The California Pre-Existing Condition Insurance Plan (PCIP) was set up under the new Federal health insurance reform law (PPACA). It’s supposed to go until 1/1/2014 at which time there will be no medical underwriting and all insurance companies must take everyone without regard to pre-existing medical conditions – i.e., you can transition to a standard plan. For someone close to age 65, enrolling on this plan would take him/her until he/she is eligible for Medicare which is currently “Guarantee Issue.” By the way, we can help people figure out their options for Medicare when the time comes and help them enroll in a Medicare supplemental policy.
Agents can’t represent the PCIP plan so we are very hesitant to give info and advice – please keep that in mind. This is a government program. Still I’ve looked through the info and here’s what we understand:
As an example the PCIP premium will cost someone age 60-64 in Los Angeles County $638/month. The benefits seem very rich: $1500 deductible with on out-of-pocket (OOP) maximum (the most you’ll pay in a calendar year) of $2,500/calendar year. The $2,500 includes the medical deductible and the $500 brand name prescription (Rx) deductible. This is amazing. No commercial product for individual or employers with fewer than 250 employees has an OOP max that includes brand Rx deductible and very few have such a low OOP max. Here is the PCIP description of benefits.
In order to be eligible for this plan one must have been declined for individual health insurance and can not have been enrolled in a health insurance plan for the preceding 6 months. Also a California health insurance company must have declined to offer you health insurance. If someone has a surgery pending as an example, that would be reason for an automatic decline from an insurance company. If you qualify for an individual plan we can assist with that. Just click here for a quote for a California individual medical insurance plan.
Another option for people with pre-existing conditions is the State of California Major Risk Medical Insurance Plan (MRMIP). This plan is funded with taxes on tobacco. Note the big notice on their web site: if you enroll in MRMIP it will prevent you from qualifying for the PCIP plan.
Here is a comparison of the PCIP and MRMIP plans. MRMIP has a lower deductible however it also has a $75,000 annual cap on benefits and a $750,000 lifetime cap. The PCIP plan doesn’t have that limitation. MRMIP is significantly more expensive. The monthly premium for someone between the age of 60-64 in Los Angeles would be $1424.40/month, or $17,093/year – that’s the price of a new car, which is unbelievable. Compare that to the PCIP price of $638/month and the PCIP plan seems to make more sense – if one qualifies.
May 2011
