Pre-existing Condition Coverage

Pre-existing Condition Coverage Under New Health Reform Law

Pre-Existing ConditionAs of January 1, 2014, under the Patient Protection and Affordable Care Act, (the new health care reform law passed in March 2010), health insurance companies will no longer be allowed to refuse to sell coverage or renew policies for U.S. citizens (or individuals residing here legally) with pre-existing medical conditions, nor will they be able to charge these individuals higher rates for insurance premiums. The law also established the Pre-Existing Condition Insurance Plan (PCIP), as a temporary form of protection for individuals with pre-existing medical conditions until the Affordable Care Act stipulations go into effect in 2014.

As of July 2013, all state-run PCIP programs are shifting to the federally-run PCIP program, which creates a new healthcare coverage opportunity for people who have been uninsured for a minimum of six months, or have been denied health coverage as a result of their medical condition. PCIP will not cost individuals more to enroll in because of their pre-existing medical conditions, and will provide coverage for all major medical and prescription drug expenses; however, enrollees will be required to pay premiums, copayments, deductibles, and coinsurance costs. The PCIP program will be available until 2014, at which point the health reform law will take effect, and will prohibit insurance companies from refusing to insure people with pre-existing medical conditions.

Also beginning in 2014, individuals will be able to buy health insurance directly, in an online marketplace known as a “Health Insurance Exchange.” Exchanges will be state-based, and will serve as competitive insurance marketplaces where small businesses and individuals will be able to select and purchase affordable health insurance plans that meet certain federally-regulated benefits and cost standards.