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Affordable coverage for pre-existing conditions
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Enrollment Support:
OnlineNavigator.org
PO Box 333, Newport NJ 08345
low cost health insurance

Highlights of PCIP

available regardless of medical history
requires six month waiting period without other coverage
premiums are subsidized by the federal government

Pre-existing Condition Insurance Plan logoPre-existing Condition Insurance Plan (PCIP)

PCIP was established by Section 1101 of the Affordable Care Act as a temporaryget a quote now  high risk health insurance program in all 50 States and the District of Columbia for uninsured people with pre-existing conditions. Twenty-seven states operate their own program, often in coordination with existing High Risk Pools, and 23 states and the District of Columbia have opted to have a Federally-operated program.

The federally administered Pre-Existing Condition Insurance Plan is available in Alabama, Arizona, Delaware, D.C. (District of Columbia), Florida, Georgia, Hawaii,
Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi,
Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Vermont,
Virginia, West Virginia and Wyoming. This plan offers coverage on a month-to-month basis until December 31, 2013.
low cost health insurance
Who is eligible?
This plan is offered to all individuals ages 0 through 64 who meet eligibility requirements.
This plan is available in AL, AZ, DE, DC, FL, GA, HI, ID, IN, KY, LA, MA, MN, MS, ND, NE, NV, SC, TN, TX, VT, VA, WV and WY.
low cost health insurance
About the Insurance Plan and Administrator
PCIP is provided through the U.S. Department of Health and Human Services and administered by GEHA in more than 20 states.
read more

News

February 23, 2012 - A 19 page annual report on the status of the PCIP is available online

Product Review

Overview

Many people who have been unable to get health insurance can now get coverage through the Pre-Existing Condition Insurance Plan (PCIP), created under the Affordable Care Act.

Choose the plan that fits your needs

PCIP enrollees can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays.

The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses.

Preventative Care

Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates a preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings.

Out-of-pocket Expenses

For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $6,050 in-network/$7,000 out-of-network. Benefits and limitations are summarized on the Summary of Benefits chart.

Standard Option: What you pay

PCIP-standard-benefits

Extended Option: What you pay

PCIP-what-you-pay          PCIP extended option

HSA Option: what you pay

PCIP what you pay          PCIP HSA option

The PCIP insurance plan does not come with a Health Savings Account but these are available at no additional charge through other Freedom Benefits affiliate partners. (Some HSAs charge a fee for optional expanded banking and investment services).

Maximum Benefits

There is no lifetime maximum or cap on the amount the plan pays for your care.

Eligibility

To be eligible for the Pre-Existing Condition Insurance Plan, you must be a citizen or national of the United States or residing in the U.S. legally, have been uninsured for at least the last six months, and have a pre-existing condition or have been denied coverage because of your health condition.

Pros

Covers the expense of pre-existing medical conditions immediately upon acceptance. The average benefits expected to be paid are over $29,000 per person in 2012.

Cons

Applicants must have been uninsured for six months prior to application.

Forms in PDF format for download

Summary of Benefits in PDF format

Annual report for 2012

Question and Answer Topics


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This web site is independently owned and managed by Tony Novak operating under the trademarks "Freedom Benefits", "OnlineAdviser" and "OnlineNavigator". Opinions expressed are the sole responsibility of the author and do not represent the opinion of any other person, company or entity mentioned. Tony Novak is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide uncompensated advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the commercial companies listed on this site. Information is from sources believed to be reliable but cannot be guaranteed.