Pre-Existing Condition Insurance Plan Texas
Humana exchange rates here…..
BLUE CROSS BLUE SHIELD (BCBS) exchanges rates here…..
Now available to Texans that have A Pre-Existing Condition and have been declined. THIS IS NOT A DISCOUNT PLAN but the Government Guarantee Issue Health Insurance.
THE PCIP PLAN ENDED IN FEBRUARY 2013….YOUR NEXT CHANCE IS OCTOBER 2013. BOOKMARK THIS PAGE AND CALL ME IN OCTOBER 2013.512-963-5000 SCOTT
Just in….exchange rates in texas…
first go here and find your Rating Area ID…..http://www.cms.gov/CCIIO/
now go here and run your rates……http://aspe.hhs.gov/
then go here to see how much of your premium the govt. is going to pay on any plan you choose..
How to apply
To apply for the PCIP plan,
The link above will take you directly to a independent Texas insurance broker , which is referring all PCIP applications for the states run by the U.S. Department of Health and Human Services.
To be approved, you must submit a complete application with all required documentation, including proof of citizenship.
If you enrolled in the HSA Option, you’ll want to consider opening a health savings account (HSA) next. To apply for an HSA.
PCIP enrollees can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses.
Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates a preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of network. There is no lifetime maximum or cap on the amount the plan pays for your care.
Premium rates for Texas
Here are the 2011 monthly PCIP premium rates for Texas by the age of an enrollee, effective July 1, 2011.
|Age||Standard Option||Extended Option||HSA Option|
|0 to 18||$133||$179||$138|
|19 to 34||$199||$268||$207|
|35 to 44||$239||$323||$248|
|45 to 54||$306||$412||$318|
PCIP enrollees can choose from three plan options, with different levels of premiums,
calendar year deductibles, prescription deductibles and prescription copays. The
HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt
account where you can deposit funds for eligible medical expenses.
Each of the three PCIP plan options provides preventive care (paid at 100%, with no
deductible) when you see an in-network doctor and the doctor indicates a preventive
diagnosis. Included are annual physicals, flu shots, routine mammograms and
cancer screenings. For other care, you will pay a deductible before PCIP pays for
your health care and prescriptions. After you pay the deductible, you will pay 20%
of medical costs in-network. The maximum you will pay out-of-pocket for covered
services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is
no lifetime maximum or cap on the amount the plan pays for your care.
Are you eligible?
To be eligible for the Pre-Existing Condition Insurance Plan, you must be a citizen
or national of the United States or residing in the U.S. legally, have been uninsured
for at least the last six months, and have a pre-existing condition or have been
denied coverage because of your health condition.
PCIP enrollees can purchase prescription drugs through the Medco Pharmacy home delivery service or at a participating retail pharmacy.
Your costs for medication are determined by:
- Where you buy your medication. You can purchase medications through Medco Pharmacy home delivery or through participating retail pharmacies.
- What type of medication you take. You save money when you take generic drugs.
Medco offers an Extended Payment Program (EPP) to make your mail-order prescriptions more affordable. When you enroll in EPP, you can spread your prescription payments over three installments. There is no waiting – your medication is shipped after the first payment. To get started with EPP, call the toll-free Medco number on the back of your prescription card or visit www.medco.com.
You may also save money by using preferred drugs from the Medco Drug Formulary. For example, brand-name drugs may have generic versions that may have lower copayments. Go to Preferred Prescriptions® for information and to access a formulary list of medications.
Certain specialty drugs which are injected or infused are subject to copayments. Please refer to the PCIP Brochure for complete information. Click for a list of PCIP’s current Specialty Drugs .
My Drug Costs
To find out what your cost share will be for a prescription drug under one of the three plan options, click on the plan option below:
- Standard Option
- Extended Option
- HSA Option
The links above will take you to Medco, PCIP’s prescription drug benefit manager. Once at the Medco website, enter your prescription drug name and you can find out exactly what you should pay out-of-pocket for that drug. The amount you will see displayed on the Medco site is your cost before meeting your plan deductible. If you have met your plan deductible, you can review what you will pay for prescription drugs in the PCIP Benefits Summary (PDF).
