Insurance for the Un-Insurable

One of the Patient Protection and Affordable Care Act’s (PPACA) most important changes to the health insurance system is its provision for Individuals who are unable to obtain private health insurance coverage because of pre-existing medical conditions. For the past 12 years in Texas, the High Risk Insurance Pool has served as a “safety net” for those excluded from regular coverage. This year, Texas had the option of adapting the high risk pool to follow new federal guidelines, but decided to opt out, allowing the U.S. Department of Health and Human Services to run the program instead.

The newly designed federal insurance pool, known as the Pre-Existing Conditions Insurance Plan (PCIP), will allow previously uninsured individuals to obtain insurance, and pay premium rates equal to standard market rates. Texas' high-risk pool costs consumers twice as much as the federal one, but there’s no switching of plans allowed—in order to qualify for the federal plan, one must have been uninsured for at least 6 months.

The “rolling implementation” of the PPACA means that by 2014, insurance companies will no longer be able to refuse coverage to those who have historically been considered uninsurable. Twenty-eight states are improving their health insurance systems to include a risk pool, and 22 other states (including Texas) are relying on the federal PCIP to serve as a “stop-gap safety net” for the next four years.

Beginning today, July 1, applications for the Pre-Existing Conditions Insurance Plan can be submitted, and those who enroll in the plan before July 15 can anticipate coverage beginning August 1. More information about the plan can be found at www.pcip.gov.

Sources: Austin American-Statesman, “Texans can apply for U.S. health insurance pool.”

Healthcare.gov