In the past, many Americans have been unable to obtain private health coverage at any price because of a pre-existing health condition. Now, as a result of the new health reform law (the Affordable Care Act), individual states or the federal government have begun offering coverage to these previously uninsurable individuals. These Pre-Existing Condition Insurance Plans are transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive insurance exchanges. (In 2014, Members of Congress will also be required to purchase their insurance through these exchanges.)
Since July, eligible residents of Pennsylvania have been able to apply for coverage through the state’s Pre-Existing Condition Insurance Plan which is being run by the Pennsylvania Insurance Department.
To qualify for coverage:
• You must be a citizen or national of the United States or lawfully present in the United States.
• You must have been uninsured for at least the last six months before you apply.
• You must have had a problem getting insurance due to a pre-existing condition.
The PA Pre-Existing Condition Insurance Plan is called PA Fair Care. It covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a pre-existing condition.
Premium: $283.20 per month
Deductible: $1,000 in-network, $10,000 out-of-network
Out of Pocket Limit: $5,000 in-network, $20,000 out-of-network
More information on the Pennsylvania Plan is available at the following links:
- To access the online application, you may click this link, or you may copy and paste this link into your web browser: https://www.humanservices.state.pa.us/Compass.web/MenuItems/FCSystemCompatibility.aspx
Information on the following topics is available at http://www.pafaircare.com/:
Eligibility and Availability
How to Apply
Fact Sheet on PA Fair Care
Link to news release announcing approved proposal
Link to the final proposal
Link to news release announcing proposal submission
Link to Health Care Reform & You page
In addition, a toll-free number, 1-888-767-7015 (TTY 1-888-767-7018), is available to help you. This PA Insurance Department call center is open Monday thru Friday, 8:30 a.m. to 4:30 p.m.
Pennsylvania is one of 29 states and the District of Columbia which have chosen to run their own Pre-Existing condition insurance programs. The other 21 states have elected to have the federal government (HHS) administer the plans. If you are not a Pennsylvania resident you can get more details, including a list of states in each category, by clicking here. For information on how to apply for coverage, click here.