Pre-Existing Condition Insurance Plan: District of Columbia
Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide. We encourage you to visit http://finder.healthcare.gov to explore your other health care options.
Note: If you lost PCIP coverage during the past 6 months because you moved out of state, you may be eligible to re-enroll in PCIP in your new state of residence. Please call 1-866-717-5826 (TTY: 1-866-561-1604), Monday – Friday, 8 a.m. to 11 p.m. EST, if you believe you are eligible.
Why is PCIP enrollment being suspended?
PCIP is a temporary program for those locked out of the current insurance marketplace. The program has a limited amount of funding from Congress.
Based on program experience and trends since the start of the program, PCIP enrollees have serious and expensive illnesses with significant and immediate health care needs. More information can be found in the Annual Report on the Implementation and Operation of the PCIP Program at http://www.cciio.cms.gov/resources/files/pcip_annual_report_01312013.pdf.
This suspension will help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.
The Health Insurance Marketplace
Starting next year, the Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – will finally have access to quality, affordable coverage. People will be able to apply for affordable health insurance coverage choices in Health Insurance Marketplaces when open enrollment begins on October 1. The Health Insurance Marketplace will offer a choice of quality, affordable health plans. Coverage begins on January 1, 2014. Visit www.healthcare.gov/marketplace to learn more about the Marketplace.
To qualify for PCIP coverage:
- You must be a United States citizen or reside here legally.
- You must be without health coverage for at least the last six months before you apply.
- You must have a pre-existing condition or have been denied coverage because of your health condition.
PCIP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a pre-existing condition.
The monthly premiums for your state are:
|0 to 18||$148|
|19 to 34||$223|
|35 to 44||$266|
|45 to 54||$341|
In addition to your monthly premium, you will pay other costs. PCIP offers one plan to people enrolled in the program. The Standard Plan has a $2,000 annual deductible for covered medical benefits (except for preventive services) and a $500 drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 30% of the costs of any other covered benefits you get. For 2013, the maximum you will pay out-of-pocket for covered services in a calendar year when you use an in-network provider is $6,250. There is no lifetime maximum or cap on the amount the plan pays for your care.