Dear Cheasty,
I am a veteran of the Vietnam War and I get my health care through the VA. Is the Affordable Care Act going to make me buy insurance, too? I don’t think it should, because I already get all my health care at the VA.
Sincerely,
Vexed Veteran
Dear Veteran,
I think we can safely take the “vexed” out of your name, because the Affordable Care Act will not affect the health care you already receive from the Veterans Health Administration. If you get health care from the VA, you are NOT required to purchase additional insurance. If you want to buy additional coverage, you are welcome to do so (it won’t compromise your existing VA benefits), but nothing in the law requires you to buy insurance. Hooray!
So that’s the quick and dirty: if you are eligible for VA health care, you will remain eligible. Nor does the Act change the TRICARE or TRICARE for Life benefits your family may receive. But let’s look at some other situations veterans find themselves in.
For veterans who are NOT eligible for VA health care and do not get insurance through an employer, they and their families may qualify for tax credits and subsidies that make purchasing health insurance easier and more affordable. Starting January 1, 2014, those veterans, just like every other uninsured Americna, can shop for insurance on the Health Insurance Exchange, and hopefully get some help finding coverage they can afford.
Well, what about veterans who get insurance coverage through an employer, you might ask? What then?
In that case, veterans will benefit from the consumer protections in the Affordable Care Act. To sum it up, you will get preventive care with no co-pays, you won’t have lifetime or annual caps on your insurance benefits, and you won’t have to worry about being denied insurance (or charged more!) because of pre-existing conditions. If you want to know about additional benefits under the ACA, click here to read all about it.
So there you have it, Veteran. If you get health coverage through the VA, nothing will change for you in 2014. But if you know other veterans who don’t, the Affordable Care Act will be able to help them get access to better, more affordable coverage for them and their families. I hope this explanation has helped put you ‘at ease,’ soldier. (Haha.)
To a well and healthy Texas,
Cheasty Anderson
Do you have more questions about health reform? Email Cheasty at [email protected]
I’ve heard about the Affordable Care Act and how small businesses don’t have to provide insurance, but large employers do have to, or they’ll pay a penalty. I run a business with 16 full-time office employees (whom we insure) and over 250 part-time employees (who don’t get insurance), and I’m curious whether that means I’m a small or large employer. I heard you speak at a presentation last week and you said that it would be based on FTE’s. Also, I’d like to know the effect on part-time employees. Will I have to provide insurance for all of my employees? I would love to know the answer when you get a chance.
Thanks,
Trying to Get My Ducks in a Row
Dear Ducks,
I take my hat off to you for doing your best to understand one of the more complicated aspects of the Affordable Care Act – determining whether large employers have to pay a penalty if they don’t insure their full-time employees. OK, first let’s sketch out the broad regulations, and then I’ll talk about your case in particular.
Starting in 2014, the ACA essentially requires large employers to provide full-time employees with affordable health coverage. Small employers (fewer than 50 employees) have no obligation to provide insurance, will face no penalties if they do not, and may even qualify for tax credits to help them afford coverage.
The difference between a small employer (no obligation to provide insurance) and a large employer (obligation to provide insurance) hinges on the magic number 50. Fifty FTEs (full-time equivalent positions – keep in mind that the limit for “full time” in the ACA is 30 hours a week) is the line between small and large. In other words, if you have 51 or more FTE employees, you are a large employer, and therefore required to provide insurance to all full-time employees (only those employees who work 30 hours a week or more, on average).
So here’s where the penalty comes into play. If you choose not to provide insurance for your employees, and any of your full-time workers get subsidized health coverage in the exchange (relatively likely if you are a large employer that doesn’t provide insurance), you will pay the tax penalty. That tax penalty is $2,000 a year for your total number of full-time employees minus 30. In other words, if you have 70 full-time employees and choose not to insure them, you’ll pay $2,000 a year on each of those 40 employees (broken into 12 monthly payments).
Confused yet? Great! Let’s keep going.
Let’s say that you DO provide health insurance, but it’s not very good insurance. If the insurance you provide either (a) costs the employee more than 9.5% of his/her household income, or (b) offers exceptionally poor coverage (e.g., it fails to cover at least 60% of the cost of covered benefits, on average) then those employees may seek out and qualify for subsidized health insurance on the Health Insurance Exchange. If any of your employees does that, then we go through another set of questions.
Ready for the next set of qualifiers and if/then statements? OK! Let’s say that you offer your employees an expensive health insurance plan, or one with poor benefits. If one or more of your employees qualifies for subsidies and enrolls in an Exchange plan, you will have to pay the shared responsibility penalty.
