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.

In a letter to governors, Secretary Sebelius laid out several options states will have to use $5 billion in the Patient Protection and Affordable Care Act to bridge the time from July 1, 2010 until January 1, 2014 when the insurance exchanges will be available.

Coverage will need to include at least a floor set of benefits established by the federal government.  Out-of-pocket costs are limited to $5,950 for an individual, and premiums cannot be set at more than the existing standard non-group rates.  There can be no exclusion for pre-existing conditions.

Governors were asked to respond with a letter of intent by April 30, 2010.  If a state does not want to participate in the program, the Department of Health and Human Services will provide the high risk pool services to needy individuals in that state.

In order to be eligible coverage through the high risk pools, individuals must,

• Be a citizen or national of the United States or lawfully present in the United States.
• Not have had credible coverage for the six months before applying for coverage.
• Have a pre-existing condition.  The Secretary will provide guidance as to what determines pre-existing conditions.

States will have the option to,

• Operate a new high risk pool alongside a current state high risk pool.
• In states without high risk pools, establish a new one.
• Build upon other existing programs designed to cover people with pre-existing conditions.
• Contract with a current HIPAA carrier of last resort or other carrier, to provide subsidized coverage for the eligible population, or
• Do nothing, in which case HHS would carry out a coverage program in the state.

Writing to governors, Secretary Sebelius stressed willingness to be flexible in getting the program off the ground.

In reviewing the existing state high risk pools, there is much common ground in the benefits currently provided. Since HHS is considering establishing a floor set of benefits that all the new high risk pool programs must cover, we anticipate that these benefit requirements would take into account benefit lists currently used by existing state high risk pools. Similarly, states would have the option to follow pre-existing condition criteria for determining eligibility established by the Secretary, or propose their own, subject to Secretarial approval. We are committed to working with states to identify other areas where flexibility is appropriate.