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  • The Affordable Care Act was established in March 2010
  • PCIP plan gives patients with pre-existing conditions a choice in healthcare providers
  • Routine doctor visits and certain prescriptions are covered under the PCIP plan


The pre-existing health insurance plan from Healthcare.gov is part of the Affordable Care Act that became effective in March of 2010. It provides people with health coverage if you have previously been denied and without medical insurance for six months or longer. To qualify, you must meet both criteria and be a legal resident of the United States.

The pre-existing health insurance plan program is available on two levels, state and federal. Currently, 27 states have programs that are run on a state level, and 24 are controlled on a federal level.

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What kinds of benefits are available?

adobestock_55566404-1600x1600You can verify what type of assistance you qualify for by accessing the government healthcare site. You will be directed to a map of the United States. You can then select your region and review the information that relates to you. Millions of Americans are unable to receive adequate health care due to lack of insurance.

The irony is that most who require medical assistance are those who have pre-existing conditions and these people are often caught in a never-ending catch-22 scenario from which they cannot escape.

Luckily, the PCIP plan can help patients who suffer needlessly by providing them with the best possible treatment at a price that is comparable and reasonable.

You can expect to have coverage for hospital visits, routine doctor visits, and prescription drugs. You are also able to see any specialist that is required to treat your pre-existing condition.

Do I have to pay a high deductible?

Unlike traditional health insurance policies and procedures, you will not be subjected to an astronomical rate simply because you have a pre-existing condition. You will be treated fairly and only expected to pay premium rates based on the type of plan you select.

Because the plans are either state or federally controlled, the common factor for all new health insurance applicants will be based on the state in which they reside and the individual program specifications.

You will no longer be considered high-risk because you have a chronic illness and your income is taken out of the equation.

Previously, patients who suffered from pre-existing conditions found it extremely difficult to purchase affordable health insurance. The PCIP plan gives you options that you never thought possible and you can choose a plan based on your medical requirements, rather than your risk group.

How can I confirm eligibility?

adobestock_107423396-1600x1600There are several steps involved with verifying if you qualify for the PCIP plan. Just because you have a pre-existing condition, does not necessarily mean you are automatically eligible.

To find out for sure, you will need to complete a few questions or provide documentation. Some specifics include:

  • Proof of citizenship – You must be able to produce a birth certificate or documents that show your legal right to reside in the United States of America.
  • Proof of your medical situation – Your medical records should have details regarding your pre-existing condition.
  • Proof of health insurance denial – You should have letters or email’s from each health insurance provider who denied you coverage.

You may also need to keep records of the health insurance companies who accepted your application, but quoted a price that you could not afford; this may help with your eligibility requirements, especially if you live in a state where health insurance is guaranteed.

Are there any restrictions on the PCIP plan, like other health insurance plans?

There are restrictions that apply to approved applicants. Some of these restrictions include:

  • Elective surgery – Any type of surgery that is aesthetic but not necessary is covered. For example, you may want a scar removed because of the location. This procedure will not be covered because it does not relate to your condition, considered life threatening, or deforming.
  • Experimental procedures – Unless the experimental procedure or surgery is relative to your pre-existing condition and will improve your quality of life, you will not be covered.
  • Fertilization procedures – Things like donor egg transplants or artificial insemination are not included in the PCIP plan.
  • Pregnancy termination – Your plan will not cover pregnancy terminations unless it is deemed a medical emergency. There are also certain situations like rape, where the PCIP plan will provide coverage.

While the Affordable Care Act of 2010 is not scheduled to fully activate until 2014, this new law can help virtually hundreds of thousands of Americans who have been without ample health insurance for so long. Long suffering patients may soon find themselves eligible to receive the type of health care they really deserve.

Unfortunate circumstances may occur in life; it is very important that you be protected against sickness and injuries. Having the ability to purchase health insurance at an affordable rate is something that Americans will appreciate for many years to come.

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[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]

  1. http://Healthcare.gov
  2. https://www.healthcare.gov/coverage/pre-existing-conditions/
  3. http://www.medicalnewstoday.com/info/medicare-medicaid
  4. http://obamacarefacts.com/pre-existing-conditions/
  5. http://www.lifenews.com/2013/09/06/21-states-ban-insurance-coverage-for-abortion-does-yours/
  6. https://en.wikipedia.org/wiki/Affordable_Health_Care_for_America_Act