Premiums Reduced for Pre-Existing Condition Insurance Plan
This week, the Department of Health and Human Services (HHS) announced it will reduce premiums and ease eligibility rules for federally administered Pre-Existing Condition Insurance Plan (PCIP) programs. The federal government operates PCIP programs in 23 states and Washington, D.C. Premiums will drop by as much as 40 percent in 18 states so that they more closely align with rates in the private market, a change that reflects policies in the other six states with federally administered PCIP programs. HHS is also easing eligibility rules. Starting on July 1, 2011, patients can provide letters from doctors dated within the past year as proof of a pre-existing condition rather than obtaining a denial letter from an insurance company, as is the current policy. However, individuals must still meet other eligibility criteria, such as the requirement that they be without insurance for at least six months and be a legal resident or citizen of the United States. In addition, HHS sent information to the 27 states that currently operate their own PCIPs to encourage them to adopt similar measures. The changes in rules are intended to make insurance through the programs available to more people.
The PCIP was enacted by the Affordable Care Act (ACA) as a temporary insurance bridge for individuals who are unable to obtain insurance because of a pre-existing condition. Beginning in 2014, insurers will no longer be allowed to deny people coverage based on pre-existing conditions, and this population and others will be able to obtain insurance through the expansion of Medicaid programs and the establishment of insurance exchanges. The PCIP is an important option for people with disabilities, who must wait 24 months after being determined disabled by Social Security before they are able to access Medicare. Many individuals in the 24-month waiting period are unable to obtain insurance because many insurance companies will not provide coverage to them as a result of their conditions, and because the coverage options that are available come at a high cost.
Read the HHS press release on changes to PCIP.
Read more about the changes to federally administered PCIPs.
Learn more about PCIPs and eligibility rules.
Consumers with Extra Help Can Switch to a Zero-Premium Plan at Any Time
This past week, the Centers for Medicare & Medicaid Services (CMS) sent its annual notice to individuals enrolled in the prescription drug Low-Income Subsidy (LIS) program, reminding them that they can switch to a lower-cost plan in their area at any time.
LIS, also known as Extra Help, is a federal program that helps eligible individuals with limited income and resources pay for drug costs under the Medicare prescription drug benefit. The government sets a benchmark premium amount annually, and LIS will pay for enrollees’ premiums up to that amount. Some people with LIS choose to enroll in plans with premiums over the benchmark amount and, as a result, pay the difference between the plan premium and the benchmark premium. Individuals with LIS are not limited to changing plans during the Fall Open Enrollment Period and therefore always have the option to change to a lower-cost plan.
The notice was sent to nearly 950,000 individuals across the country who have LIS, and who currently pay premiums. The notice was tailored by region to include the names and contact information for plans that would require $0 premiums.
Read the CMS notices.
Find out if you are eligible for LIS.
Read more about LIS on the Social Security website.
If you have been diagnosed with End-Stage Renal Disease (ESRD) and are getting dialysis treatments or have had a kidney transplant, you are eligible for Medicare. Enrollment depends on your condition.
Learn more about how your condition affects enrollment.
When you get Medicare because of ESRD, there is a period of time when your employer group health plan will pay first and Medicare will pay second. This is called the 30-month coordination period, and it starts when you first qualify for Medicare coverage, even if you haven’t signed up for it yet.
At the end of the 30-month coordination period, Medicare will pay first for all Medicare-covered services and your employer group health plan will pay second. (Your employer group health plan may also pay for services not covered by Medicare. Call your benefits administrator to find out.)
Learn more about how to enroll in Medicare if you have ESRD at www.MedicareInteractive.org.
A free health reform webinar is now available on Medicare Rights University. The webinar features Medicare Rights Center President Joe Baker, and covers improvements to the Medicare prescription drug benefit, the expansion of Medicare-covered services, changes to Medicare Advantage plans and much more.
Watch the webinar.