Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

Health Care Coverage while in College

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Rev. Moon:

--- Quote from: Hellraiser on October 12, 2010, 01:44:44 AM ---JR, is this already in effect?  I was under the impression this would not be part of the law until 2014.  With that said I was covered by my new health insurance within thirty days with no mention of a pre-existing condition exclusion.

--- End quote ---



--- Quote from: Assurbanipal on October 12, 2010, 12:40:31 PM ---
I noticed that too, and you are right.  It went into effect for children this year and goes into effect for adults in 2014.

Here's a link to a summary of the law from my new faorite website:  http://www.healthcare.gov/law/about/order/byyear.html

--- End quote ---

I may be confused then; I thought that the "high-risk pools" provision was effective July 2010?  Wouldn't this include those living with HIV?

http://www.healthcare.gov/law/provisions/preexisting/about/index.html

Thanks JR for what you've been doing in this area of the forums; I believe it is and will be of great help to all of us.

Assurbanipal:

--- Quote from: Rev. Moon on October 12, 2010, 12:49:40 PM ---
I may be confused then; I thought that the "high-risk pools" provision was effective July 2010?  Wouldn't this include those living with HIV?

http://www.healthcare.gov/law/provisions/preexisting/about/index.html

Thanks JR for what you've been doing in this area of the forums; I believe it is and will be of great help to all of us.

--- End quote ---

The high risk pools are currently effective.  But that is not the same as "preexisting conditions being a thing of the past" 

The high risk pools allow you an option to find insurance if you have been denied coverage for 6 months because of a preexisting condition.  But they are expensive and you need that 6 month coverage gap to get in (although some states are more generous). 

Starting in 2014, all insurance will have to be sold without preexisting coverage conditions on it.  (I think there may be an exception to allow some "grandfathered" employer plans to keep their preexisting coverage exclusions, but they often don't apply preexisting condition requirements anyway.)

Rev. Moon:
Thank you, Assurbanipal.  That makes it more clear to me. 

I am almost sure that you discussed this in a previous thread.  And you are right, the cost can be quite high when all things are considered, ranging between $350 and almost $800 depending on state and age group. 

I believe that the OP will benefit equally with whatever plan that is offered by his university; it would all depend on specific coverage, deductibles, etc.

JR Gabbard:
Hi everyone,

I admit that I hadn't really boned up on the new health care law before I made my broad proclamation.  I'm working on that!  I've read what Assurbanipal linked to, and what Kaiser Foundation has to say.  I still need to read the law itself.  But from what I've discovered I'd like to clarify my post on pre-existing conditions.

If you are currently insured, including Medicaid, Medicare, a local government insurance plan (ie. Healthy San Francisco), or a private plan you got through your job or that you purchased on your own, and you lose your coverage, then for 6 months afterward an insurance company cannot deny coverage for your pre-existing condition.

If you have a 6-month gap in coverage, then effective June 2010 you can buy a policy through a high-risk pool that is administered state by state (although the federal government maintains control of the program).  I have no idea how expensive this option is, and each state will have different rates.  There will be a premium credit available, but not until Jan. 2014.

In Jan. 2014, private policies will no longer be able to deny coverage due to a pre-existing medical condition.  Group policies (the kind you get through employment) already do not exclude people for pre-existing conditions, although there may be a waiting period before you can claim benefits.  In 2014, that waiting period will be limited to 90 days.

Thanks Assurbanipal for posting the link to healthcare.gov.  I agree.  A great resource.  There is a link at the bottom of the page, by the way, that can get you state-specific information on the pools.  Also to Hellraiser (do you play Starfleet?) for calling me out for my hyperbole.

Here's another helpful link for information on the healthcare reform act.

Best of luck, Tim.  I hope it works out for you that you can go to school.  Look at it as an investment in your future, the one you got back when the meds started working!

Rev. Moon:

--- Quote from: JR Gabbard on October 12, 2010, 05:19:54 PM ---
If you have a 6-month gap in coverage, then effective June 2010 you can buy a policy through a high-risk pool that is administered state by state (although the federal government maintains control of the program).  I have no idea how expensive this option is, and each state will have different rates.  There will be a premium credit available, but not until Jan. 2014.


--- End quote ---

Since Tim mentioned that he is in SC here are the listed rates from the healthcare.gov website:


Below are the monthly PCIP premium rates for South Carolina by the age of an enrollee.

Ages 0 to 34: $301

Ages 35 to 44: $361

Ages 45 to 54: $462

In addition to your monthly premium, you will pay other costs. You will pay a $2,500 deductible for covered benefits (except for preventive services) before the plan starts to pay. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the planís network.

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