Few know about helpful federal insurance plan

January 27, 2012

The Health Reform Act passed by Congress almost two years ago requires all health insurers to cover pre-existing conditions starting in 2014.  Until then, an interim program is available to help people who have serious or chronic medical problems.

Alison Ballai Alison Ballai's heart problems are covered by a federal insurance plan for people with pre-existing conditions who have been denied insurance. (Photo by Paul Atkinson - KJZZ)

But as KJZZ’s Paul Atkinson reports from Phoenix, few Arizonans have enrolled because they may be unaware it exists.

PAUL ATKINSON: Alison Ballai would sometimes cry herself to sleep after she and her husband lost their health insurance two years ago. Ballai tried to buy private insurance, but because of a pre-existing condition--a heart attack at the age of 52--no company would touch her.  

ALSION BALLAI: I have to have insurance, when you have heart disease or cancer, you have to be covered.  You can only do so much on your own financially.

ATKINSON: An insurance broker told Ballai about a new program called the Pre-Existing Condition Insurance Plan or PCIP. It was part of the federal health reform law approved by Congress in 2010. Ballai had to prove she had a pre-existing condition, had been turned down for insurance, and had been without coverage for at least six months.

ALSION BALLAI: I thought this could…save my life.  Because I didn’t have insurance at the time and I was really scared that if my artery blocked again, financially, my husband and I would be done, we’d lose everything.

ATKINSON: Ballai is one of almost 2,000 Arizonans enrolled in PCIP. The Centers for Medicare & Medicaid Services runs the program in Arizona and 26 other states. David Sayen is the regional administrator.

DAVID SAYEN: This program is intended to be competitive with the rates of what we call individual issued insurance…so if I have my own business or I work as a consultant and just go out on the market and try to buy insurance just for me -- these rates are commensurate with that.

ATKINSON: Sayen says monthly premiums for PCIP were recently reduced. Alison Ballai was paying $570 a month for individual coverage. She now pays $334. The plan works just like private insurance. Wellness checks are free, but there are co-pays for doctor visits and prescriptions. Once deductibles for each are met, PCIP covers 80 percent of costs, patients like Ballai pay the remaining 20 percent.

ALSION BALLAI: I feel relieved that I’m covered by medical insurance.  I’ve been to my doctor, my cardiologist.  I have regular checkups.  I can go to the pharmacy and feel good that don’t have to pay for all of my prescriptions, that I’m covered for some of it.  Just having that as a safeguard knowing that I’m insured in case anything else happens to me.

ATKINSON: Ballai’s only complaint is that few people are aware PCIP even exists.

ALSION BALLAI: I know there a lot of people that don’t have insurance that could probably be covered by this, but they just don’t know about it.

ATKINSON: Congress earmarked $5 billion to fund PCIP until 2014 when all insurance must cover pre-existing conditions. Close to 400,000 people were expected to enroll the first year alone, so, not much was spent on marketing. But David Sayen of the Centers for Medicare & Medicaid Services, says so far, only 47,000 people have signed up.

DAVID SAYEN: We didn’t have a large amount of dollars available to tell people about the program.  Actually, initially, we kinda concerned that we wouldn’t have enough money to sustain the program –that people would sign up so quickly.

ATKINSON: The government isn’t planning to increase funding for marketing, but Sayen expects enrollment to pick up as more people learn about the program. 

Pre-existing Condition Insurance Plan Website

1-866-717-5826  (TTY:) 1-866-561-1604

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