Apr 07 2011

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Uninsured Texans have a new option

If you’ve been unable to get private health insurance because of an illness or disability, you may now have an answer to your dilemma.
The Pre-Existing Condition Insurance Plan, created as part of last year’s Affordable Care Act, is making health care coverage available to people who couldn’t or afford it because they have a pre-existing medical condition.
As many as 7 million Americans, including 776,160 uninsured Texans with pre-existing conditions, may be eligible for the new insurance. The federal government and individual states are administering the PCIP’s, as they’re called.
The publicly funded PCIP program has been designed to help the uninsured until 2014, when the Affordable Care Act will begin requiring the private insurance industry to cover people despite their pre-existing illnesses or disabilities.
The new plans are an alternative to the high-risk pools that many states now offer to people locked out of the insurance market. The PCIP’s have lower premiums, and they require no waiting period for the coverage of pre-existing conditions.
The PCIP program will improve the health care of the previously uninsured, help them become more self-sufficient and ease the financial burden on the health care professionals and facilities that have had to provide uncompensated care.
If this new insurance program sounds intriguing, here’s what you’ll need to know to decide whether it’s the right fit for your individual needs.
Who’s eligible?
You need to meet three requirements: You must be a U.S. citizen or legal resident. You must have a pre-existing condition. And you must have been uninsured for at least the last six months. Your income isn’t a factor in determining eligibility.
What’s covered?
This is comprehensive coverage. A PCIP covers primary and specialty care, hospital stays, skilled nursing care, home health care and . And the coverage comes at the same price that healthy people pay for individual insurance policies.
You may choose from three coverage options in the federally administered plan in Texas: standard, extended and a health savings account, which is a tax-exempt account where you can make deposits to pay for medical expenses.
All three options provide preventive care, paid in full with no annual deductible, when you see an in-network physician. Included are annual physical exams, flu shots, routine mammograms and other cancer screenings.
What’s the cost?
In Texas, the standard option comes with a $2,000 deductible for in-network care and a $500 deductible for formulary . The monthly premium will range from $174 to $557, depending on your age. The extended option has lower deductibles ($1,000 for in-network care and $250 for formulary ) but higher premiums, from $234 to $749.
After your deductible, your out-of-pocket costs will be $25 for doctor visits and usually 20 percent of your other charges from in-network providers. Those costs will be higher if you go outside the network. Your yearly out-of-pocket maximum will be $5,950 for in-network care and $7,000 for out of network.
To find out more about these new insurance options available in Texas, visit the Pre-Existing Condition Insurance Plan’s website, at www.pcip.gov, and look at the side-by-side comparisons of both the coverage and the costs of the three choices.
How can you apply?
You can enroll by going to www.pcip.gov or by calling 1-866-717-5826 and requesting an application. Typically, you’ll need a denial letter from an insurance company for individual insurance coverage, or an offer of individual coverage that says your illness or disability won’t be covered if you purchase the policy.
Or you can submit a letter from an insurance agent or broker that shows you aren’t eligible for individual coverage because of your medical condition.
The Texas Consumer Health Assistance Program can answer any questions you have about applying to the Pre-Existing Condition Insurance Plan. Visit the program’s website, at www.texashealthoptions.com, or call 1-855-839-2427.
If you’ve thought you were out of options and out of luck because of a disability or illness, you owe it to yourself to consider this insurance. Assuming you’re eligible, your coverage will start several weeks after the PCIP has received your completed application and all required documents.

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