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New Plan Options for Federally Administered Pre-Existing Condition Insurance Plan in 2011

May 7, 2011 By Leave a Comment
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Taken from healthcare.gov

The Department of Health and Human Services (HHS) announced new plan choices for people enrolling in the Pre-Existing Condition Insurance Plan (PCIP) for 2011.  These options will give current and future enrollees a greater number of coverage choices and allow people to select the plan that best meets their needs.  The new options will be offered in a three-tiered structure beginning January 1, 2011, and will be available in States where the program is federally administered through the Office of Personnel Management.  These choices build on the current single plan option: experience with the program has provided valuable information that has allowed for the creation of new and improved options.

The federally administered program is available in 23 States and the District of Columbia.  To find out if your State’s PCIP is federally administered please visithttp://www.healthcare.gov/law/provisions/preexisting/index.html

PCIP provides Americans living with such conditions as cancer, diabetes, or heart disease the opportunity to obtain insurance coverage.  The program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market.  In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through a new competitive marketplace, and insurers will be prohibited from denying coverage to anyone based on the state of their health.

For more information about eligibility and benefits please visit www.pcip.gov.

Expanded Plan Options in 2011

In 2010, people enrolled in the federally-administered PCIP program were offered one plan.  Beginning in 2011, such enrollees in the federally administered PCIP program will be able to choose between three plan options:  the Standard Plan, the Extended Plan and the Health Savings Account eligible plan.  In addition, families will be able to enroll their eligible children in PCIP at child-only rates.  These options will allow enrollees to select a plan that best meets their needs.

2011 Standard Plan

The existing option in PCIP has been improved.  The 2010 Standard Plan had a single, combined medical and pharmacy deductible of $2,500.  The 2011 Standard Plan now has two separate deductibles — a $2,000 medical deductible and $500 drug deductible, while also offering premiums that are almost 20% lower than the 2010 premiums.  The reduced pharmacy deductible is particularly beneficial for people who take one or more maintenance medications.  The lower premiums result from experience and are expected to be more affordable for the eligible population with pre-existing conditions.

2011 Extended Plan

A new plan option, called the Extended Plan, has a $1,000 medical deductible and $250 drug deductible plan.  The premiums for the 2011 Extended Plan will be slightly higher than 2010 premium levels.  Just as with the Standard Plan, separating the drug and medical deductibles makes this plan option more valuable for those enrollees who take one or more maintenance medications.

Health Savings Account Option

The Health Savings Account (HSA) Option will carry a $2,500 deductible but with premiums that are 16% less than 2010 premiums.  As with the current plan, this option is eligible to receive favorable tax treatment by the federal government when used with a Health Savings Account (HSA).

Child-Only Rate

To ensure that children have more affordable access to coverage, HHS has established premiums targeted for covering children under PCIP, creating a child-only rate for PCIP enrollees between 0-18 years of age.


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Health Care Bill

October 24, 2009 By Leave a Comment
U.S. Capitol

by Benny Arce

The cost of health insurance in the United States is increasing at a faster rate than either wages or inflation. This means that if this trend continues more and more Americans, particularly those who have to purchase it on their own, will be unable to afford any form of health insurance.

In the face of this, President Barack Obama and other Democratic leaders are trying to pass legislation aimed at making insurance coverage more affordable. Critics, however, argue that even with their proposals, such a coverage would still be beyond the reach of most of the middle class.

The proposed legislation, while requiring insurance coverage for all Americans –whether through an employer, a government program, or a private purchase— offers tax credits to help pay for the coverage.

Some Calculations

An online tool called The Health Reform Subsidy Calculator that was developed by the Kaiser Family Foundation provides an idea on how far the proposed tax credits under the Democrats’ health care bills can go to help families of varying income and age levels.

Using a family of four with a 45-year-old household head earning $63,000 a year as an example, the Calculator estimates that that family will need a policy worth $11,080 to provide sufficient coverage. However, under the bill proposed by Sen. Max Baucus, D-Mont., the family is only entitled to $3,970 in tax credits to help pay for the policy.

It will have to shell out $7,110. That is 11% of the family’s total income.

The Health Reform Subsidy Calculator does not even take into consideration co-payments and deductibles. Analysis by a Congressional Budget Office estimates that this could add another 9% to the total cost of coverage.

The Problem Sectors

In order to stay within the President’s goal of a $900 billion health care reform budget over ten years, Congress is trimming the budget for subsidies, at least in the Baucus plan. This leads to higher premiums than in earlier health reform proposals.

A Senate Health, Education, Labor, and Pensions Committee plan submitted earlier would provide the hypothetical family mentioned above $2,500 more in assistance.

Persons who need to purchase their own health insurance coverage such as small businesspeople and freelance workers are directly affected by the higher premiums. For those whose coverage is based on their jobs, their employers will continue to pay for the policy.

The bill provides the highest subsidies to those who are at or near the poverty line. These can be as high as $22,000 for a family of four. And here is where another problem lies. Of the uninsured, three-fourths belong to households that earn less than two times the poverty level.

