About Amy Umble:
Amy Umble is health reporter for The Free Lance-Star
Pre-existing condition? Plan may help
One of the earliest provisions allowed young adults to stay on their parents’ insurance plans until age 26.
Now, those who have been uninsured for at least six months because of a pre-existing medical condition will be able to purchase coverage.
Dozens of states are using federal money to operate their own versions of these so-called “high-risk pool” programs. Virginia is one of 20 states that has decided to let the federal Department of Health and Human Services do it.
The Pre-Existing Condition Insurance Plan began July 1 and will expire in 2014, when the new law requires insurers to accept all applicants. Coverage is expected to begin by the end of the summer.
The plan is aimed at those who are uninsured because of medical problems. Unlike Medicaid, the program is not based on participants’ incomes. Congress appropriated $5 billion for the program, including $113 million for Virginia residents.
The plan covers primary and specialty care, hospital care and prescription drugs. Participants are responsible for premiums, deductibles and copayments.
Rates for Virginia won’t be set until July 15. But the federal government estimates that the premium for a 50 year old will be between $440 and $538 per month. The plan also carries a $2,500 deductible, and copayments of $25 for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of other covered benefits. Out-of-pocket costs cannot be more than $5,950 per year.
For more information about the plan, check out their web site here.