But this penalty may be less than the flat fee assessed at the “I don’t offer insurance at all” level, described earlier. Instead, here you’d pay the lower of the following two amounts: EITHER $2,000 a year for each full-time employee (minus the first 30), OR $3,000 a year for just the number of full time employees who receive government subsidies for insurance on the Health Insurance Exchange.
OK, how are you doing, Ducks. Still with me? You are? Wow, I’m impressed. This is dizzying stuff! OK, now let’s look at your scenario.
You employ 16 full-time and 275 part-time employees. By any calculation, you, Ducks, are a large employer and would be obligated to provide insurance for all full-time employees (30+ hours/week). But I’m not sure how many hours a week your part-time staff work, so I’ll just assume that each part-timer works an average of 20 hours a week.
You already provide insurance (and you’re probably a good boss, so I’ll assume it’s fairly decent insurance) for your 16 employees, so none of them will qualify for or seek out subsidized coverage on the Exchange. You are only obligated to insure those employees that work 30 hours a week or more (on average), so chances are good that you are all ready for full ACA implementation in 2014, Ducks. You will not have to offer coverage to previously uncovered employees, and you won’t have to pay a penalty because you are already providing insurance to your full-time (remember: 30+ hours a week!) staff.
If you (or anybody out there) have more questions about their status relative to insuring employees, feel free to write me, but I also recommend you consult with your tax guy or an attorney who understands the regulations, just to make sure all relevant details get taken into consideration.
To a well and healthy Texas,
Cheasty Anderson
More questions for Cheasty? Email them to [email protected]
Under the ACA, will the August 1 no-copay rule for contraception apply to EXISTING health plans or just new ones? And do you know if IUDs will be covered?
Sincerely,
Confused About the Contraception Rule
Dear Confused,
What a great question! There has been a lot of chatter about the August 1, 2012 start date at which all insurance plans must provide co-pay-free contraceptive coverage. Before diving in to an answer, Confused, let me give a little background information for those who haven’t heard about this yet.
No co-pay, you say? That’s right.
If you are insured and using contraceptives (and by “contraceptive” I mean every FDA-approved contraceptive, from the pill to the patch, to the ring, to the shots, to IUDs and even tubal ligation) as of August 1st of this year, you will no longer pay any out-of-pocket cost for this coverage. Why? Contraception is classified as preventive care (in this case meaning you are preventing an unintended pregnancy and all the associated medical costs), and under the Affordable Care Act (the health reform law), preventive care must be covered by insurers out of the cost of your premiums. No more co-pays. Click here for a complete list of preventive care offered to women under this new rule.
So, to answer your question. The rules for contraception apply to all health plans EXCEPT those that are grandfathered under the “keep your health care if you like it” provision in the ACA. Click here for a full explanation of how plans are grandfathered, but in sum, it goes like this: the grandfather clause states that any health insurance plan in existence on March 23, 2010 does not have to comply with rules like this one for contraception. UNLESS that plan makes (or has made) “meaningful” changes to its plan (i.e., raising costs or reducing benefits for beneficiaries), in which case it does then have to comply. On the other hand, all new plans, or recently altered plans must comply.
My advice? Call your plan to find out whether they are grandfathered or whether they will comply with the regulation.
As for whether IUDs will be covered, yes. All IUDs (intra-uterine devices), both hormonal and non-hormonal, are FDA-approved contraceptives. They will be covered under this ACA rule. Go forth and save money, my friend!
To a well and healthy Texas,
Cheasty Anderson
Dear Cheasty,
I got an email the other day that said my Medicare premium would go up to $247 a month with Obamacare. I live on my Social Security and I can’t afford my Medicare if this is true. Is it true?
Sincerely,
A Worried Senior
Dear Worried Senior,
No, it is not true! It isn’t even partly true, or sort of true, or true-if-you-look-at-it-sideways.
There have been a number of emails that have circulated with scary lies about the Affordable Care Act (a.k.a. the ACA or “Obamacare”). These emails are scare tactics, pure and simple, and it is so smart of you to try and fact check the one you got recently about Medicare premiums.
Let me explain why this is false, and what the real truth is.
The premium that email is talking about is your optional Medicare Part B premium, which is currently $99.90 a month (if you’ve opted in to this part of the program). This premium is set BY SOCIAL SECURITY LAW (not the Affordable Care Act) and that law has not changed. Furthermore, the ACA (Obamacare) never will affect the Medicare premium calculation. It can’t be changed by the President’s executive order. It can’t be changed by anything other than Congress, and they haven’t done anything!
