HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Condition

[okarol]

HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Insurance

The U.S. Department of Health and Human Services (HHS) today announced new steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan. Premiums for the Federally-administered Pre-Existing Condition Insurance Plan (PCIP) will drop as much as 40 percent in 18 States, and eligibility standards will be eased in 23 States and the District of Columbia to ensure more Americans with pre-existing conditions have access to affordable health insurance. The Pre-Existing Condition Insurance Plan was created under the Affordable Care Act and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.
 
To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program.  HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied.
 
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 new competitive marketplaces called Exchanges, and insurers will be prohibited from charging more or denying coverage to anyone based on their health status.
 
For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit www.pcip.gov and click on “Find Your State.”  Then select your State from a map of the United States or from the drop-down menu.
 
To find a chart showing changes to PCIP premiums in the States with Federally-administered PCIP programs, visit www.HealthCare.gov/news/factsheets/pcip05312011a.html.
 
The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time.  Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).
 
A HHS press release regarding the PCIP changes can be found here: http://www.hhs.gov/news/
 

[lmunchkin]

What about Cobra.  When it ends, can we keep it going, Okarol?  This is my biggest concern!!!!

lmunchkin   

[Bill Peckham]

What about Cobra.  When it ends, can we keep it going, Okarol?  This is my biggest concern!!!!

lmunchkin   

The question is how does the insurance available through the exchange compare to insurance available through COBRA? I'd love to hear if you look into it - my COBRA is pretty expensive so since I qualify for premium support the exchange would be a lot cheaper, though I don't know how the terms of the two plans compare, (and since I am Medicare Primary I don't think I can join an Exchange).

[plugger]

HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Insurance


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.
 

Private health insurance is great!   - until they actually have to pay for something.  I was glad to see Vermont at least is moving towards a sane system:

http://uprisingradio.org/home/?p=21203

[Zach]

Corrected:  Individual COBRA from a good plan with small deductions may cost around $600.00 per month.

Here is an example of costs of the HHS-run plan in Florida:
Pre-Existing Condition Insurance Plan for individuals: Florida
Age   Standard Option   Extended Option   HSA Option
0 to 18    $118                $158                 $122
19 to 34   $176                $237                $183
35 to 44   $211                $284                $220
45 to 54   $270                $363                $280
55+         $376                $505                $390

In addition to your monthly premium, you will pay other costs. In 2011, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate 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 out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

http://www.healthcare.gov/law/provisions/preexisting/states/fl.html
~~~~~~~~~~
With those high initial deductiables, I'm not sure these rate are very affordable.

[Meinuk]

Always beware the fine print!  My heels came to a screeching halt when I read about the NY State "Bridge" Program:

http://www.ghi.com/nybridgeplan/faq.html

Eligible applicants will be notified in the order that their applications are received. For completed applications received and approved by the 15th of the month, coverage will be effective the first day of the next month. For those received after the 15th, coverage will be effective the first day of the month after the following month. For example, for applications approved by October 15, coverage will be effective November 1. For applications approved after October 15, coverage will be effective December 1. If the NY Bridge Plan reaches capacity, a waiting list will be established.[/b]

So, my next question is, what is the capacity?  Where is that published?

[okarol]

We have been paying a COBRA payment of $2100 a month - for 10 years! It's the only way we can keep private insurance since my husband became disabled.

[lmunchkin]

The thing is we have been paying Cobra since Jan. of this year. $1200 per month for me and husband.  He also has Medicare primary.  But it's my understanding that Cobra is only good for 18mths.  I can't work full time to get insurance through employer and quite frankly, it is a Major Medical policy with very high Deductible and out of pocket.  It doesnt have alot of employees and employer is paying out the Kazoo in premiums.

I have always been covered under husbands group since we married in 1994.  Now that he has stopped we picked up Cobra. Im not only concerned for myself, but very concerned for the costs of the dialysis.  It can totally wipe us out! That is a frighting thing! 

We have yet to recieve the first Disablity check. It will start in August, Lord, I do not understand that AT ALL!!!!

Here I go, working myself into a tissy!

How do I get Cobra for 10 years?  Are the laws different in each state?

lmunchkin   

[Bill Peckham]

Wowsa!


Once you're paying >$6,000/year the exchange looks good. Zach I think the high deductible policies are HSA (Health Savings Accounts). I think someone with ongoing medical needs should not choose a HSA so that leaves the better version of a policy in the pool, I think when the Exchanges come online there will be three policy levels and from what I'm hearing the platinum option would be vastly cheaper and offer better coverage (for a lot of people) then what's available through COBRA.


@Anna all these state programs had limited funding but since some states are not taking advantage of the money available it means there is more money for the states that are. Once you're in, you get to stay in (until 2014 when the exchanges open to all comers).

[okarol]

It's an extension of the COBRA that was offered to keep the preferred insurance (I can't remember what it is called.) With my husband unable to work and with his and Jenna's health issues, we do not dare let the insurance lapse. But it sure would be nice to have that money!

[Meinuk]

My point in posting was that sadly one must look a gift horse in the mouth.  "Gap" insurance is wonderful in theory, but if you are starting dialysis and need to use it in NY State, it would be nice to know your chances of actually getting it.  All of the publicity is that it is universal if you meet certain criteria.  This builds false hopes and expectations.  Imagine signing up the month before you start dialysis, and then finding out that you have been "Wait Listed".  There needs to be transparency in all of this.

As it stands now, with the chance of being put on a waiting list, you can't rely on having insurance.  It is like the lottery, I would like to see them publish the odds - not just a buried line in a FAQ "If the NY Bridge Plan reaches capacity, a waiting list will be established."

These nuances that can be crippling are like the bill sitting in congress for immunosuppresives.  The bill was written to pay for immunosuppresives ONLY, and most of the patients lobbying did not understand that they were simply lobbying for Medicare to pay for Prograf, Cellcept and their cohorts. If that bill had passed, people with transplants would have had access to overpriced immunosuppresives (and big pharma would have had the cash rolling in) but the people taking the immunosuppresives would have been saddled with no insurance coverage for blood tests, doctor visits or any other physical followup for their transplants.

It is in the details and loopholes that a system is corrupted.  Look at what has happened with dialysis since the 1980's.  I am jaded, cynical and I have little faith in what is being presented to us - at least here in NY State.