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Act fast to get this health reform benefit

Act fast to get this health reform benefit

Q As a diabetic I am medically uninsurable here in Colorado where I live. At 57 I’m too young for Medicare and I’m not eligible for Medicaid. Is there anywhere else I can turn?

A Yes, but you better be fast about it, and also thank your lucky stars you live where you do. A temporary program of federally subsidized state high-risk plans for people in your situation is about to shut down early, but if you act quickly you can get into Colorado’s just under the wire. Unfortunately, the plans have already closed to new enrollees in many other states.

Here’s what’s going on. The Affordable Care Act set aside $5 billion to fund something called the Pre-Existing Insurance Plan (PCIP). Every state had a PCIP, open to people with pre-existing conditions that made it impossible for them to get affordable private coverage and who had been uninsured for at least six months. Subsidies from that $5 billion brought premiums down to what healthy people would pay. The federal government operated PCIPs in 23 states and the District of Columbia (indicated in blue on the map below), and the other 27 states (in yellow) elected to run their own plans.


By design, the PCIPs were slated to shut down at the end of 2013, because starting in 2014 people with pre-existing conditions may no longer be turned down or charged higher premiums so they can buy coverage on the open market.

But a funny thing happened in the meantime: the PCIPs are running out of money. Among their 135,700 enrollees are “some of the sickest people, who have immediate and expensive health care needs,” says Brian Cook, a spokesman for the U.S. Department of Health and Human Services. In 2012, the average cost per enrollee was more than $32,000 a year.

To make sure people already in the plans don’t get kicked off before the end of the year, HHS closed all 24 federally-run plans to new enrollees on Feb. 16. It allowed the state-run plans the discretion to continue to accept new enrollees until March 2.

Additionally, people already in a PCIP who move to another state will be allowed to transfer to the new state’s PCIP.

Cook said there’s no master list of which state-run plans are extending the deadline. But I contacted Colorado’s state-run plan, GettingUSCovered, directly and learned that as long as you get your application in before March 2, and qualify, you can get coverage that starts April 1. So get cracking, and good luck.

For more information, see our Health Insurance Buying Guide as well as rankings of health insurance plans.
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