I heard risk pools are closing. I have a pre-existing condition and can’t afford to have a coverage gap. What should I do?

March 31, 2014

Q: I’m in a high-risk pool because of a pre-existing condition.  I can’t afford to have a gap in coverage, but I know that the risk pools are closing. What should I do?

A: Don’t panic. HHS announced last week that Pre-Existing Condition Insurance Plan (PCIP) members could continue to be covered until April 30, 2014 if they had not been able to select a new exchange plan yet.  In order to have new coverage effective May 1, you must complete your enrollment by April 15.  Open enrollment in the exchanges technically ends on March 31, but there are widespread extensions available in most states that allow people who begin their application by March 31 to complete it after that date if they need assistance or have technical problems with the exchange websites.  The April 30 extension applies only to the ACA-created PCIP policies.  It does not apply to state-funded high risk pools that pre-date the ACA, although many of them have extended their coverage as well.  If you’re covered under a non-PCIP high risk pool, contact your risk pool for the most up-to-date information on policy end dates.

If you’re enrolled in one of the 35 state-run high-risk pools that were operating prior to the creation of the ACA’s Pre-Existing Condition Insurance Plan (PCIP) program, your policy might be available for at least part of next year or even longer. This chart shows anticipated termination dates for state-run high-risk pools. At least 18 of the pools already planned to continue providing coverage after the start of 2014, even before the technical problems at Healthcare.gov and many state-run exchange sites became apparent.

But in light of the enrollment problems, some states have taken action to prevent possible coverage gaps for residents who are enrolled in non-PCIP high risk pools, and it’s likely that others will follow suit.

  • Indiana is extending coverage in its high-risk pool until January 31.
  • Vermont had originally planned to have all existing individual and small-group plans terminate at the end of the year, but they have extended the existing plans until the end of March.
  • Oregon‘s high-risk pool is scheduled to end on December 31, but the state has created a Temporary Medical Insurance Plan and will automatically transition high risk pool members to the temporary plan if they have not been able to enroll in an exchange plan with a January 1 effective date.  The temporary plan will be available until the end of March.
  • Texas has extended its high risk insurance pool until March 31, 2014.
  • New Hampshire‘s Insurance Commissioner issued an order on November 22 that extends the existing risk pool “until the federal marketplace is fully available.”
  • Wisconsin‘s governor has proposed legislation that would extend coverage under the state’s high risk pool until the end of March.

The PCIP program was created by the ACA and covers people with pre-existing conditions in all 50 states. Enrollment in these plans closed in early 2013, but they were still covering about 85,000 people as of October 2013.  By mid-January 2014, enrollment had dropped to around 30,000 – so they majority of enrollees have already transitioned to a new plan.

Although the PCIP policies are being extended until the end of March, insureds need to enroll in a new policy by March 15 in order to have coverage effective April 1.  Most of the exchange sites are working very well in mid-January, so if you tried earlier in open enrollment and were unable to enroll, now’s a good time to go back and try again, either online or using one of the other enrollment methods. You can also contact the administrators of your risk pool and ask them if they have specific advice for people in your situation.

Tags: Affordable Care Act, pcip, pre-existing condition, pre-existing condition insurance plan

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