Pre-existing Condition? Now, a Health Policy May Not Be Impossible

http://www.nytimes.com/2011/03/19/health/19patient.html?_r=1

By WALECIA KONRAD
Published: March 18, 2011

SIX years ago, Jerry Garner, 45, a real estate agent in Gowen, Mich., underwent a kidney transplant. He recovered nicely, and thanks to diligent adherence to his drug regimen and frequent checkups, he has been healthy ever since — “a miracle,” said his wife, Stephanie.

But last year, the Garners were starting to believe that their good fortune had run out.

Mr. Garner’s insurer asked that he fill out a survey, but somehow this piece of mail slipped through the cracks at the Garner household. As a result, he lost his health insurance. (Ms. Garner, 44, and three of the children — their oldest child is grown — were covered under a different policy.) But because of his pre-existing condition, Mr. Garner proved impossible to insure.

Transplant recipients must take expensive immunosuppressant medications. Without them, the new kidney will not survive. The couple paid Mr. Garner’s $2,000 monthly drug bill out of pocket and prayed nothing went wrong. Some months they had to choose between the medication and the mortgage.

Finally, after weeks of searching the Internet, making phone calls and praying, Ms. Garner saw a television ad for Michigan’s new pre-existing condition insurance plan. P.C.I.P.’s, as they are known, are state and federal programs for people previously deemed uninsurable because of pre-existing conditions. They offer a bridge to 2014, when the new health insurance exchanges, which must accept all comers, are to open.

Mr. Garner applied to Michigan’s plan and was accepted. Now he pays less in premiums than he did under his previous plan, and he receives more comprehensive coverage.

“It was definitely an answered prayer,” said Ms. Garner. “Two thousand dollars when you’re already struggling is just impossible.”

Plenty of people with pre-existing conditions like Mr. Garner are struggling to find affordable insurance. These plans offer a real alternative, but consumers are only now becoming aware of them. Plus, there are some tough restrictions. Here is what you need to know:

FINDING A PLAN Pre-existing condition insurance plans, required by the new health care law, opened for business in July. The new plans come in two flavors: 27 states run their own plans with federal money, while the rest rely on the federal Department of Health and Human Services to administer the plans within their borders.

The new plans did not replace state high-risk pools, which have long offered insurance to people with pre-existing conditions. But the premiums in the new plans are generally much lower. That is why experts had worried that the new plans could be overwhelmed by a deluge of desperate applicants.

In fact, the P.C.I.P.’s got off to a slow start, and many consumers still have no idea they exist. In January, premiums in the federally run plans were reduced nearly 20 percent. Since then, enrollment in all of the new plans has increased 50 percent to 12,000 members.

To find a plan in your state, start with the federal government’s Web site, PCIP.gov, which offers lots of application information and details about each of the state plans the department administers. An interactive map at www.pcip.gov/StatePlans.html links to each federal- and state-run plan.

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