Here’s something else to put your mind at ease. By law, (the Social Security law), you are protected from rising Medicare rates that might cut into your Social Security benefits. Here’s how it works. The only way they can raise Medicare rates is if your Social Security cost-of-living adjustment also goes up. And even then, they can’t raise your Medicare premiums more than your cost of living adjustment. That way, your net benefits stay the same! This provision in the law is called the “hold harmless” provision, and it means exactly what it says. They can’t harm your pocketbook, and they can’t harm you.
I hope this puts your mind at ease, Worried. Thanks for checking, and please write again if you get any more scary emails about health reform!
To a well and healthy Texas,
Cheasty Anderson
Dear Concerned Friend,
In the first part of my response, I shared the PCIP health insurance option for your pregnant and uninsured friend. There is also good news for others who lack employer sponsored insurance, including your friend’s husband. His health needs, unlike those of his wife who is expecting, are likely less time-sensitive but equally as important.
Currently, people searching for coverage outside their jobs and in small businesses can have a hard time finding coverage that meets their needs. For example, it’s often hard for a woman to purchase a plan with maternity benefits on the individual market. Similarly, health insurers sometimes don’t cover mental health benefits for these types of policies. As a result, many people find themselves in the same position as your friend’s husband: self employed but uninsured.
Here is the good news: If he chooses to buy health insurance in 2014, his insurance plan will be subject to the Essential Health Benefits (EHB) rule. The EHB rule of the Affordable Care Act mandates that all health insurance plans for individuals and small businesses cover 10 categories known as the Essential Health Benefits. These benefits will include coverage that most people would want in a plan.
With the health reform, all policies for individuals or small groups must cover the following 10 EHBs:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services chronic disease management
- Pediatric services
Did you see where it said “maternity and newborn care?” Awesome. If your friends decide to have another child in 2014, mother and baby will be covered by the EHB rule!
As you can see, it will be harder for insurers to hide behind loopholes and small type, and that’s good news for the consumer in general, and for folks like your friends, in particular. People trying to make it either by taking employment without benefits, or as a small entrepreneur, will have a better shot at success with access to affordable coverage, thus protecting them from catastrophic medical costs should they become ill, have an accident, or get pregnant.
Dear Concerned, thanks for being a good friend. Having a new baby is a big life change by itself and these new parents will likely need your caring and support. I hope this helps!
To a well and healthy Texas,
Cheasty Anderson
Dear Cheasty,
My friend just found out she’s pregnant. She and her husband each own small businesses (she’s a massage therapist and he’s an artist), and they don’t have health insurance. When she tried to buy health insurance for her pregnancy she found she couldn’t because being pregnant is considered a pre-existing condition. So then he tried to buy insurance, but they wouldn’t let him do it either, because he’s an expectant father and I guess that’s a pre-existing condition, too. I know that the health reform has some things in it that will help them out, but can you tell me what they are so I can tell them?
Thanks,
A Concerned Friend
Dear Concerned,
Wow, pregnant AND uninsured. That’s a stressful situation to be in. Given how expensive individual health insurance policies are, I can understand making that decision and taking the risk. But, even if your friend weren’t pregnant, in today’s market she should know it would be near impossible to purchase an individual policy that covered maternity benefits (unless she purchased a “maternity rider” which is so expensive it isn’t even insurance – it’s essentially paying for maternity care at full price). In sum, even if she had purchased insurance, she’d probably be in the same pickle anyway regarding the upcoming baby.
The thing to note, however, is that the full implementation of the Affordable Care Act (ACA) in 2014 will address your friends’ predicament in two ways. The first has to do with coverage for pre-existing conditions, and the second has to do with something called Essential Health Benefits, which I’ll cover in more detail in a separate post.
Both will be vital to making sure that none of us ever finds ourselves in your friend’s predicament again.
For now, please tell your friend she can apply today for the Federal Pre-Existing Condition Insurance Plan (PCIP), which provides insurance to people currently excluded from coverage until 2014. Since pregnancy qualifies in the insurance world as a pre-existing condition your friend may be eligible for health insurance after all!
Please check out one of my earlier posts detailing the PCIP, here.
