AARP Bulletin - September 2010

miums. For consumers, this is
how the program works:
Who qualifies? You must have
been without health insurance
for at least six months before you
apply; have a qualifying preexist-
ing medical condition; and be a
U.S. citizen or legal resident.
How do I apply? You must ap-
ply to the federal plan provided
in your state. Go to www.pcip.
gov for information and to apply
online. Or call your state depart-
ment of insurance.
How do I prove that I qualify?
You must show evidence that an
insurance company has denied
you health coverage because of a
preexisting condition or excluded
coverage for that condition; or, in
some states, has quoted you a pre-
mium much higher than the fed-
eral plan requires. You also need
a letter from your doctor confirm-
ing that you have a medical condi-
tion that makes you eligible.
Does my income make any dif-
ference? No. Income isn’t taken
into account.
Can I apply if I’m already en-
rolled in my state’s own high-
risk program? No, because this
means you’ve been insured within
the last six months.
How soon can I receive cover-
age? If you apply by the 15th of
any month and are accepted, full
coverage—even for your preexist-
ing medical conditions—starts the
first day of the following month.
What benefits will I receive?
Benefit packages vary according
to the state you live in. But they
must all cover a wide range of
services, including primary and
hospital care, specialists and pre-
scription drugs.
What will it cost me? In the fed-
erally run programs, you pay
a $2,500 annual deductible (except
for preventive services), a $25 co-
payment for doctor visits, and 20
percent of the cost of other covered
benefits. Some state-run programs
are a lot more generous. Each state
decides premiums, which may vary
according to age and tobacco use.
I’m over 50. Will I pay higher
premiums? Probably. Premiums
in most states vary by age.
Will my out-of-pocket expenses
be capped? Yes, at an annual
amount specified by law—current-
ly $5,950 for each person, but some
states have lower limits. The caps
apply to deductibles and copays,
but not premiums.
Can I get coverage for my fam-
ily? There are no special rates for
family coverage. Every member of
your family who meets the condi-
tions can apply as an individual.
What if I’m not eligible? Check
out your state’s own high-risk
program, if it has one. In some
states you may qualify even if
you’ve had insurance within the
past six months. To see if your
state has its own program, go to
www.naschip.org/states_pools
.htm or call your state’s depart-
ment of insurance.
What if I can’t afford the pre-
miums? For this coverage there
are no subsidies, no matter how
low your income. But some states’
high-risk plans o;er special rates
for low-income people. Call your
state’s medical assistance o;ce to
see if you or family members qual-
ify for Medicaid or the Children’s
Health Insurance Program.
What if I enroll but federal
funding dries up? If that hap-
pens, your coverage will not nec-
essarily end. Your program would
likely freeze enrollment and wait-
list new applicants. ;