Pre-Existing Condition Insurance Plan
A New Health Coverage Option for the Uninsured
P
eople who have had diculty nding health coverage or have been turned down for coverage
because of a pre-existing condition and feel like they are out of options are not out of luck.
ey may now be eligible for a new program created by the Aordable Care Act—the
Pre-Existing Condition Insurance Plan (PCIP). PCIP is one way the Aordable Care Act helps
uninsured people with pre-existing conditions get high quality care at aordable prices. PCIP is
designed as a bridge to 2014 when the nation transitions to a new marketplace and all
Americans—regardless of their health status—will have access to aordable, quality health
coverage through a competitive marketplace for health plans called a Health Insurance Exchange.
is health coverage program is administered at the state level in 27 states and by the federal
government in 23 states and the District of Columbia.
Plan Eligibility
To qualify for this program, a person applying for coverage must be: a U.S. citizen or reside here
legally; have been without health coverage for at least 6 months before applying; and have a
pre-existing condition or have been denied coverage because of a health condition. Eligibility is not
based on income and enrollees are not charged a higher premium because of a medical condition.
Coverage
e Pre-Existing Condition Insurance Plan provides people with a pre-existing condition
comprehensive health coverage at the same price that healthy people pay. It covers primary and
specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing
care and preventive health and maternity care.
Premiums may vary depending on where you live, your age, and which health plan you choose.
Enrollees may be responsible for paying a deductible and some cost-sharing expenses.
Life-Changing Results
is coverage program is already changing—and saving—the lives of enrollees across the country
and helping them nally receive treatment for conditions that have plagued them for years. James
of Katy, Texas was diagnosed with brain cancer last year. James was able to join the Pre-Existing
Condition Insurance Plan in Texas and he received the medical treatment that he needed.
More Information
Each state may use a dierent method to determine whether a person has a pre-existing
condition or has been denied health insurance coverage. For more information, including
eligibility, plan benets and rates, and how to apply, visit www.pcip.gov and click on “Find Your
State.” en select your state from a map of the United State or from the drop-down menu. e
PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826
(TTY 1-866-561-1604).
www.pcip.gov
Toll Free Line: 1-866-717-5826 (TTY 1-866-561-1604)
CMS Product No. 11548
