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U.S. Makes It Easier to Get Insurance With Pre-Existing Conditions

By Steven Reinberg
HealthDay Reporter

TUESDAY, May 31 (HealthDay News) -- U.S. health officials announced Tuesday that a reduction in premiums and an easing of standards for the federally administered Pre-Existing Condition Insurance Plan will allow more Americans to get health insurance.

Premiums under the Pre-Existing Condition Insurance Plan, which is part of the Affordable Care Act, will drop as much as 40 percent in 18 states. And standards for eligibility will be eased in 23 states and Washington, D.C., said officials from the Department of Health and Human Services (HHS).

"Before the law, too many people were turned away or shut out of the insurance market," HHS Secretary Kathleen Sebelius said during a morning press conference.

"You could be denied coverage if you were a breast cancer survivor or if you had a pre-existing health condition like diabetes or asthma. This forced people to skip care or medication and it has bankrupted way too many families and left people's health at risk," she added.

The reduction in premiums will offer real savings for people, Sebelius explained. "For example, consumers in Virginia will save almost $1,200 a year thanks to the premium reduction," she said.

The Pre-Existing Condition Insurance Plan was designed to help people with pre-existing health conditions get health insurance until 2014 when insurance companies can no longer deny coverage to people with pre-existing conditions.

In 23 states the federal government administers the program, while the other states use federal funds to operate their own program.

It's in 18 states where the federal government operates the program that premiums will drop. Decreasing premiums in these states will bring the premiums in line with rates already established in these states, which is mandated by the Affordable Care Act, HHS officials said.

In the remaining states, premiums were already at state levels and will not change.

"We are not just lowering premiums, we are making it easier for people to become eligible for the program," Sebelius said.

Beginning in July, anyone applying for health insurance coverage only needs to show a letter dated in the last year from a doctor, a physician's assistant or nurse practitioner stating that he or she has a pre-existing condition.

Applicants will no longer need to have a letter from an insurance company denying coverage, Sebelius said.

In February, children under 19 were given this option, which is now being extended to all ages. To take advantage of this program you must be a U.S. citizen and have had no insurance coverage for six months.

Starting this fall, the federal government will begin paying insurance agents and brokers to help enroll people in the program. The goal is to get more eligible people to take advantage of the program.

From November 2010 through March 2011, enrollment in all Pre-Existing Condition Insurance Plan programs increased 129 percent, with more than 18,000 people now enrolled, officials said.

The Pre-Existing Condition Insurance Plan is a comprehensive health plan that includes primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care.

According to HHS officials, the program limits out-of-pocket costs. Eligibility is not based on income and those who enroll do not pay a higher premium because of a pre-existing medical condition.

More information

For more on the Pre-Existing Condition Insurance Plan, visit the

SOURCE: May 31, 2011, teleconference with Kathleen Sebelius, secretary, U.S. Department of Health and Human Services

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