More in Pennsylvania eligible for health insurance

| Wednesday, July 7, 2010

For eight years, Bev Dochstader has lived a nightmare that many Americans face -- how to secure affordable health insurance when saddled with a pre-existing condition?

The 48-year-old Tioga County resident was diagnosed with breast cancer in 2003 and had surgery a year later. Since then, Dochstader has been turned down numerous times for health insurance -- and waited years for additional surgery because she couldn't afford it or had insurance that didn't cover a pre-existing condition.

With the help of breast cancer advocates and the power of a federal law mandating health insurers cover necessary breast cancer-related surgeries, Dochstader now is recovering from her latest surgery.

What if another cancer surfaces?

"I'm certainly hopeful that insurance for people with pre-existing conditions becomes available and is affordable," Dochstader said.

Within a few weeks, up to 5,600 Pennsylvania residents with pre-existing conditions will have an opportunity to purchase full-coverage health insurance at a greatly reduced price.

Using $160 million in federal funds from the federal Health Care Reform Act, Pennsylvania will offer insurance covering hospital and physician visits; prescriptions; mental-health services; and diagnostic tests -- for $283.20 a month.

"The Obama administration has approved our plan to provide health insurance to thousands of Pennsylvanians who have been unable to obtain affordable coverage because of pre-existing conditions," said state Insurance Commissioner Joel Ario.

The new program will provide bridge coverage for some until 2014, when the full implementation of federal health-care reform will ban discrimination by health insurers against individuals because of their health status.

An estimate by Families USA found that 2.1 million in Pennsylvania between ages 18 and 64 have pre-existing conditions that could qualify them for the new program. Nationwide 52 million people could qualify.

There's not enough money, however, under the stop-gap Pre-existing Condition Insurance Plan for all to get in. The law allocates $5 billion for all 50 states.

Premiums will range from $140 a month to as much as $900 in some states, said Richard Popper, deputy director of a new insurance office at the federal Health and Human Services Department.

"We plan on opening up the program initially to 3,800 adults," said Pennsylvania Insurance Department spokeswoman Rosanne Placey.

Not knowing what kind of response the program will receive and the individual needs of those applying, the program will serve as many residents as can be covered by the state's share of the funding, Placey said. State officials estimate a maximum of 5,600 could be covered.

Popper estimated that nationwide, about 200,000 people would be enrolled in the program at any one time. But other Health and Human Services experts estimated that 375,000 would sign up this year, and the Congressional Budget Office says the total could reach 700,000 in 2013.

In Pennsylvania, the program sign-up will be on a first-come, first-served basis, Placey said.

The pre-existing conditions-insurance plan will start taking applications in every state by the end of the month. Coverage will be available as early as Aug. 1.

"We currently are reviewing the bids from organizations to be the program's administrator," Placey said, noting that the administrator will handle claims administration and customer service.

Despite the monthly premiums, consumer advocates are urging uninsured people with health problems to sign up soon because they can't be turned away for medical reasons. Family members could help with premiums, which are competitive with rates paid by people who buy their coverage directly from an insurance company.

Additional Information:

Basics of the plan

To qualify for Pa.'s pre-existing conditions health insurance, residents must be:

• A citizen or national of the United States or lawfully present in the country

• Uninsured for at least the past six months before applying and must have had a problem getting insurance because of a pre-existing condition.

The program will include:

• A $283.20 monthly premium in Pennsylvania

• A deductible of $1,000 for in-network coverage; $10,000 for out-of-network coverage

• Out-of-pocket limit: $5,000 for in-network expenses; $20,000 for out-of-network expenses

Consumers can go online to learn other coverage options.

Source: Pennsylvania Insurance Department

Subscribe today! Click here for our subscription offers.


Show commenting policy