My Rx Choices
If you are a PCIP enrollee and you take medications on an ongoing basis, you could potentially save hundreds of dollars a year when you use Medco’s My Rx Choices online benefit service.
After you access My Rx Choices, you’ll get a confidential and personalized prescription drug comparison, listing the drugs you’re taking on an ongoing basis, your current out-of-pocket costs and any lower-cost alternatives – including lower-cost brand or generic drugs. From your personalized comparison, you can choose which lower-cost alternatives you want to try, confirm with your doctor that the alternatives are appropriate for you, and start saving money. Medco will not make changes without your doctor’s approval, and will notify you if and when changes are made.
Consumers unable to get health insurance because of a pre-existing medical condition now have a new option.
The federal government on Thursday began accepting applications for its new Pre-existing Condition Insurance Plan, which was authorized by the health care overhaul signed into law this year by President Barack Obama.
To be eligible, people must be uninsured for at least six months and have been turned down for coverage by a private insurer because of a medical problem. Applications for the insurance are available online at www.HealthCare.gov. Coverage starts Aug. 1.
The Pre-existing Condition Insurance Plan is a separate program from Texas’ high-risk pool, the Texas Health Insurance Pool. In the existing Texas Health Insurance Pool, premiums are set by state law at twice the standard individual market rates.
But in the new Pre-existing Condition Insurance Plan, premiums will be similar to average individual market premiums charged to healthy people in Texas.
Estimates on HealthCare.gov show premiums for a 50-year-old in Texas will be $491 to $600 for the Pre-existing Condition Insurance Plan. The size of the deductible has not been released.
In comparison, the state’s high-risk pool offers insurance for a 50-year-old nonsmoking man living in Dallas’ 75202 ZIP code for $520 a month with a $7,500 deductible.
If he wants a smaller deductible, say, $1,000, his monthly premiums would jump to $1,171.
As of June, there were 26,894 in the state’s high-risk insurance pool.
People in the state’s high-risk pool would not qualify for the government’s pre-existing condition insurance, because one of the requirements is to be without insurance for at least six months.
Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities, a nonprofit, nonpartisan Austin-based public policy research group, says the high-risk insurance pool will still be needed after the federal insurance plan goes into effect in August.
“It’s not a permanent solution,” Pogue said of the federal government’s new plan. “It’s just a temporary bridge to help them get to 2014.”
At that time, many of the main provisions of the health care overhaul will go into effect, including a rule requiring insurers to accept applicants with pre-existing health conditions.
Pogue said there’s little chance that a private insurer would start accepting people with pre-existing conditions now, because it would create an imbalance of unhealthy, expensive claim-filers.
“If you only have sick people in your pool, affordable premiums can never cover claims,” Pogue said.
Insurers have said they are willing to accept applicants with pre-existing conditions in 2014 because the law would then require everyone – healthy people included – to purchase insurance.
The risk and costs would be shared among more people.
The Federal Government has announced that, as part of the Affordable Care Act, U.S. citizens who have pre-existing medical conditions and have been turned down for health insurance may qualify for the Pre-Existing Condition Insurance Plan (PCIP). This program, acting as a bridge to full Affordable Care Act implementation in 2014, will give Americans access to affordable, quality health coverage through a competitive marketplace for health plans called a Health Insurance Exchange. This program is administered at the state level in 27 states and at the federal level in 23 states and the District of Columbia. Under this new program, you’ll receive health coverage for a wide range of medical benefits, including physicians’ service, hospital care and prescription drugs…and you won’t be denied or charged a higher premium for pre-existing medical conditions.
Like standard health insurance plans, you will be required to pay a monthly premium, a deductible and some cost-sharing expenses. Premiums may vary depending on where you live, your age and which health plan you choose.
To be eligible for this program you must be a U.S. citizen, have been without health insurance for at least six months and have a pre-existing health condition or have been denied coverage because of a health condition.
Brian Riddle, CEO of Emanuel Medical Center in Swainsboro, encourages anyone who has been denied coverage for a pre-existing condition to look into this program. “PCIP gives our citizens who have been denied health insurance coverage the chance to obtain competitively priced insurance for the first time. In 2014, the term ‘Pre-Existing Condition’ will be removed from our industry’s lexicon. But until then, PCIP will help fill the gap.”