The most important take-away about pre-existing conditions is this: Beginning January 1, 2014, NOBODY, EVER AGAIN, will be denied or up-charged for a pre-existing condition, no matter what that condition is. In other words, if we were having this conversation two years from now, well… we wouldn’t be having this conversation at all!
The other great piece of news for people who don’t get insurance through their employer and instead have to buy their insurance on the individual market, is a part of the ACA that requires ALL insurance policies to cover a set of ten Essential Health Benefits, including maternity services. For more about these Essential Health Benefits, click here.
Concerned, I hope this initial post helps to take away at least some of the worry for your friends.
To a well and healthy Texas,
Cheasty
Dear Cheasty,
My question is the following: What if I am insured and I have my family on my plan. Because of this, my premium is high - very high - to where I am barely making my bills on time. Will there be a change in family plan insurance premiums with the health reform?
Sincerely,
Struggling to Make Ends Meet
Dear Struggling,
Boy, do I hear you. Millions of Americans are in exactly the same boat – insurance premiums so high that you either can barely afford to adequately insure your family, or you simply cannot do so. It’s this very situation that has brought about our current crisis in health care. In Texas, almost 25% of us have no insurance whatsoever, and many more of us are under-insured – meaning we have a policy, but the policy has strict limits on what it will cover, often leaving us with staggering medical bills in the event of an illness or accident.
The problems caused by the high cost of insurance leave us all vulnerable to financial and physical ruin when we do eventually get seriously ill, and need to call upon those policies we’ve been paying for. And as you pointed out, Struggling, even when we aren’t running up high medical bills, it can be extremely difficult to make ends meet and still hang on to our insurance plans.
So what will the Affordable Care Act (a.k.a., the health reform law) do to fix this situation? Well, the ACA is tackling this problem in a variety of ways. Before I get started, however, I should emphasize that the main goal of the ACA is to expand coverage to more Americans. Controlling costs in the private insurance market is a secondary goal, and as such will have to be improved upon in the future. Nonetheless, there are provisions in the law that will help make health insurance more affordable for poor and middle class families.
Two provisions are regulatory in nature, and will have an impact on all insured people, regardless of economic status. The third, however, is the most helpful for struggling families because it has to do with affordability support.
There are two provisions in the law that aim to control the exponential growth of premium costs in the private insurance market. These two regulations are called rate review and Medical Loss Ratio, or the “80/20” rule. If you want to read more, click on each term to read a description of what each does. In sum, however, what these two provisions do is twofold. First, they hold insurers to a higher standard for premium increases by ensuring that the rate hikes are “justifiable.” Second, they make sure that for every dollar you (and by “you” I mean the average consumer) spend on health insurance, you get good value in actual health care. Neither of these provisions will lower premiums. Instead, they promise that premiums will rise more slowly than they have historically, and that insurance companies must spend more of the money they collect on actual health care, rather than profits. These regulations are an important first step toward reining in the explosive growth in health insurance costs.
The third provision that will help make insurance more affordable for the average citizen is something called premium subsidies. As of 2014, each state will have a health insurance Exchange, an online marketplace where you can go (if you don’t get insurance through your employer) to purchase insurance for yourself and/or your family. You’ll be able to compare, “apples to apples,” the prices, benefits, and customer support systems of competing insurance companies, and then select the plan that best fits your needs.
One benefit of these Exchanges is that people who buy through the Exchange will be eligible for significant discounts on the price of their plan, depending on their income level. Individuals earning up to 400% of the Federal Poverty Level will receive discounts on the price of their health insurance policy. For a family of four, 400% of the FPL is over $90,000 a year – so families well into the middle class will benefit from these affordability supports.
To calculate your income level and the subsidies you’ll be eligible for, click here to calculate your income and family size as a percentage of the Federal Poverty Level.
Struggling, I don’t know much about your income level or how many people you’re trying to insure, but there’s a good chance that you’ll be one of the millions of people who will see dramatic reduction in the monthly cost of their insurance premiums thanks to the subsidies. Additionally, the competitive marketplace, in combination with rate review and Medical Loss Ratio provisions in the ACA will begin to slow the speed with which health insurance costs are currently growing.
I hope this information gives you some hope for the future, Struggling. Until 2014, just hang in there with the rest of us.
To a well and healthy Texas,
Cheasty Anderson
I saw a political advertisement the other day saying that the Affordable Health Care Act would not help out Senior citizens. It depicted President Obama pushing an elderly woman over cliff. Will the Affordable Health Care Act throw grandma over the cliff?????
