One of the most important changes that will take place with the passage of the Patient Protection and Affordable Care Act (PPACA) is the mandate that people will no longer be denied insurance coverage because they have pre-existing medical conditions, according to HealthCare.gov, a federal government website managed by the U.S. Department of Health and Human Services. Before the health care law was enacted, many consumers were frustrated with private insurance companies denying coverage to people with pre-existing conditions or excluding pre-existing conditions from coverage. This, in addition to the consumer outcry over some insurance companies dropping sick people who desperately needed coverage, also led to important changes outlined in the Affordable Care Act.
This mandate that prohibits insurance companies from denying coverage to people with pre-existing conditions will go into effect in 2014. In the meanwhile, a program called the Pre-Existing Condition Insurance Plan (PCIP) will temporarily cover uninsured Americans and legal residents with pre-existing conditions until the 2014 provisions of the Affordable Care Act are completely rolled out.
Pre-Existing Condition Insurance Plan
Under the Pre-Existing Condition Insurance Plan, U.S. citizens and legal residents have access to health insurance coverage if they have been denied coverage for a pre-existing condition and have been uninsured for a minimum of six months, according to HealthCare.gov. Health insurance under the PCIP will provide coverage for primary and specialty care, hospital care, and prescription drugs. However, the plan is delivered differently depending on the state you live in, with states like Texas, Florida, and Massachusetts offering a federal program, and states like California, Colorado, and North Carolina offering a state program.
Another perk of the program is that the insurance coverage offered through the PCIP does not come as a result of paying a higher premium, and a person’s income level will not affect their eligibility, HealthCare.gov explains. In the past, with private insurance companies, pre-existing conditions meant that Americans who did not receive health insurance through their employer had few options. They could either pay an extremely high premium to have their pre-existing condition covered, accept health insurance that did not cover their pre-existing condition, or be refused coverage altogether.
Those Who Do Not Qualify for PCIP
While the PCIP will help many uninsured Americans who cannot find coverage for their pre-existing conditions, the plan does not extend to individuals who currently receive health coverage through their employer and whose pre-existing conditions are not covered. To qualify for the PCIP, a person must be without insurance coverage for at least six months; therefore, those who are currently insured are not eligible even if they have a health condition that is not covered. Similarly, those who are covered under COBRA or any other individual insurance plan will not be eligible. These individuals have little recourse until the full provisions of the Affordable Care Act are rolled out in 2014.