Subsidies decrease as income rises. For a family with four members making $45,000, federal assistance is at 71%. If another family of the same size makes $63,000, the figure is 36%. For one that makes $90,000, the subsidy disappears altogether.

Not Soon Enough

If the Baucus proposal passes, tax credits aren’t forthcoming. The first will only be released in 2013 following the next presidential elections in order to keep costs down. The affordability of health care insurance has to be considered against the backdrop of its cost to the government.

It’s Not Over Yet

The bill is still being debated. Compromises and modifications might yet be necessary. Last week, for instance, Baucus’ committee approved provisions that would exempt a certain class of individuals from buying health insurance. This may end up exempting some two million, a far cry from the original plan to require insurance for all Americans.

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Medicare’s Coverage Gap: Seniors and families feeling a big bite in costs

August 24, 2009 By Leave a Comment
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by Rose Broyles

This is the predicament we are currently in. In fact, I just had to make a call to my dad’s doctor today to see if there is a lower cost alternative to Advair, the drug my dad needs to control the symptoms of his COPD and asthma. But before I get into all of that, what exactly am I talking about?

What is the Medicare Coverage Gap?

There was a story showcased on CBS Evening News regarding the Medicare Coverage Gap or “Doughnut Hole” back in 2006. Unfortunately, nothing has changed to alleviate the problem of Medicare Coverage Gaps.



Watch CBS Videos Online

While the debate rages on in this country about how much the government needs to get involved in healthcare, people like my dad are seeing their only means of living depleted by high prescription costs. You see, my dad reached the threshold for the amount that Medicare will pay for his medicines. He does have Secure Horizons but they have already paid out their share and so Dad is responsible for the rest of his. At least, this is what the representative told me on the phone. Health insurance is so confusing!

Regardless, what was $30.00 for Advair is now $200.00. This price is for one medicine! Don’t forget, we also have all of Mom’s prescriptions, some of which cost around the same price without additional help from insurance.

Options to Consider

While I wait for Dad’s doc to get back to me on other generic alternatives, I’m trying to find other ways for us to afford these medications until January when everything resets and Medicare covers everything again. Medicare Interactive has a list of suggestions to follow if you fall into the “doughnut hole” . You can read more about the details of each, but I will summarize the suggestions below.

  1. Ask your doctor
  2. If you have extra help, find out about a mail order option.
  3. Request that your loved one’s  plan put your drug in a lower “cost tier” . This will require a formal request from the primary care doctor. Ask them to put your loved one’s plan and ask for an “exception” to the formulary.
  4. Some pharmacies and hospitals will waive copays for people with low incomes
  5. Some states offer pharmaceutical assistance programs that help their members pay the out-of-pocket costs of a Medicare private drug plan.
  6. Some charities may pay a portion or the full cost of your Medicare prescription copays.
  7. Catastrophic coverage.
  8. Some pharmaceutical companies have Patient Assistance Programs (PAPs) that offer low-cost or free drugs to people with low incomes.
  9. Lower price at the pharmacy.
  10. Prescription drug discount programs. You can try a place like http://www.needymeds.org/drugcard/index.shtml to see if you can get big discounts on prescriptions.

***I’m going to add another suggestion here which we in fact, are going to try if his doctor can’t give us a good generic that’s affordable. We’re going to ask him if it would be ok for us to order from Canada and get a prescription. Canada follows a very strict quality control of medicines in the same way that the FDA does for us.

Therefore, their drugs are of high quality and safe to use. Advair is on sale for $249 for a 3 discus pack as opposed to around the same price at CVS for one.

This is also the actual brand name. So, this sounds like a great deal. There are of course, a ton of other drugs available of up to 80% cheaper than the drugs you will find here. Now, not to say that we couldn’t just drive across the border to Mexico to get prescriptions (I know some people who do) but I feel more comfortable ordering from Canada because of their stringent standards.  Now be careful of just ordering from any online pharmacy that claims to be Canadian. You have to make sure they are the real deal. Since we are partnered with Canada Pharmacy.com and will be ordering from them ourselves, they are verified by pharmacychecker.com and certified by the Canadian International Pharmacy Association . The seal itself isn’t a guarantor of authenticity so you should directly go to CIPA’s website and manually enter the pharmacy name in their search box.

So, as another challenge presents itself to us, Dad has to forgo this important medication for a couple of days while we figure things out. What happens though to the millions of other seniors who do not have family to help them? This is where I feel people should put their politics aside and at least, regardless if we have a nationalized healthcare system or not, consider the most vulnerable of our nation–seniors and children. They should be attended to, if not everyone else. This is a prime example of why our healthcare system needs serious reform.

**Update: Later today we got a call from Dad’s doctor’s office. Tomorrow we will have to pick up samples! So there you have it, it was option 1 from above! This is only a temporary fix so I still have to see what else we can do. It looks like we will end up getting some meds through Canada.


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