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
Name: 
I had a torn meniscus about 6 years ago during high school and surgery 3 years ago during college and I recently graduated, and I have not had insurance coverage or a job for nearly 6 months since. the knee I had the arthroscopic surgery for is starting to bother me again, I believe it may have torn again, would it be considered as a pre-existing condition to insurance companies?
Hi Brad, you would need to apply for a health insurance plan and disclose your medical history. The insurance company would evaluate your medical history including the recent problems that you are having. It sounds like you’re concerned that you may need another surgery. Pending surgery is typically an automatic decline. If the insurance company declines to offer you an individual policy, you may be eligible for the PCIP plan. Give us a call if you would like to discuss and/or apply for coverage.
I have been paying for major risk insurancs for a chronic illness since approx. 1998. I am unable to work although I have not been certified as this by whoever is authorized to decide if it is impossible for a patient to work. I am in severe chronic pain, under a doctors care since the late 1990′s. At that time my rheumatologist threw up her hands & said you are in more pain than I know how to deal with; I;m sending you to pain management. I have seen an endocrinologist, rheumatolagist, internist, the general feeling is I have one or several autoimmune disorders. I am not going to live through 6 months without health are & medication, forget waiting for 2014. Are you an alternative for me? I am shaking while I write this, the idea of losing my insurance which affords me a quality of life of even the humblest sort. My husband would like to divorce me, which would be a good idea, it would improve my life, however he is not the type who would just leave me on the street. He is retiring at the end of September. I am 58 years old. He is 74. He’s had it being my care taker. My & my daughters medical and her university degrees which are paid, & we have no real retirement savings, so I;ll be broke & we will sell the house with a small amount of equity to add to his social security which I am entitled to part of I thin, or my own. Sorry to wander, I am in horrible pain and scared to death. Is there a program you have that would help me?
Thanks you sincerely!
Jerri
Jerri, I am so sorry to hear about your difficult position. From what you have explained, when your husband retires you will be eligible for health insurance coverage through COBRA or Cal-COBRA. Your husband can enroll in Medicare with a supplmental policy or he can enroll in a senior HMO (Medicare advantage plan.) You should consult your husband’s HR department to fully understand your options and premiums under COBRA or Cal-COBRA. As I understand that you are currently insured you would not be eligible for the PCIP plan because of their requirement that a person must have been uninsured for 6 months. Similarly, the MRMIP plan requires that an applicant have no other health insurance option and you would have COBRA or Cal-COBRA as an option. It seems that COBRA or Cal-COBRA is your best option. The pre-existing medical conditions you describe imply that you would likely be declined for a private individual plan. I hope that this information is helpful and I wish you the best of luck. Please call us if you feel that we can be of further assistance.