Health Reform’s Temporary High-Risk Pool Open For Business

Nearly 62,000 individuals nationwide had enrolled in the Pre-Existing Condition Insurance Plan (PCIP), the temporary high risk health insurance pool established under the Patient Protection and Affordable Care Act, in the first quarter of 2012, the Center For Consumer Information and Insurance Oversight (CCIIO) reported.

These numbers are not as impressive as supporters hoped they would be, however-- 5 million persons had been expected to enroll in the $5 billion program. To help more individuals with preexisting conditions sign up for the program, last year, the CCIIO reduced premiums in the PCIP by as much as 40 percent in 18 states and eased eligibility standards in the 23 states and the District of Columbia where the federal government administers the PCIP.

The PCIP is designed to provide health insurance coverage for individuals who have been uninsured for six months and who have been denied a policy because they have preexisting conditions, including employees in companies that do not provide health coverage. The program is administered by either the state or the federal government and 27 states have elected to administer their own. In the 23 and the District of Columbia states where the federal government runs the program, enrollment applications began to be accepted on July 1, 2010, with coverage beginning Aug. 1, 2010, at the earliest. The pool will run until Jan. 1, 2014, when state-based Affordable Insurance Exchanges are scheduled to begin operation.

Massachusetts and Vermont are guarantee issue states that have already implemented many of the broader market reforms included in the Affordable Care Act that take effect in 2014. Existing commercial plans offering guaranteed coverage at premiums comparable to PCIP are already available in both states, the CCIIO explained.

Premium costs and the six-month waiting period likely are obstacles to increased PCIP enrollment. For example, in Illinois, a state that runs its own PCIP, the following options are available:

Premium: $76 to $693 for a non-smoker, rates vary by region


Deductible: $500, $1000, $2,000, and $5,000


Out of Pocket Limit: $2,850 to $5,000 for medical depending on plan option, $0 to $1,600 for pharmacy depending on plan option, with a maximum out-of-pocket limit from $5,000 to $5,950 depending on plan option

The federal government’s HealthCare.gov website has a helpful feature that allows individuals to search for insurance options in their state and lists options for affordable health care services regardless of insurance-status. Awareness-raising would help.