Pre-Existing Conditions Plans (PCIP)

[Inchlingblue]

I didn't realize that part of the federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act calls for establishing bridge plans for people with pre-existing conditions so that they can have insurance until the rest of the law comes into effect in 2014.

This is great!  This link has all the pertinent information about how to find out more as well as a story about a man who had a kidney transplant and has to take meds that cost about as much as an average ARV combo:

http://www.nytimes.com/2011/03/19/health/19patient.html?ref=health

[Inchlingblue]

I knew there had to be a catch:


You must be uninsured for at least six months to be eligible for a plan. That means people already enrolled in state high-risk pools or private insurance cannot apply, even if the new plans would be far less expensive. Unemployed people who are on Cobra or whose benefits have only recently expired are also not eligible.

Why is it that these things have to make it so difficult for those of us with chronic conditions? So you have to go without insurance, find a way to access meds for SIX MONTHS and then you qualify. Gee, thanks!

And more hoops to jump:

To qualify for a federally run plan, you will need proof that you have applied for individual insurance and that a carrier denied you coverage because of a pre-existing condition, or proof that a carrier approved coverage but with a rider that excluded payment for your pre-existing condition.

Do you also have to recite all of Shakespeare backwards while standing on your head making a souffle? The whole time not receiving the medications that mean the difference between staying healthy and dying.

[DanMo]

Sometimes I HATE living in the United States.

I thoroughly believe that democracy is DEAD in the US. What we have now is an plutocracy, "rule of the rich". Our "representatives" in Congress care more about lining the pockets of the corporations who pay for their campaigns, than the welfare of the common person.

If you notice, those catches are designed to make it easier on the Insurance Companies rather than make it easier for people to get insurance.

Although I will concede that the ACA is a huge step forward. Can't wait and see how things will be when the Law is FULLY implemented in 2014.

Dan

P.S. I still think the Dems are a bunch of wussies for not charging through with a "public option".

[Inchlingblue]

You make a lot of good points Dan.

The thing about those particular catches is I don't even think they benefit insurance companies. These PCIP policies are subsidized by Federal money.

It should be enough that a person shows they have a pre-existing condition based on their medical records, period.

If they want to take it a step further and make people show a letter of rejection from an insurance company, fine. But what I don't get is the screwed up logic of making people then go SIX MONTHS without insurance! We're talking people with pre-existing conditions; these are precisely the most vulnerable people who should not go without insurance for even a day let alone six months.

I'd be curious to know what is the "reasoning" behind making people go uninsured for 6 months before they're eligible for a PCIP?

When making such rules do they factor in that apart from being ethically questionable it makes no financial sense? It will cost a lot more in the long run when those people who have not actually died after waiting six months will likely have more medical complications that will have to be dealt with?

[DanMo]

I also find it ridiculous. It makes no sense whatsoever; it's bureaucracy at it's most horrible. It's incompetence and a general lack of understanding the issues which they legislate.

A simple rejection from an insurance company should suffice. I don't understand the reasoning behind it at all.

Dan

[cardsfan69]

I looked into those PCIP plans. I even applied for health insurance so i could get a denial letter from Aetna. Then I looked at the application for the PCIP plan and the details and found out there is a 2500 buck deductible......350/month premium....... plus for brand name drugs they only pay 50percent of it. Screw that! I'm enrolled in ADAP (even though i hate the jumping thru hoops to get it) but I'll continue to jump thru the hoops before i can afford to pay all that so i can have health insurance. I sure hope in a couple of years when the full health care plan has kicked in those prices and co-pays have changed!

[Inchlingblue]

I looked into those PCIP plans. I even applied for health insurance so i could get a denial letter from Aetna. Then I looked at the application for the PCIP plan and the details and found out there is a 2500 buck deductible......350/month premium....... plus for brand name drugs they only pay 50percent of it. Screw that! I'm enrolled in ADAP (even though i hate the jumping thru hoops to get it) but I'll continue to jump thru the hoops before i can afford to pay all that so i can have health insurance. I sure hope in a couple of years when the full health care plan has kicked in those prices and co-pays have changed!

The whole thing is so ridiculous. I think the people who come up with the legislation aren't in touch with the financial realities of the average person.

[Dachshund]

I'm on ADAP and work full time without health insurance. I read the federal plans (no state plan) and doubt that I could afford it. It does state that there is a cap of about 5k that one would have to pay out of pocket in a year. What worries me is that cash strapped states that don't offer a plan will force people like me into the federally mandated plans. I doubt very few people with a pre-existing condition could afford it. The shared cost of my meds alone would be too difficult. Is there anyone out there using one of these plans?

[denb45]

The whole thing is so ridiculous. I think the people who come up with the legislation aren't in touch with the financial realities of the average person.

They aren't in that class of the average person, so they really don't care, they're are simply just going thur the montions, if they don't do this no-body will vote or even re-elected them  the only thing that most
legislators are in-touch with is there own pocket book 

[DanMo]

They aren't in that class of the average person, so they really don't care, they're are simply just going thur the montions, if they don't do this no-body will vote or even re-elected them  the only thing that most
legislators are in-touch with is there own pocket book 

As my dad says, "ˇSon un montón de ladrones!" (They're a bunch of thieves!) LOL 

Dan

[Hellraiser]

I'm on ADAP and work full time without health insurance. I read the federal plans (no state plan) and doubt that I could afford it. It does state that there is a cap of about 5k that one would have to pay out of pocket in a year. What worries me is that cash strapped states that don't offer a plan will force people like me into the federally mandated plans. I doubt very few people with a pre-existing condition could afford it. The shared cost of my meds alone would be too difficult. Is there anyone out there using one of these plans?

Is moving to another state an option?  I know I've been considering it myself.  After the waiting list for LA ADAP has gotten to nearly 1000 people with no movement I've been a little scared of attempting to go back to school and utilizing my ADAP instead of my health insurance and then having the ADAP rug pulled out from under me.

[denb45]

Is moving to another state an option?  I know I've been considering it myself.  After the waiting list for LA ADAP has gotten to nearly 1000 people with no movement I've been a little scared of attempting to go back to school and utilizing my ADAP instead of my health insurance and then having the ADAP rug pulled out from under me.

Yeah, that could very well end being a reality 

[Dachshund]

Is moving to another state an option?  I know I've been considering it myself.  After the waiting list for LA ADAP has gotten to nearly 1000 people with no movement I've been a little scared of attempting to go back to school and utilizing my ADAP instead of my health insurance and then having the ADAP rug pulled out from under me.

I think it's healthcare.gov where you can see states that have their own plan versus states that have opted out and the federal gov. offers their plan. I'd be more than happy to pay for insurance if it was anywhere close to feasible, but AIDS treatment is just so expensive.

http://www.healthcare.gov/