The Real Cost Of PCIP(Pre-Existing Condition Insurance Plan) Health Care.

For those uninsured in America because of a pre-existing condition, Obama says help is on the way. And by help he means a vague new insurance that costs a lot and the benefits of which are as of yet completely unknown. Sounds like the government to me.

The new Pre-Existing Condition Insurance Plan went in to effect July 1st and is aimed at covering people who were previously uninsurable because of a wide range of 'pre-existing' conditions. Health Insurance companies had some pretty broad definitions of what that meant. Diabetics, people with cancer, obese people, etc. However, the problem was in how these conditions were defined. In the case of obese people, even someone who is packing a few extra pounds could be considered a high risk patient and denied coverage, or your premiums could skyrocket to help offset the cost of your inevitable demise to heart disease, etc.

Under the new PCIP, these people will have the opportunity to get some much needed health insurance. Is there a catch, you say? Yes, there always is. There is a website with information about the new plan that you can browse and download an application to be considered for this new plan(Available in English and Illegal, err I mean Spanish.) The plan is broken up in to two distinct versions, and the costs vary from state to state.

The first version is for states whose PCIP program is run by the U.S. Department of Health and Human Services. These states are North Dakota, Minnesota, Idaho, Wyoming, Nebraska, Nevada, Arizona, Texas, Louisiana, Mississippi, Alabama, Georgia, Florida, South Carolina, Tennessee, Kentucky, Indiana, Virginia, Delaware, and Massachusetts. In some states this law is in competition with existing laws in those states. Tennessee, for instance, has AccessTN, which will cover people with pre-existing conditions. The cost of the PCIP in Tennessee is between $500 and $600. The cost under AccessTN is between $200 and $1000.

Here is a breakdown from WSMV in Nashville.

    For Tennesseans with incomes less than $64,000 for a family of three or $75,000 for a family of four, AccessTN may still be the best choice because premium discounts of 20, 40 and 60 percent are available. The waiting period is only three months, compared to six months for the new PCIP.

The prices in states that are run by the U.S. Department of Health and Human Services range from between $356.00 and $435.00 in Wyoming, to a whopping $552.00 and $675.00 in Massachusetts.

That might be do-able for some, however you need to consider the deductible. In most cases it appears to be between $1,000 to $2,000 dollars if the doctor you are seeing is 'in-network' to $10,000 or more for out of network coverage. So even if you qualify, you are looking at blowing a minimum of $1,000 before the government even lifts a finger to help you.

On average I accrue less than $1,000 in medical debts over a two year period. So for me, this is definitely not an option. Should you be unlucky enough to live where there are no doctors that are 'in-network' you will be giving up 1/3 to ½ your yearly income before your PCIP kicks in. The real WTF-factor here is the fact that only people with serious or terminal illnesses are going to spend more than $10,000 a year on medical bills.

If you are for instance, fat, you probably might need to take meds to control your diabetes, or your high blood pressure. Medication for diabetes can run between $80-$200 a month, most blood pressure meds can be purchased at Wal-mart for about $4 a month. So between doctor visits, and medications, you will be looking at spending at least the first 4-6 months of the year paying for your treatment yourself. Some of the plans did mention what the deductible was for medication and how much it would cover yearly, but It's still a little vague, so I'll update this later with more accurate information.

The second version is for all other states, they will be running the program themselves. The costs are about the same, however some states, like New York for instance, don't even know what that Deductible or the Out of Pocket Limits are going to be yet. I guess we will just have to wait and see.

This is a very scary prospect for me, as a resident of New York. The state is in dire financial straights right now. Delayed tax return payments, delayed payments to non-profits that rely on the states help, some counties have run out of money to pay for their Social Services/Welfare programs and are being told they will have to wait for more funds. Can we seriously expect the funds for the PCIP program to be there??

According to, the plan:
  • Will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to you, even to treat a pre-existing condition.
  • Won’t charge you a higher premium just because of your medical condition.
  • Doesn’t base eligibility on income.
Let's look at those last two statements. Won’t charge you a higher premium just because of your medical condition.It doesn't have to charge you a higher premium, it's already is high. It doesn't base eligibility on income. What if I can't afford even regular health insurance, let alone the premium for having a pre-existing condition? If I can't afford your sparkling PCIP, will Medicaid cover all my bills as effectively? What if I make too much to get Medicaid, but not enough to afford your PCIP program?

