Individuals who are uninsured when diagnosed with cancer are faced with the very practical question of how they are going to pay for their health care.
Some states have major risk insurance plans or high risk pools that provide insurance coverage to individuals with pre-existing conditions.
Because these plans are subsidized by each state, the monthly premiums are typically lower than what it would cost for an individual health insurance plan. Unfortunately, these plans aren’t available in every state, some states have closed their programs to any new individuals, and some states have annual limits on the benefits, which are easily reached by someone getting cancer treatment. In addition, some states have proposed cutting their programs entirely, because of the current economic environment and state budget crises.
However, these plans may be a very good option for someone with a pre-existing condition who needs access to health insurance coverage.
There is also a relatively new health insurance option available, as part of health care reform, called the Pre-Existing Condition Insurance Plan (PCIP). PCIP is a good option for individuals who are uninsured when they are diagnosed. To be eligible for PCIP, you must:
• have a pre-existing condition;
• have been without health insurance coverage for the last six months; and
• be a citizen, or reside in the U.S. legally.
These plans are available in every state and are similar to any insurance plan that you might find being sold in your state, except that you cannot be denied because you have a pre-existing condition. Some state PCIP plans are operated at the state level and some state PCIP plans are operated by the U.S. Department of Health and Human Services (HHS). Be aware that PCIP plans operated at the state level may be called by other names.
PCIP plans cover a broad range of health care benefits, including primary care, specialists, hospital care, and prescription drugs.
According to HHS, if you submit your complete application on or before the 15th of any month, then your coverage will start on the first day of the next month.
Monthly premium rates do vary based on age and where you live. Premiums and annual deductibles are also different in each state. For example, in Texas, a 40-year old individual can get a plan for as low as $240 per month. In California, a 40-year old individual can get a plan for as low as $261 per month.
For more information about PCIP, click here.
If you are in the middle of treatment and want to find out if your providers and part of the PCIP network, click here.
If you have had insurance during the last six months and are ineligible for PCIP, you can visit www.HealthCare.gov. This website was created by HHS to help people find information about their specific health insurance options. If you are looking for health insurance coverage for your child, click here.
Cancer can be a life-changing experience. Learning about your legal, financial, and insurance options can help you successfully navigate the maze of cancer survivorship.
Joanna L. Morales, Esq. has served the cancer community as a cancer rights attorney, advocate, speaker, and author for over 18 years. She is currently Principal at North Star Alliances, a nonprofit and business consulting firm. She was formerly the Director of the Cancer Legal Resource Center and an Adjunct Professor at Loyola Law School, teaching cancer rights law. She can be followed on Twitter @CancerRights and @NStarAlliances.