Pre-Existing Condition Insurance Plan (PCIP)

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
• For More Information

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 will vary depending on the state you live in and the plan you choose.  But as an example, if you live in a state where the U.S. Department of Health and Human Services provides coverage, the premium for a 50-year-old enrollee may range from $214 to $559, depending on state of residence and plan option.  Medical and drug deductibles vary by plan option.  For an estimated premium range where you live, use the map above.

How to Apply for PCIP Coverage

State-Run Programs: There are 27 states that run their own programs. Use the map above to determine whether your state runs its own program. Click on your state to learn more and apply. These programs vary by state and each state may use different methods to determine the following:

• eligibility requirements,
• whether you have a pre-existing condition, and
• whether you have been denied insurance coverage. 

If you live in a state that guarantees insurance coverage, the state may consider you to have been denied coverage if you were offered coverage at an unreasonable price or you have a medical condition.

If you were offered coverage at an unreasonable price or you have a medical condition, your state – if it guarantees insurance coverage – may consider you to have been denied coverage.

Federally-Run Programs: The U.S. Department of Health and Human Services runs the Pre-Existing Condition Insurance Plan in 23 states and the District of Columbia.  Visit PCIP.gov to find detailed pricing, premium and eligibility information.

You can apply online or print and complete a paper application. You can also call 1-866-717-5826 (TTY 1-866-561-1604) to apply.

To apply, you will need to provide a copy of one of the following documents:

• A letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that you have or had a medical condition, disability, or illness. This letter must include:
  • your name
  • medical condition, disability, or illness
  • doctor, physician assistant, or nurse practitioner’s name, license number, state of licensure, and signature
• A denial letter from an insurance company licensed in your state for individual insurance coverage that is dated within the past 12 months, OR a letter dated in the past 12 months from an insurance agent or broker licensed in your state that shows you aren’t eligible for individual insurance coverage from one or more insurance companies because of your medical condition.
• An offer of individual insurance coverage that you did not accept from an insurance company licensed in your state that is dated within the past 12 months. This offer of coverage has a rider that says your medical condition won’t be covered if you accept the offer.
• If you are under age 19 OR if you live in Massachusetts or Vermont, an offer of individual insurance coverage that you did not accept from an insurance company licensed in your state that is dated within the past 12 months. This offer of coverage shows a premium that is at least twice as much as the Pre-Existing Condition Plan premium for the Standard Option in your state.

For More Information

• PCIP: Frequently Asked Questions.
• Find detailed technical and regulatory information on the PCIP.
• HealthCare Blog: Covering More Uninsured Americans Who Have Pre-Existing Conditions.
• Fact Sheet: About the New Pre-Existing Condition Insurance Plan.
• Patient’s Bill of Rights: Learn about other consumer protections in the health care law.
• Use our interactive FAQ tool to find answers to PCIP-related questions or ask your own at at answers.healthcare.gov.

Posted on: July 1, 2010

Last Updated: January 25, 2012