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

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

State Program: In 27 states, a state or state-designated nonprofit organization runs PCIP.  Program requirements can vary by state, such as what application you must complete and what documents you need to submit with your application. Click on your state in the PCIP map above for information on plans, premiums, eligibility, and how to apply.

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.

• Visit PCIP.gov for information on plans, premiums, eligibility, and how to apply in your state.
• You can apply online or print and complete a paper application from the web site. Or, call 1-866-717-5826 (TTY 1-866-561-1604) to apply.

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 answers.healthcare.gov.

Posted on: July 1, 2010

Last Updated: April 13, 2012