August 14, 2022

Bucks: Already Sick? You May Be Able To Afford New Government Health Premiums

If you have had trouble getting health insurance because you were already sick, the federal government is trying to make it easier for you to get coverage.

As of July 1, premiums for special government-administered health plans designed for people with pre-existing medical conditions will drop drastically in some states. The plans were established last year by the Affordable Care Act to help cover people with conditions like cancer, diabetes, asthma and other illnesses that made it hard for them to get coverage.

People with employer-based insurance generally can’t be denied coverage for a pre-existing condition. But those who are self-employed, or whose employers don’t offer insurance, must buy through the private market, and are often denied coverage.

Eventually, in 2014, the health reform law will require all plans to stop denying coverage to people because they are already sick. Until then, the law authorized the federal government to fund special plans as a temporary solution. In 23 states and the District of Columbia, the federal government administers the plans; in the other 27 states, the states run the programs using federal funds.

The plans have been available since last summer, but just 18,000 people have enrolled—far below the number the government estimates are in need. A big hurdle, says Larry Levitt, senior vice president at the Kaiser Family Foundation, is that even with a government subsidy, the plan premiums are too high for many to afford. “They’re sick, so it’s expensive,” Mr. Levitt said. “It’s a big barrier.”

To help get more people enrolled, the government is lowering the premiums in states where it administers the plans, to bring the monthly cost more in line with what a healthy individual would pay for private insurance. In some states, including Alabama, Arizona, Florida and Virginia, premiums will drop by 40 percent.

In Florida, for instance, the monthly premium for a 45- to 54-year-old will drop to $270 for the “standard” plan, down from about $450.

The drop in other states will be smaller but still significant: Nearly 16 percent in Georgia, 38 percent in Minnesota, 26 percent in Indiana. A complete list can be found here.

In states that administer the plans themselves, premiums may not change at all; it’s up to the states to decide and it’s unclear whether they will go along with the change. Even though they are using federal money for the plans, Mr. Levitt said, some states have been concerned that if they enroll too many people, they may feel pressured to contribute to the funding. That hasn’t proven to be a problem so far because so few people have enrolled. In Maine, for instance, just 13 people were enrolled as of March 31.

Applicants must still have been without insurance for six months to be eligible, but the government is easing other criteria. Previously, applicants had to submit a letter of denial from a health plan; now they can provide a letter from a doctor stating that they have a medical condition or illness.

The government is also going to start paying insurance brokers and agents for signing up customers for the plan and is working on getting the word out about the plans through consumer advocates in each state.

For information on how to enroll, visit www.pcip.gov.

Have you been denied insurance because you are ill? Would the government’s special plans be a possible option for you?

Article source: http://feeds.nytimes.com/click.phdo?i=3eeee185ce03d43d8e9df704f94c565a

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