Many Florida residents have found that obtaining health insurance coverage is a battle, particularly those who have pre-existing medical conditions. Insurers are less likely to issue policies to people when they know the patient will be in frequent need of medications and visits to their physician. There is a solution. Government sponsored insurance plans have been developed to assist those in need of medical coverage.
The insurance plans for pre-existing conditions provide significant coverage. There are three distinct plan options to choose from, depending on your specific medical needs. All of the plans provide, without a deductible, total coverage for preventative care. Flu shots, mammograms, annual physicals and screenings for cancer are considered preventative and are therefore included at no cost. One plan is called a health savings account, which allows participants to deposit money that is tax-exempt to cover medical expenses. For visits other than preventative care, a deductible must be reached before the Pre-Existing Condition Insurance Plan kicks in. The amount of your deductible depends on which PCIP has been chosen. Once the deductible has been reached, you pay 20% of the cost for care. There is no cap on how much the plan will pay over your lifetime for treatment, and the maximum amount you will be required to pay out of pocket cannot exceed $5950 per year for care in the network, or $7000 when care is provided out of the network.
Individuals must meet certain requirements to qualify for the PCIP coverage. If you are a legal resident who has not carried health insurance in the past six months, and you have been denied coverage due to your pre-existing condition, you may qualify. Your eligibility is not based on your income and you will not be subject to higher co-pays or monthly premiums simply because you have already been diagnosed with a chronic condition or are otherwise in poor health.
There are some costs associated with these plans. Depending on which plan you choose, monthly premiums vary. Standard plans for minors 18 and under begin around $118 per month, while senior citizens who enroll may pay as much as $375 in premiums monthly. The HSA (health savings account plan) starts as low as $122 a month but can run close to $400 per month for those over age 55. The third option is the plan that offers the most coverage. The extended plan offers the most coverage for most medical situations. Of course, coverage that is more complete equates to the highest premiums. In the case of this PCIP extended plan, that amounts to $158 per month for those 18 and under, while those over age 55 will pay a little over $500 each month for their coverage.
To qualify for a pre-existing medical condition plan, you must supply proof with your application. Acceptable items include a letter from a doctor, physician’s assistant or nurse practitioner, dated within the previous 12 months, verifying your medical condition. This document should also state the date your diagnosis was made, as well as the full name of the practitioner, date they were licensed to practice medicine, state they are licensed to practice in and their signature. Another form of proof that is acceptable is a letter from an insurance provider stating that you have been denied health insurance coverage due to your pre-existing medical condition. If you applied for health coverage individually, not through an employer, and you were offered a policy that explicitly excluded any care or coverage of your pre-existing condition, this too is acceptable proof on the PCIP application. To begin the process of applying for a PCIP plan, contact the U.S. Department of Health and Human Services, or call toll-free 1-866-717-5826, Monday through Friday, between the hours of 8am and 11pm.
Living with a pre-existing medical condition is stressful enough. Wondering how you’re going to afford to visit your doctor or purchase needed medication shouldn’t be. Now it won’t have to be. If your pre-existing condition has limited your options for care, consider a PCIP plan. Everyone deserves a chance to be healthy.