This plan will stay in effect until 2014, when it will become illegal for insurance providers to deny coverage to adults based on a pre-existing condition.(OFF TOPIC RANT ALERT:Even though insurance companies are jerks for denying people coverage A.They are a business and have a right to do so, and B. It is not, nor should it ever be the Governments job to dictate how and when a business can keep or lose customers. There is no defense issue here, no issue demanding regulation by the transportation commission, no issue with the environment, no issue with the border. Somehow, the Government has decided that my business needs to add people to it's roster, even if said people could cause my business to file for bankruptcy. Ummm...Well than. Where's my bailout?)

All in all, if you are one of the millions of Americans with a pre-existing condition who have been praying for help, this will only be a miracle for those of you who are already in a hospital dying, or have at least an extra $1,000 lying around to pay for the deductible. I feel sorry for those people who were cheering for “socialized medicine” and “free health care for all”. I'm sorry, on what planet is this considered free? To be fair, in England, if you have a pre-existing condition, you could end up in a hospice, being denied food and water, until you die. I would love to see people who desperately need help, get it. But Apparently the Obama Regime feels differently. They are offering us castles of hope, but making them out of paper. When they inevitably fall, we see that there was nothing there in the first place.

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Anonymous said…
Your slang and assumption that all those who speak Spanish are illegal make you sound ignorant.
Anonymous said…
I have a bad back and have been unable to get insurance for 4 years because of it. This plan isn't great but $236 a month and a $1000 deductible doesn't sound that bad even if I have to drive 4 hours to get the care compared to the alternative of having no insurance. I paid $22,000 3 years ago for surgery. I'll be having surgery again in 2 weeks this time thanks to this plan it's gonna cost about $3,000. Seems good to me. It would have broke me to have to pay full price again.
Anonymous said…
You, sir, are an idiot. PCIP is a godsend for anyone who is uninsurable due to serious medical problems, not just those already dying.
Anonymous said…
The author unfortunately has no idea what it is like for people with real pre existing conditions. Who spend significant money on a monthly basis just for a modicum of stability. My monthly PCIP payment is far less than my current monthly medical bills, and my deductable is taken care of within the first month or two, depending on what I get done. Not only will I be able to save money on medical costs, but i'll be able to get things done that may actually bring improvement and i'll also have insurance in the event of another injury or illness. This may not be the best solution, but it is far better than what existed before. The only reason it isn't better is the democrats attempted to compromise with the republicans, who even with the compromises still wouldn't vote in favor - a shining example of how big a baby most of the republican block is/was.

It just goes to show, anybody can blog and they definitely don't need to be educated or even fully aware of the issues that surround what they blog about.
Anonymous said…
Yes, of course. The Republicans are big babies because the Democrats put together a 3,000+ page document that most of them never read, don't know what it contains, and don't care.

The Republicans are big babies because after taking the time to do the math they realized this cobbled together piece of legislative ridiculousness will not be the cost saver that they had originally claimed it would be.

And of course the Republicans are babies because they had the nerve to follow the will of the people and try and stop this piece of garbage bill from wrecking our economy, killing jobs, and raising our debt to astronomical levels.

Ohh, and let's not forget that during 2009 the Republicans only put forward 30 health care bills that helped seniors, veterans, and the disabled get more help and save them money. All were summarily rejected by the Democrat controlled house.

Most of those bills were not anywhere near 3,000 pages, didn't contain tons of useless pork, or hidden tax increases and restrictions on businesses.

God, what a bunch of meanies those evil Republicans are. How dare they try to give us health care that won't bankrupt the country and send senior citizens to an early grave. Shame on you. you filthy conservative scum.
Beth said…
I don't have a "serious" or "terminal" illness. I have multiple sclerosis. The disease modification medication I am on (common to many MS patients) costs $3,000 a month. No typo: $3,000 a month! So, I consider myself lucky to have a state high risk pool insurance that "only" costs $1,100 a month and picks up my drugs after I pay $2500 per year. That translates to about $16,000 per year for drugs and insurance. That doesn't count the yearly MRI or the doctors visits. It is outrageous! I would LOVE, LOVE, LOVE to have pcip, where the insurance is only $300 a month, with about $6000 the max out of pocket. But I would have to be uninsured for 12 months. Who knows what the true cost of these drugs are, I'm sure my state and myself are picking up the tab for lots of others. I'm a conservative, but the health industry needs some overhaul. It is out of control. Medical insurance is now an American's family second home, whether or not they wanted one.