New Plan Options for Federally Administered Pre-Existing Condition Insurance Plan in 2011

The Department of Health and Human Services (HHS) announced new plan choices for people enrolling in the Pre-Existing Condition Insurance Plan (PCIP) for 2011.  These options will give current and future enrollees a greater number of coverage choices and allow people to select the plan that best meets their needs.  The new options will be offered in a three-tiered structure beginning January 1, 2011, and will be available in States where the program is federally administered through the Office of Personnel Management.  These choices build on the current single plan option: experience with the program has provided valuable information that has allowed for the creation of new and improved options. 

The federally administered program is available in 23 States and the District of Columbia.  To find out if your State’s PCIP is federally administered please visit http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html

PCIP provides Americans living with such conditions as cancer, diabetes, or heart disease the opportunity to obtain insurance coverage.  The program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market.  In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through a new competitive marketplace, and insurers will be prohibited from denying coverage to anyone based on the state of their health.

For more information about eligibility and benefits please visit www.pcip.gov.

Expanded Plan Options in 2011

In 2010, people enrolled in the federally-administered PCIP program were offered one plan.  Beginning in 2011, such enrollees in the federally administered PCIP program will be able to choose between three plan options:  the Standard Plan, the Extended Plan and the Health Savings Account eligible plan.  In addition, families will be able to enroll their eligible children in PCIP at child-only rates.  These options will allow enrollees to select a plan that best meets their needs.

2011 Standard Plan

The existing option in PCIP has been improved.  The 2010 Standard Plan had a single, combined medical and pharmacy deductible of $2,500.  The 2011 Standard Plan now has two separate deductibles -- a $2,000 medical deductible and $500 drug deductible, while also offering premiums that are almost 20% lower than the 2010 premiums.  The reduced pharmacy deductible is particularly beneficial for people who take one or more maintenance medications.  The lower premiums result from experience and are expected to be more affordable for the eligible population with pre-existing conditions.

2011 Extended Plan

A new plan option, called the Extended Plan, has a $1,000 medical deductible and $250 drug deductible plan.  The premiums for the 2011 Extended Plan will be slightly higher than 2010 premium levels.  Just as with the Standard Plan, separating the drug and medical deductibles makes this plan option more valuable for those enrollees who take one or more maintenance medications.

Health Savings Account Option

The Health Savings Account (HSA) Option will carry a $2,500 deductible but with premiums that are 16% less than 2010 premiums.  As with the current plan, this option is eligible to receive favorable tax treatment by the federal government when used with a Health Savings Account (HSA). 

Child-Only Rate

To ensure that children have more affordable access to coverage, HHS has established premiums targeted for covering children under PCIP, creating a child-only rate for PCIP enrollees between 0-18 years of age. 

Posted: November 5, 2010