard individual health insurance premiums in that state. Premiums will vary by age.

Coverage Varies State to State

Depending on where you live, the PCIP will be run by either the US Department of Health and Human Services or by your state.

The following 23 states participate in the national Preexisting Condition Insurance Plan, run by HHS. If you live in one of these states, you can fill out an online application at Coverage generally begins the first day of the month after the month that you apply.

Alabama Arizona Delaware
Florida Georgia Hawaii
Idaho Indiana Kentucky
Louisiana Massachusetts Minnesota
Mississippi Nebraska Nevada
North Dakota South Carolina Tennessee
Texas Vermont Virginia
West Virginia Wyoming

The remaining 27 states plus the District of Columbia, listed below, have contracted with HHS to administer a PCIP of their own. To learn more about how to obtain coverage in any of these states, you can visit

Alaska Arkansas California
Colorado Connecticut District of Columbia
Illinois Iowa Kansas
Maine Maryland Michigan
Missouri Montana New Hampshire
New Jersey New Mexico New York
North Carolina Ohio Oklahoma
Oregon Pennsylvania Rhode Island
South Dakota Utah Washington State

For many years, millions of Americans with preexisting conditions have been denied access to affordable medical coverage. We still haven’t solved the long-term problem of how we can as a society make health care affordable to all while preserving choice and entrepreneurship in the system… but it’s a great relief to see some help coming for the sickest among us!

Source:  Jessica Santillo, spokesperson, US Department of Health and Human Services, Washington, DC.


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