Sincerely,
Worried about Grandma
Dear WAG,
Oh, my goodness. NO, NO, NO!! The attack ad you saw, and others like it, are definitely not based on reality nor on any components of the actual health reform law. They are nothing more than politically motivated fear tactics designed to make people like you question the law. The people who make those ads either don’t know or don’t care what the law actually says – maybe both.
In actuality, the ACA is going to improve health care for senior citizens big time once the law is fully implemented in 2014. And, here are some of the biggest improvements seniors are ALREADY enjoying right now as a result of the new law:
First, all seniors on Medicare are now receiving preventive care, FREE. That means annual exams, mammograms, screenings, colonoscopies, etc., all with no co-pay.
For a complete list of preventive care covered by the ACA, click here. You’ll be blown away by all the things you won’t be paying for!
Second, the ACA is closing the Medicare prescription drug “doughnut hole,” so seniors don’t end up paying so much out of pocket for their meds. The doughnut hole is what they call the $1,750 gap between when Medicare stops helping to pay for people’s prescription drug benefits and when it starts coverage again at “catastrophic” levels. The goal is to close that gap, so that Medicare ALWAYS helps seniors with their drug costs, and seniors are NEVER left to pay the full cost of drugs out of pocket.
The ACA is closing the gap gradually through rebate checks and steep discounts to drug costs, and it will be completely gone by 2020. Click here to read exactly how they are doing it.
Lastly, let’s talk about seniors who don’t rely on Medicare, but instead have private insurance associated with a pension or retirement package. Any health insurance plan that was active as of March 23, 2010 (the date the law was signed) will be grandfathered into the new system.
This means that for seniors counting on their pension-related insurance, nothing will change in 2014 except that the plans they already have will be more robust to meet their needs.
And, these are just a few of the benefits that ALL insurance plans, regardless of grandfathered status, will be required to provide for consumers:
- No lifetime limits on coverage for all plans;
- No cancellation of coverage when people get sick and have previously made an unintentional mistake on their application;
- No “restricted” annual limits.
In sum, not only does the ACA not push Grandma off the cliff, it helps her to stay healthy, save money, and count upon better coverage under whatever health plan she might have, private insurance or Medicare.
Please lay your fears to rest, dear WAG. Grandma is going to be just fine, if not better than before, if we can just hang onto this important law. Thanks for your letter.
To a well and healthy Texas,
Cheasty Anderson
Dear Cheasty,
This is an interesting time to talk about non-profits given the economic collapse and the health care reform act. Would you be able to write a few paragraphs regarding the impact of healthcare reform, the rising costs and the challenges non-profits may feel with regard to offering benefits to their employees?
Thank you,
Needing to Know about Non-Profits
Dear Non-Profits,
Over the last 10 or 15 years, health care costs in the commercial insurance industry (i.e. anything that isn’t Medicaid or Medicare) have ballooned. Therefore, the cost of providing health insurance for employees has gotten harder and harder. This is true for both private industry as well as non-profits.
To make matters worse, most non-profits, like small businesses, may be saddled with the curse of the small group plan where prices are higher in order to cover the larger proportion of policy holders in the group with greater (read: costlier) health care needs. As a result, many non-profits are having to make tough decisions about the quality of coverage they can afford to offer their employees, what percent of cost-sharing the organization can afford to bear, etc. In the end, both employer and employee spend more, but get weaker benefits compared to years past.
The Affordable Care Act (the health reform law Congress passed in March, 2010) has been steadily making progress towards reducing insurance costs for small businesses and non-profits. And, when the law is fully implemented in 2014, it will go even further towards controlling costs in the health care industry at large.
Right now, however, here are some of the ways the ACA is helping make health insurance more affordable for non-profits:
- In the first place, small non-profits (fewer than 25 employees) can qualify for a refund up to 25% of the cost of purchasing insurance for their employees. Check with your tax accountant to see if you qualify, and whether you’ve filed the appropriate paperwork. In 2014, that refund cap will be even higher – you could get up to 35% back!
- Second, an industry regulation called “Medical Loss Ratio” (commonly referred to as the “80/20 Rule”) stipulates that insurance companies MUST spend at least 80% of the premium dollars they collect on the delivery of health care services, and only 20% on administration, profits, and payouts to shareholders. If they fail to make those percentages, then the insurer has to refund money to its beneficiaries in order to comply with the 80/20 Rule. This is a significant change in the way most insurers did business before, and the result is fantastic for people in the small group and individual markets.
