Covered California and ACA related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the ACA and Covered California knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Why Haven't More Californians Signed Up for the Preexisting Conditions Insurance Plan?

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Question: I read in the newspaper that the Preexisting Conditions Health Insurance Plan was a bust. What happened?

Answer: It's not a failure by any means, however enrollment is less than expected so far.

Several months ago, the special insurance pools became one of the earliest facets of the new health-care law to take effect. They are intended as a temporary coping mechanism for people with preexisting medical conditions that traditional insurance companies do not want to cover. The program is temporary, because, starting in 2014, the law will forbid insurers to reject customers based on whether they are healthy or sick.

One must be a resident of California, have a pre-existing condition as shown by a
Rejection letter from a health insurance company in the last 12 months, or coverage offered with premiums higher than those of the state risk pool, be a U.S. Citizen, U.S. National or lawfully present foreign national, and have been uninsured for 6 month prior to application for the plan.

A fundamental problem is that insurance for people with existing medical problems remains too expensive for many. Monthly premiums range from $350 to $600 for a middle-aged individual in California.

Another hurdle is the requirement that an applicant must have been uninsured for 6 months prior to applying for the special risk pools. The thinking behind this requirement is to prevent a wholesale migration of insureds from existing state major risk pools to the new pools where rates and coverage are better. HHS needs to take a look at removing that requirement.

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