HHS to Reduce Premiums
WI Staff Report | 6/8/2011, 11:29 p.m.
Buying Health Insurance to Become Easier for Some Residents
The U.S. Department of Health and Human Services (HHS) today announced new steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan (PCIP) in District of Columbia. PCIP is a new program created by the Affordable Care Act to help uninsured people with a pre-existing condition get high quality care at affordable prices and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.
"The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives," said HHS Secretary Kathleen Sebelius. "We need to reach more people and these changes help us do that."
Premium prices in District of Columbia for PCIP dropped by 18.3%. Now a 50 year old in District of Columbia can get comprehensive health coverage for as low as $324 per month. These new, reduced premiums take effect July 1, 2011.
Not only has PCIP coverage become even more affordable, but enrolling is even easier. Starting July 1, 2011, residents of District of Columbia applying for coverage in the Federally-administered PCIP can prove their pre-existing condition simply by providing a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness. This option became available to children under age 19 in February, and we are extending this pathway to all applicants regardless of age. Applicants will no longer have to wait on an insurance company to send them a denial letter. Applicants will still need to meet other eligibility criteria.
"These changes will get more Washingtonians covered," said Steven Larsen, the Director of the Center for Consumer Information and Insurance Oversight. "We're encouraged by recent increases in enrollment and we're excited to build on these efforts and reach even more people."
PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care. It limits annual out-of-pocket spending and does not carve out benefits the people need. Washingtonians enrolled in PCIP have access to a provider network that includes 3,025 physicians, 129 pharmacies and 12 hospitals throughout the State.
To qualify for this program, a person applying for coverage must be: a U.S. citizen or residing here legally; have been without health coverage for at least 6 months before applying; and have a pre-existing condition or have been denied coverage because of a health condition. Eligibility is not based on income and enrollees are not charged a higher premium because of a medical condition.
To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but un-enrolled. Several States have experimented with such payments with good success. This is a part of continuing HHS outreach efforts with States, insurers, providers, and agents and brokers to reach more eligible people and let them know that coverage is available. HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied
To find a chart showing changes to PCIP premiums in the States with Federally-administered PCIP programs, visit www.HealthCare.gov/news/factsheets/pcip05312011a.html.
For more information, including eligibility, plan benefits and rates, and how to apply, visit www.pcip.govand click on "Find Your State." Then select District of Columbia from a map of the United States or from the drop-down menu. The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).