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I know you're out there. People with pre-existing conditions without any coverage who think they can't get health insurance. Because whenever I write a diary like this, at least a few people tell me they weren't aware of the information you're about to read.

You probably already know that starting in January, 2014, one year hence, Obamacare will forbid health insurers from denying you insurance or making you pay more than anyone else, and you might get subsidies to help pay for the insurance if you qualify.

But there are people who can't wait one more year. And for those people who aren't already aware that you can obtain health insurance RIGHT NOW at a price no higher than the average person in your state pays, this diary is for you.

It's pretty easy, as government programs go.

If you or someone you know

  • hasn't had insurance coverage for six months (or are paying through the nose because of your pre-existing condition), AND
  • are legally entitled to be in the United States, AND
  • has a pre-existing condition

You are almost certainly eligible for the Pre-Existing Condition Insurance Plan, aka the PCIP.

You may also need either

  • a denial letter or a letter stating your aren't eligible for insurance from an insurance company within the last 12 months, OR
  • an offer for insurance that you turned down because it had a rider that said your condition would not be covered.
(If you don't have one of these you can probably obtain one by applying for health insurance, since they will turn you down because of your pre-existing condition).

One you apply to the PCIP program and are accepted, coverage begins the 1st of the next month. There is no waiting period. In theory you could have coverage for eleven months this year if you apply soon.

How much is it going to cost?

That depends on the state you live in. Some states have PCIP programs run by the Federal Government, and some have PCIP programs set up by state officials. Generally the ones run by the Federal Government seem less expensive. Some examples:

These two examples are Federally run PCIP programs:

In Florida:

If you're 50 years old, it will cost you $311/month, with a $2000 medical deductible and a $500 drug deductible. Your maximum out-of-pocket is $7000 and it says it is less if you use only in-network services.

In Minnesota:

A 50 year old pays only $224/month with the same deductibles and out-of-pocket limits as described above.

These two examples are State run PCIP programs:

In California

If you're 50 years old and live in San Francisco, premiums are $428/month with a $1500 in-network medical deductible and a $500 in-network drug deductible and a $2500 maximum out-of-pocket in-network.

In North Carolina

Premiums run from $69/month to $658/month depending on plan chosen, age and geographic region of the state. Depending on the plan, deductibles range from $1000 to $4500, and the out of pocket maximum is $5950.

No matter how high or low the premium,  that amount of money plus the deductibles and out-of-pocket can be an unjumpable hurdle for some. For others, though, who could not possibly afford, say, $100,000 for treatment over the next year, but could scrape together $5,000 or $10,000, it could be a lifesaver.


The PCIP program, put in place as part of the PPACA (aka ObamaCare), began in August, 2010 amidst fears it would be flooded with applicants and run out of its $5,000,0000,000 allocation before its scheduled end on January 1, 2014.  Instead, far fewer people than expected applied, so many fewer that premiums were reduced and eligibility requirements, to the extent allowed by law, were eased at the beginning of 2011.

Even so, enrollment never met expectations. More than 300,000 people were projected to be enrolled in the program, but at the end of August, 2012, only 86,000 were. The Federal Government pretty much gave up at some point after that attempting to publicize the program, and there are very few articles that have been written about the PCIP in these last several months.

Which means there's still plenty of room for anyone who qualifies and applies.

Might this help someone you know?

Think about if someone you know needs health insurance and may not be aware of this program. If so, Tell them to start here,, or, in a state using a Federal PCIP program they can apply by phone (1-866-717-5826).


Note: It used to be the case that you could be eligible for the PCIP program, at least in some states, if you already had insurance but it was outrageously expensive. This seems to have changed some time in the last year.  Not sure why or when.

Originally posted to jpmassar on Tue Jan 01, 2013 at 10:21 AM PST.

Also republished by Progressive Policy Zone, Single Payer: The Fight for Medicare for All, Healthcare Reform - We've Only Just Begun, Dailykos Kossacks For Action, and KosAbility.

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