Help is on the way for people who are uninsured because of a pre-existing condition such as heart disease, diabetes, cancer or AIDS — if they can afford it.
Floridians can now apply for health coverage through a new federal pre-existing condition insurance plan, also known as a high-risk pool. It is one of the first programs to take effect under the new health reform law.
The plan is a temporary fix that's supposed to cover this high-risk group until Jan. 1, 2014, when more permanent components of the health reform law take effect. In 2014, insurers will no longer be able to exclude people with pre-existing conditions, and a new health insurance exchange is expected to offer more affordable premiums for them.
But even as the new program launches this week, many questions remain. It's unclear at this point whether the program will be able to accept everyone who applies, since no one knows how long the $5 billion set aside for the program will last. And there's concern that many will not be able to afford the premiums, which in Florida can be more than $900 a month, depending on your age and health condition.
Here are the basics:
What is a pre-existing condition?
It's a health condition, disability or physical or mental illness that you have before you enrolled in a health insurance plan.
Who can apply for coverage?
You must be a U.S. citizen or legal U.S. resident and have been previously denied insurance coverage because of a pre-existing condition. And you must be uninsured for at least six months before applying. State health officials estimate that as many as 760,000 Floridians meet the criteria.
How do you apply?
You can download and print out an application in English or Spanish at a newly created website, www.healthcare.gov. Applicants must include a copy of a letter from an insurance company denying coverage or excluding coverage for a medical condition. U.S. noncitizen nationals must include a copy of a document that confirms their status, such as a U.S. passport, and a copy of their immigration documents. You must mail in your completed application. But starting on Aug. 1, applications can be filled out online at the same website. If you don't have access to a computer, call (866) 717-5826.
Once your application is accepted, you will be notified by mail with information about your premium, and you'll also receive your first monthly bill.
How much will premiums be?
Premiums must be the same as the standard individual health insurance rates in each state. In Florida, that ranges from about $140 to $984 a month, depending on the type of plan and the applicant's age. Federal health officials estimate the premium for a 50-year-old in Florida will be between $552 and $675 a month for a plan that includes deductibles of $2,500 for in-network and $3,000 for out-of-network care. Once you meet the deductible, you are responsible for a $25 co-pay and 20 percent of in-network and 40 percent of out-of-network costs.
The plan will cover primary and specialty care, hospital care and prescription drugs.
How soon will coverage begin?
If you apply and are approved for enrollment by July 15, your coverage will begin Aug. 1. Generally, applications received on or before the 15th of the month will take effect on the first day of the next month. Those received after the 15th of the month will go into effect on the first day of the following month.
Will there be limits to the number of people who can enroll?
There are no plans to limit enrollment. But the law does give the secretary of Health and Human Services the ability to impose limits if necessary. Federal health officials expect the program to cover 200,000 people nationally at any given point.
How far can $5 billion go?
One of the biggest criticisms of the plan is that $5 billion will not be enough to cover everyone who is eligible and can afford the coverage until 2014. "The consensus of opinion is that it's underfunded," said Mary Beth Senkewicz, deputy commissioner for life and health with the Florida Department of Health.
Cost was a major reason Florida opted not to run its own high-risk pool plan, choosing instead to have the federal government run it. Twenty-one states have gone this route.
But Richard Popper, deputy director of a new insurance office at the federal Health and Human Services department, said $5 billion can be sufficient if managed properly. The federal government can work with states to adjust benefits and co-pays to their plans. And even though each state is allotted a share of the $5 billion (Florida's is expected to be about $351 million), money can be shifted from states where there isn't high participation, Popper said.
Richard Martin can be reached at [email protected] or (727) 893-8330. For the latest in health news, visit tampabay.com/health