PCIP Enrollment is Low Critics Say

[DS4]

The PCIP is offered to people who haven't had insurance for 6 months prior to applying.

Yes..........

 

[Norwayguy]

The PCIP is offered to people who haven't had insurance for 6 months prior to applying.

I know you can't comprehend how wrong it is to offer full insurance to people that previously rejected partial insurance, vs. people that accepted that same insurance.

But all you care about is commissions - right? Wouldn't it be horrible if one of your "customers" dropped a policy with you in the hopes of waiting out that six month roulette period in the hopes of getting real insurance?

No we understand...What you have to realise is that this is one of the uninteded consequences of the way the bill was written...Another one is children are GI now...So most carriers no longer offer Child Only plans so even healthy children can not get coverage..

I've been posting about the inequities of irresponsible people getting into the PCIP without a period of pre-x and recieving coverage for premiums that are not rated up to reflect their true cost as compared to someone like yourself...Definatly speak up about this to your Congressman and Sentators...Take it to the News Media...You'll find that many here feel compassion for your plight but we have no control of PCIP.

 

[TXINSURANCE]

I believe PCIP should not be only open to those with 6 months of no prior coverage. This is an insane requirement.

This is also why enrollment is so low. The uninsured crowd is a rough group. In virtually every state and situation these people could have been covered, even for their conditions long before PCIP.

Most chose not to pay the premium of guaranteed issue plans or state risk pools. Some legitimately couldn't afford it either.

What makes you think this crowd will start coughing up $350 to $600 a month which is a bargain as it is tax subsidized? They won't. Some might like if they have a pending treatment or major costs coming.

Retention on PCIP plans will be horrible. Buy it. Use it. Cancel it. Jump back in later if six months has passed.

It's s flawed system.

A national risk pool was the answer run on a state level, but democrats were having none of those logical solutions.

As for PCIP I believe in opening to everyone previously declined, wavered, or rated regardless if previously insured. However.... And here's the part that makes it work...

Those with a break in coverage should have a six month pre existing waiting period. Period. No exceptions.

Remember it is the lack of pre existing waiting periods that is at the core of this failed system.

 

[AllenChicago]

The Illinois PCIP (known as IPXP in this state) covers applicants on the 1st day of any given month IF the application is received BEFORE THE 15TH of the prior month.

This takes away the incentive to enroll and expect immediate coverage for the medical emergency. But we still have the problem here in Illinois of not knowing what the PPO network is. Really strange.

Ref: http://www.insurance.illinois.gov/ipxp/IPXPBrochurev6.pdf

-AC

 

[DS4]

UnderwritterPawn,
The PCIP was developed for one purpose. To move "uninsureds" to "insureds". It was not developed to make your personal current health insurance situation better.
The PCIP is not underwritten by an insurance company. Funding for claims for the PCIP comes from the Federal Gov't., and, premiums paid by insureds.
If you do not like the terms & conditions of the PCIP, complain to Harry Reed, Nancy Pelosi and Obama.
I only play the game. Someone else makes the rules.
I would suggest that you seek out a professional health insurance broker like myself, in your state, to try and move yourself away from Mega. Most of us on this board are ins agents.
With Mega, if you had a catastrophic claim, because of the internal limits with Mega, you would be lucky to have 20 to 30% of your claims paid.

 

[somarco]

Funding for claims for the PCIP comes from the Federal Gov't.,

What kind of pinko trash talk is that?

Funding comes from tax payers and the Chinese. The govt doesn't have any money except what they take from us and swindle from the Chinese.

 

[UnderwriterPawn]

UnderwritterPawn,
...
I would suggest that you seek out a professional health insurance broker like myself, in your state, to try and move yourself away from Mega. Most of us on this board are ins agents.
With Mega, if you had a catastrophic claim, because of the internal limits with Mega, you would be lucky to have 20 to 30% of your claims paid.

Thank you for the information on Mega. I'll post a request for a Florida broker on this board, but I have tried two brokers before with horrible results. One broke my COBRA continuation by dragging me beyond the time limit (which put me in this mess), the other just had me apply to a company that had already rejected me. Florida seems to have a very unregulated environment with just a few big players. And the big players I've dealt with underwrote me with many more exclusions than mega.

Where can I read about MEGA's internal limits? I didn't see any limits in my policy documents.

I'll just accept that we disagree on the purpose and fairness of the PCIP - but "it is what it is" until it's fixed.

 

[Norwayguy]

I'll just accept that we disagree on the purpose and fairness of the PCIP - but "it is what it is" until it's fixed.

Nobody disagrees with the fairness of how this has been setup. And only the people who drafted the law (and I doubt they knew their purpose) know the true purpose of the PCIP...But I think we can infer from the fact that since you have coverage even with riders/exclusions and you can't join PCIP that the purpose was only to insure people without coverage at this time.

 

[DS4]

Thank you for the information on Mega. I'll post a request for a Florida broker on this board

Isn't Moonlight an agent in Florida?

Where can I read about MEGA's internal limits? I didn't see any limits in my policy documents.

Your MEGA policy looks something like this.
http://www.insurancepickle.com/pdf/nase.pdf
Even if you check the highest option limit per category of service, you would still be underinsured.

 

[somarco]

I have tried two brokers before with horrible results. One broke my COBRA continuation by dragging me beyond the time limit (which put me in this mess), the other just had me apply to a company that had already rejected me.

Sorry, but presumably you are an adult. Painting all brokers with the same brush because you had encounters with idiots is a bit unfair.

Your former employer or COBRA administrator should have provided you with information on COBRA options. You have found this forum so presumably you know how to use the web to conduct your own research.

Blaming them for your failure to accept responsibility is a bit much.

Except in extreme situations, once a carrier has rejected you that's it. You are toast.

I have had a few situations where I have taken someone back to a carrier that rejected them earlier and have had success but those situations are rare and time consuming.

But most agents don't have my background or experience to pull that off either.

Florida seems to have a very unregulated environment with just a few big players. And the big players I've dealt with underwrote me with many more exclusions than mega

Actually FL is more tightly regulated than many states and considering the number of HMO's operating there, actually has more carriers than most states of its' size.

If someone other than Mega issued coverage, even with exclusions, then why didn't you take their offer?

Of course you have said nothing about your medical conditions but it seems that you are not uninsurable.

Since you have been offered coverage that makes it less likely you would be granted coverage under PCIP which is reserved for those who cannot get coverage. Even if you had PCIP you most likely would not be pleased with it either.

PCIP has a LOT of OOP and an almost microscopic network. If you can find a doc in network good luck getting them to accept you as a patient. The reimbursement levels under PCIP are the same as Medicaid and very few docs take Medicaid patients unless the doc is hard up for cash flow or a crook.

As for your Mega plan, I understand they have changed some of their policies. The plans they sold for years had a per hospital confinement deductible, a daily R&B limit and a cap on surgery. I believe the Rx benefit was an add-on and even when you bought it the plan paid very little toward Rx.