To sum it all up, you stand a good chance of getting money back this summer. In fact, Texas – with its previously unregulated market – is benefiting the most of any state. A new report from the Kaiser Family Foundation has estimated that this year 1.8 million Texans will receive more than $186 million in rebates because of the 80/20 Rule.
Some insurers are retroactively lowering premium payments for some small businesses, while others have decided to start providing free preventive health care (checkups, screenings, etc) for beneficiaries ahead of schedule to bring their numbers up to scratch. (In 2014, free preventive care will be the law of the land and we’ll all get those annual exams free.)
So that’s what non-profits need to know about health reform right now.
In less than two years – on January 1, 2014, to be precise! – you’ll need to know about a whole raft of ACA provisions that are going to control costs and enhance coverage in the insurance industry in general, but I’m just going to skim over them right now in the interest of time.
- The first thing to know is that insurers will no longer be able to deny coverage or even charge more for people with pre-existing conditions. That will lower costs for everybody, but especially in small group markets.
- Secondly, all insurance plans will have to cover 10 categories of health coverage called the “Essential Health Benefits.” This will ensure your employees get more robust coverage under whatever insurance plan you choose.
- And lastly, with the Health Insurance Exchanges for individuals and small businesses, you and your employees will have many more options of how to best guarantee the affordability of coverage for all.
The Affordable Care Act isn’t a guaranteed panacea for all the ills of the health care crisis in the United States, but it is a remarkable effort to begin fixing the problem, one step at a time. I hope this helps explain what non-profits should be looking for, both now and in the next few years.
To a well and healthy Texas,
Cheasty Anderson
Dear Cheasty-
My sister is 45 and had no insurance through her job (she is a Licensed Social Worker, has worked for MHMR for years) and was recently diagnosed with Stage IV Gastric Cancer. Her bills for diagnosis and surgery have probably topped $150K so far; she is on her 2nd round of chemo. She had enough leave time that she got her last paycheck this month; so she won’t qualify for Medicaid until she can show only her husband’s income. I have read about a high-risk insurance pool, but no one has been able to tell her about it. Would that be an option for her?
Thank you so much -
Hurting Sister
Dear Hurting Sister,
In the first place, let me just say how sorry I am that your sister and your whole family is going through such a difficult experience. As it stands, our current health insurance system is terrible at helping people who are actually sick, and often only adds stress and pain to any health crisis.
The good news is that your sister is likely an ideal candidate for the Pre-existing Condition Insurance Plan (PCIP), also known as a high risk pool. Here’s how it works:
The PCIP accepts individuals who have fallen through the proverbial cracks (as long as they meet certain basic criteria). Those of us with pre-existing conditions who don’t have insurance through our employer are often “uninsurable” according to the insurance industry because of those conditions. And those conditions can range from cancer to depression to – check this one out – being an expectant parent, whether you’re the mother or the father!
In 2014 this will change, and all of us will be insurable, thanks to the Affordable Care Act. In the meanwhile, you are eligible for PCIP if you meet the following criteria:
- You must be a citizen or national of the United States or reside in the U.S. legally.
- You must have a pre-existing condition or have been denied coverage because of your health condition.
- You must have been without health coverage for the last six months or more, prior to enrolling.
- Please note: if you currently have insurance that does not cover your condition, or if you are currently enrolled in a state high risk pool, you are not immediately eligible for PCIP. To be eligible for PCIP you must be without health coverage for a period of six months prior to enrolling.
If you fit the above description, click here to enroll in the PCIP either online, by phone, or by mail.
Hurting, I assume your sister fits the first and second criteria, but I’m not sure about the third one. If she previously had insurance through her husband’s job, or if she used to purchase her own insurance but has recently been dropped from the plan, there may be a waiting period before she qualifies for the PCIP. I hope for her sake that she qualifies immediately.
If for some reason your sister does not qualify for PCIP, she can also try the state high risk pool. Unlike the PCIP, the state high risk pool has no 6-month uninsured requirement. It can be prohibitively expensive for many as the monthly premiums are double the PCIP rates. Nonetheless, expensive insurance is often better than no insurance at all.
To explore the state high risk pool as an option, you can visit www.texhealthpool.org for enrollment instructions.
Best wishes to your sister for a full recovery, HS, and please keep me posted on her insurance status. Keep in mind, too, that with full implementation of the ACA in 2014, nobody will ever be in your sister’s position again, because no insurance company will ever be able to deny coverage (or even charge more for insurance!) based on pre-existing conditions.
To a well and healthy Texas,
Cheasty Anderson
