Cost Drops for Patients with Pre-Existing Conditions

Enrollment for the Pre-Existing Condition Insurance Plan (PCIP) just got a big boost.

Cost has long been suspected as one of the limiting factors to signing up people to the federally funded PCIP program. Now, according to officials of the Managed Risk Medical Insurance Board (MRMIB), the cost of premiums in the plan are about to drop by an average of 18%.

“We have new premiums now with a significant reduction in cost,” MRMIB chair Cliff Allenby said, “at an average of 18%, which is anywhere from 8.2% to 24.3% lower cost.”

The lower premium prices were recently approved by CMS. Because enrollment in the program has been much lower than expected, California was eligible to recalculate its premium rates, according to David Sayen at CMS.

“PCIP was created as a bridge to take us to 2014,” Sayen said, “when insurers won’t be allowed to exclude based on pre-existing conditions.” Sayen said that the slow uptake in the program is due to a variety of things, and not just price. Many people eligible for the program just don’t know about it, he said.

“We’re used to working with the elderly, with lower-income people,” Sayen said. “The challenge is, we have to reach the millions and millions of people [in the nation] who have these pre-existing conditions.”

To that end, MRMIB has been busy putting together an outreach program to reach all of those eligibles. And board member Richard Figueroa of MRMIB said there has been one other recent change in eligibility requirements that might help.

“Along with premium rate reduction, it will be easier now to get into the plan,” Figueroa said. “Sometimes getting proof of denial can be a barrier, but now they can just submit a letter from their physician that says they have a pre-existing condition.”