Help Available If You're Uninsured and Have a Pre-existing Medical Condition

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If you haven't been able to get real, affordable coverage for at least 6 months due to a pre-existing medical condition, you may now qualify for coverage through a new program called the Pre-Existing Condition Insurance Plan, or PCIP.

PCIP, often described as the “high risk pool,” is part of the new health law, the Affordable Care Act. PCIP is a temporary program that will expire when health insurance exchanges start in 2014.

PCIP applications are available now at PCIP.gov.

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Do I qualify for PCIP?
To qualify, you must: 1) be uninsured for at least the past 6 months, and 2) have had problems getting coverage due to a pre-existing condition.

How do I apply?
Complete the PCIP application and mail it in. (You cannot submit your application on line at this time.)

• You must include a copy of a recent letter from an insurance company showing that, because of your pre-existing condition, you were either: 1) completely denied coverage, 2) offered coverage that excluded certain benefits, or 3) (applies to children only) offered coverage that costs at least twice as much as PCIP.
• Until August 15, you'll also need to include a copy of a document showing you are a U.S. citizen or are lawfully present in the U.S.

What is covered?
PCIP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to you, even to treat pre-existing conditions.

How much will coverage cost?
Premium amounts won’t be released until July 15. If you apply before then and qualify, you'll get a letter saying how much your premiums will be. You won't be charged more based on your health. (The estimated premium for a 50 year-old is between $552 and $675.)

When should I apply?
Apply as soon as possible. Applications will be processed on a “first come, first served” basis.  Because of limited funding, only about 25,000-30,000 Floridians will be able to get coverage through PCIP, far less than need it.

Do I have other options?
Many children under 19 may qualify for Florida KidCare. Some low-income adults who are unemployed or especially vulnerable may be eligible for Medicaid. To learn more about what coverage options you may have, visit healthcare.gov. This new health insurance website will explain what those plans cover and how much they cost.