Two Big Health Care Reform Implementation Deadlines Today: Establishment of High Risk Pool Plans and Launch of New HHS Insurance Web Portal

July 1 is a big day for implementation of the new health care reform law.  It is the deadline for establishment of the high risk pool plans now known as “New Pre-Existing Condition Insurance Plan (PCIP)” and also the deadline for the U.S. Department of Health and Human Services (HHS) to launch a new insurance web portal.

Register for C3′s upcoming webinar to learn more about the new health care reform law including: upcoming implementation deadlines; opportunities for advocates to get involved; and an explanation of how the law will affect the colorectal cancer community.

The new HHS web portal, HealthCare.Gov, includes a yellow-page like listing of health insurance plans.  By October, HHS would like to have more information available on the site for consumers – information about plan costs and coverage benefits as well as data about insurance claims (for example, the percent of claims denied and the percent of claim denials that have been appealed).

The New Pre-Existing Condition Insurance Plan (PCIP) is a stopgap fix for the most vulnerable until 2014, when core provisions of the new health care law take effect.  In order to enroll in the PCIP program an individual must meet the following eligibility requirements:

• Be a U.S. citizen or legal resident.
• Have a pre-existing medical condition.
• Been uninsured for six months or longer.

If the PCIP program in your state is run by HHS, you can apply to participate in the program online.  While individuals can apply for the HHS run Pre-Existing Condition Insurance Plan today, the premium rates won’t be officially available until July 15.

Premiums will vary from state to state.  If you live in a state where HHS provides coverage, the premium for an age 50 year old enrollee may range between $320 and $570.  In California, for example, the cost for a 50-year-old is estimated at $575 a month, with a $1,500 annual deductible and 15 percent co-insurance.  Premiums in states with lower medical costs could be around $400 a month.

If your state is one of the 30 states running its own Pre-Existing Condition Insurance Plan you can get information about eligibility requirements, premiums, and how to apply online.

Millions of Americans are have been denied insurance coverage because of a pre-existing medical condition, and experts estimate that the new PCIP program could enroll as many as 375,000 people this year, but run out of money around the end of 2011.  While Congress has already appropriated $5 billion to fund the PCIP program through 2013, the Congressional Budget Office estimates that another $5 billion to $10 billion will be needed to fully meet the enrollment demand and prevent the program from running out of money before the core provisions of the new health care law take effect in 2014.  It’s unclear what the Administration and Congress will do if the money runs out.

To make matters more confusing, most states already operate their own high risk insurance pools, covering about 200,000 people in total.  However, the state plans tend to charge significantly higher premiums than the new PCIP program, and many offer fewer benefits.  Individuals currently enrolled in a state high risk pool will not be able to switch from state to federal coverage (to switch to receive coverage through the PCIP program an individual would have to risk going six months without health insurance).

Register for C3′s upcoming webinar to learn more about the new health care reform law including: upcoming implementation deadlines; opportunities for advocates to get involved; and an explanation of how the law will affect the colorectal cancer community.