Federal Officials Offer New Options For High Risk Insurance Coverage In Effort To Boost Enrollment

The Department of Health and Human Services (HHS) announced new plan options and lower premiums in the 24 high risk insurance pools that are under federal control in an effort to bolster enrollment in the fledgling program. The so-called Pre-Existing Condition Insurance Plan (PCIP) functions as a bridge to the Affordable Care Act’s exchanges for people who can’t find affordable coverage in the individual market, but thus far, the program’s high premiums have kept many eligible individuals from enrolling. The program currently boasts just 8,011 beneficiaries.

Starting January 1, however, Americans enrolled in a federally-run PCIP program, will have two new coverage options: a plan with a $1,000 deductible and $250 deductible for prescriptions, a $2,000 deductible with $500 deductible for prescriptions and the exiting option of a combined medical and prescription drug deductible of $2,500, which will be paired with a federal health savings account.

“Adjustment in rates in existing and new premiums will be nearly 20 percent below what is currently being charged today, “ Richard Popper, Director for the Office of Insurance Programs in HHS’s Office of Consumer Information and Insurance Oversight, a said on a conference call attended by the Wonk Room. He suggested that PCIP enrollment levels are comparable to the early enrollment rates in CHIP and predicted that the program’s “enrollment continue to grow and with the change in premiums we see that trend escalate.”

In working towards that end, the government is also stepping up its outreach and enrollment efforts:

– Working with states in the federally-run pool programs to encourage their state insurance departments to require individual market insurance companies to notify those who may deny coverage about the availability of PCIP.

– Encouraging insurers to notify denied applicants about the PCIP option. A number of insurers have agreed to put notice in their denial letters about availability of PCIP.

– Working with the Social Security Administration to inform individuals under 65, who are not yet eligible for Medicare, about PCIP.

– AARP has sent out notices to their 24 million members about the availability of PCIP.

Some of the 27 states that are operating their own high risk health insurance pools are already offering similar options and all states will have “the opportunity to submit any changes they would like to make in their benefits or premiums for 2011.” “But we are not requiring the states to exactly adopt the changes that we are rolling out,” Popper said. “This program is largely build on state flexibility. With that flexibility and with the available products available we don’t feel the need to require them to copy what’s being done on the federal pool level.”


“We are doing everything we can do get as much enrollment and we’re doing as much outreach and we think premiums will help and hope that other states will follow suite,” Liz Fowler, Director for Policy in HHS’s Office of Consumer Information and Insurance Oversight said on the call.