Affordable Care Act (ACA) Pre-existing Condition Insurance Plan Changes

pills and stethoscopes scattered on money and medical reportsGetting health coverage for individuals with pre-existing conditions is now a lot easier—and  in some cases, more affordable—thanks to recent changes to the Pre-Existing Condition Insurance Plan (PCIP).  On May 31, 2011, the U.S. Department of Health and Human Services released new eligibility standards for the PCIP, created by the Affordable Care Act (ACA), that will go into effect on July 1, 2011.
“We’re very excited about this,” says Lee Page, Paralyzed Veterans of America associate advocacy director, noting that Paralyzed Veterans of America has been working on pre-existing conditions and related issues in various capacities for more than seven years.

“Getting rid of the lifetime cap [lifted January 1, 2011] was a major victory for individuals with spinal cord injury or disease—it was so easy to blow through a million dollars,” Page says. “Having pre-existing condition insurance is also huge, because so many people get disqualified—not just someone like myself, with a permanent disability, but those where smoking or alcohol or heart disease figures in.”

Already PCIP’s impact has been profound. Participants in the federally administered plan get primary and specialty care, hospital care, maternity care and preventive health care. Skilled nursing care, prescription drugs, home health and hospice care are also included.

When expanded standards go into effect, people will be able to prove eligibility simply by providing a letter from a doctor, physician assistant or nurse practitioner. It must be dated within the past 12 months and state that he or she currently has—or at any time in the past had—a medical condition, disability or illness. A previous age requirement that limited participation to children under 19 also has been lifted. Now, all U.S. citizens or legal U.S. residents can enroll—providing they have been without health coverage for at least six months. More details about the program are available at

Some current PCIP enrollees will see premiums fall by as much as 40 percent in some states. Letters that began mailing in early June will include the amount of their new premium effective July 1, 2011, and will explain what to do if they have paid future months’ premiums and need a credit adjustment. To view the current rate for a specific state, visit the “State Plans” section of

Created as a transition program to provide comprehensive health coverage at the same price healthy people pay, PCIP will by replaced in 2014 by a new competitive marketplace call an Exchange, which will offer affordable, qualified health insurance choices for individuals and small businesses. 

“Right now, the ACA’s pre-existing condition plan is breakthrough,” Pages notes. “But by 2014 all insurance policies across the board have to accept people, regardless of illness, condition or disability.”

Lee Fleming is a writer based in Washington, DC, whose articles appear in national publications and on the Web. 


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