Friday, July 2, 2010

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. http://www.wsmv.com/health/24114532/detail.html

    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 healthcare.gov, 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.


7 comments: