On March 23, 2010 the Patient Protection and Affordable Care Act was enacted bringing hope to potentially millions of uninsured Americans, millions who could not get or afford health insurance by traditional means. On July 1 of this year HealthCare.gov, a website related to the Affordable Care Act and managed by the U.S. Department of Health & Human Services, went live.
While robust and educational, those with pre-existing conditions with be sorely disappointed once they are redirected to the sister site, PCIP.gov, (“PCIP” being short for Pre-Existing Condition Insurance Plan), especially those who live in the state of Florida.
Florida residents can expect to pay the highest premiums in the nation when compared to the nineteen other pre-existing insurance plans run by the Department of Health & Human Services. In addition, a $2500 deductible must be met before benefits, mirroring a standard 80/20 insurance plan, kick in. Further details are below.
Pre-Existing Condition Insurance Plan: Florida
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods.
The monthly premiums for your state are:
In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year. However, your out-of-pocket costs may be higher if you go outside the plan’s network. See below for a benefits summary.
If you apply for PCIP coverage, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed.
Compare the rates of Florida to those for Wyoming,
or even Mississippi, the unhealthiest state in the nation for nine years running
and it is a mystery why Florida would be so high.
While the good news is that at least coverage will now be available for those with pre-existing conditions, the Affordable Care Act proved to be anything but for them.