Pre-Existing Condition Insurance Plan (PCIP)

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.

The Pre-Existing Condition Insurance Plan makes health coverage available to you if you are a U.S. citizen or reside here legally, you have been denied health insurance because of a pre-existing condition, and you’ve been uninsured for at least six months.

• Benefits & Premium Rates
• State & Federal PCIP Programs: How to Apply

Benefits & Premium Rates

The PCIP program covers a broad range of health benefits, including:

• primary and specialty care,
• hospital care, and
• prescription drugs.  

All covered benefits are available to you, even to treat a pre-existing condition.

The program doesn’t charge you a higher premium just because of your medical condition, and eligibility is not based on income. Premiums vary by state.

State and Federal PCIP Coverage

Use the map above to see whether a state or federal program operates in your state.

State Program: In 27 states, a state or nonprofit organization runs PCIP, and program requirements can vary. To apply to the state-based PCIP in your hometown by March 2, 2013, click on that state in the PCIP map above to learn how.

Federal Program: The U.S. Department of Health and Human Services, with the help of the U.S. Office of Personnel Management and the U.S. Department of Agriculture’s National Finance Center, runs PCIP in 23 states and the District of Columbia. The Federal government contracts with a national insurance plan to administer benefits in those states. The website for people currently enrolled in the federally-run program is www.pciplan.com.

Posted on: July 1, 2010

Last updated: February 15, 2013