Adults Living with Type 2

[ajsammycat]

Pre-Existing Condition Insurance Plan

From: http://www.pcip.gov/  (call center, M-F, 8 am – 11 pm ET, 1-866-717-5826; TTY: 1-866-561-1604)

This program is meant to provide people who have a pre-existing condition with comprehensive health coverage at the same price healthy people pay while receiving benefits at any qualified provider of their choice.  It was designed as a bridge until the new insurance rules go into effect in 2014, when all Americans will have access to health insurance.  Currently, 27 states administer their own plans for their residents while 23 plans are administered by the federal government.  Thus, no matter which state in which you reside, there is an option.

The following conditions must be met to be eligible for this program:

• · You must be a citizen or national of the United States or reside in the U.S. legally.
• · You must have been without health coverage for at least the last six months. Please note that if you currently have insurance coverage that doesn’t cover your medical condition or are enrolled in a state high risk pool, you are not eligible for the Pre-Existing Condition Insurance Plan.
• · You must have a pre-existing condition or have been denied coverage because of your health condition.

Income is NOT a factor in determining eligibility for these plans.  

Among the important benefits offered is prescription drug coverage – whether the plan is administered by your state government or the federal government. However, which drugs are allowed and the co-pay for the drugs differs from plan to plan. Check the federal database (https://pcip.gov/StatePlans.html) to see the different plans offered in the state in which you live.

If you live in a state with a federally-administered plan, please check this page (https://pcip.gov/Apply.html) for the application form. For people residing in places with state-administered plans, you will need to go to your state’s site to obtain the proper application forms (see https://pcip.gov/StatePlans.html).

All information is provided in both English and Spanish!

Remember, the main website is: www.pcip.gov.

A call center is available Monday – Friday, 8 AM – 11 PM Eastern Time:

1-866-717-5826

TTY: 1-866-561-1604

[annieO]

Thanks for posting this information.

I'm sure it will be a help to others.

AnnieO

[lizzylou Diabetes Brain Trust]

Thanks for the info. Angela.  I'll add this post to my resource listing.

Lizzy

[ajsammycat]

Annie,

You're welcome! I personally think it's important. Anyone who is self-employed, who works for a very small company that does not provide health insurance, who makes too much money for Medicaid and/or is too young for Medicare and who has been denied health insurance coverage could find this a viable option. I checked out the costs for a number of states, and it appears the premiums range from a low of $100/month to a high of over $1,000/month. Most seem to have a 20% co-pay on prescriptions, and a reasonable deductible to meet (that most diabetics would likely meet or exceed quite easily).

This is not additional insurance for those who have coverage, it's not meant for those whose condition has not yet been documented, it's not meant for the indigent. It's meant for US citizens with a documented condition who are working and can afford the premiums but who've been denied coverage because of their condition. Without a doubt, there are people with diabetes who do fit into this category!

Angela

[ajsammycat]

Lizzy,

You're welcome! Believe it or not, I found this information from a brochure at the CVS pharmacy right down the road from my house! When I saw it, I knew it was something that needed to be placed online for the DOC asap. Before yesterday, I hadn't realized this program was available. So, it's good news!

Angela

[lizzylou Diabetes Brain Trust]

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ajsammycat wrote:

Lizzy,

You're welcome! Believe it or not, I found this information from a brochure at the CVS pharmacy right down the road from my house! When I saw it, I knew it was something that needed to be placed online for the DOC asap. Before yesterday, I hadn't realized this program was available. So, it's good news!

Angela

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Did you post it on T1?  I haven't even had time to look.  Trisha will probably want to add it to her resources too.

I just linked right to your post, so that people can read the comments too.

Lizzy

[Brokendreamz]

I just checked into the Pre-Existing coverage plans, and it has been suspended. 

[deafmack]

Thanks Angela for posting this. I also found out through the newsletter from Integrated Diabetes by Gary Scheiner that Medicare will drop what they pay for glucose strips by two-thirds thus putting the extra cost on consumers. This change will take affect this July. And since insurance companies seem

to follow Medicare we can expect this to happen with insurance companies as well. This could well mean higher out of pocket costs for people with diabetes as well but that remains to be seen.

Gary did say that he found the store bran meters to meet the equivalents of the brand name meters though and set his requirments pretty high and suggested maybe shying away from the brand name meters if the cost became prohibitive. Although he did say that using a brand name meter may be the riight way to go if a person is using a pump.

[George_M]

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Brokendreamz wrote:

I just checked into the Pre-Existing coverage plans, and it has been suspended. 

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These are being suspended by the states, some states have suspended already, but they will all be suspended by March 2.  Didn't do what they told us it would do - last until 2014 - but it did last through the election.  Somehow, the news that they were suspending the programs was announced much more quietly than the original news that the programs would be available.

[debfish]

Just to clarify, those who are already enrolled will continue to get coverage.   They are not accepting any new enrollees.

Deb