Pre-Existing Condition Insurance Plan: Maine
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.
Eligible residents of Maine can apply for coverage through the state’s Pre-Existing Condition Insurance Plan program run by Dirigo Health Agency.
To qualify for coverage:
- You must be a citizen or national of the United States or residing in the United States legally.
- You must have been uninsured 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.
The Pre-Existing Condition Insurance Plan will cover 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.
|0 to 18||$201|
|19 to 34||$300|
|35 to 44||$360|
|45 to 54||$461|
In addition to your monthly premium, you will pay other costs. In 2013, you will pay 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 20% of the costs of any other covered benefits you get. Your combined out-of-pocket costs for in-network and out-of-network covered services cannot be more than $7,000 per year. The maximum is even less if you use only in-network providers.
To contact this program, please call 1-877 892-8391 (TTY: 207-287-4344) or visit http://www.dirigohealth.maine.gov/Pages/pre_exist.html.