U.S. Department of Health and Human Services Rolls Out Health Care Plan for Pre-Existing Conditions

In March 2010, President Obama signed the Affordable Care Act that included the most sweeping health care reform provisions in decades. One of the most significant changes to health care under the new law is how insurance companies cover pre-existing conditions. Beginning in 2014, health care insurance companies will no longer be able to deny people medical insurance coverage based on pre-existing conditions.

The 2010 Affordable Care Act provides a way for people who have been denied health care insurance based on pre-existing conditions, to get health care insurance on the pre-existing condition between now and 2014. The new program managed by the U.S. Department of Health and Human Services is called the Pre-Existing Condition Insurance Plan (PCIP) and is now offered in all states.

According to a 2006 study by the Government Accountability Office as reported at National Affairs, as many as 4 million Americans have a medical condition that might affect their ability to get health care coverage. Four years ago, when my husband changed jobs, he was denied medical coverage for two years on any health care provided for his neck and spine because he had C4/C5 fusion surgery the year before. The surgery cost $30,000 and the doctors told him because of degeneration, he would probably need another surgery within 3 years. Fortunately for us, we made it through the two-year denial period before he needed the next surgery, but for others, that health care coverage denial is devastating.

A pre-existing condition is defined under the new law as a physical or mental condition, disability or illness that you had before you enrolled in a health plan. The eligibility requirements for the Pre-Existing Condition Insurance Plan vary, but at minimum:

You must have been without health care insurance for at least six months, including not using COBRA.

You must have a qualifying pre-existing medical condition.

You must be a U.S. citizen or legal resident.

You must provide evidence that a health care insurance company denied you health care benefits because of a preexisting condition, or denied you coverage for that specific pre-existing condition.

You must provide a letter from your doctor certifying that you have the pre-existing condition for which you were denied health care insurance.

The U.S. Department of Health and Human Services offers more information about the new Pre-Existing Condition Insurance Plan at HealthCare.gov The PCIP program is administered differently by each state. PCIP information for each state can be found here. You can also call 1-866-717-5826 (TTY 1-866-561-1604) for more information about PCIP in your state.