This is a great article from Ted Griggs. . .
Louisianians who haven’t been able to buy health insurance because of a pre-existing condition now have a new option under a federally administered insurance program.
The Pre-existing Condition Insurance Plan – part of President Barack Obama’s health-care overhaul – will provide coverage for people who have lacked insurance coverage for at least six months and have been denied coverage by a private insurer because of a pre-existing condition.
It’s unclear how many Louisiana residents will be eligible for the program, said Cheryl Fish-Parcham, deputy director of health policy at Families USA, a consumer advocate group. Until now, Louisiana residents had to shop for coverage from the Louisiana Health Plan, the state’s high-risk health pool, if they had been denied elsewhere, Fish-Parcham said. But the state high-risk pool’s premiums were roughly twice what a healthy person paid in 2008.
“This new plan is priced at the same rates healthy people pay. That’s standard rates,” Fish-Parcham said. “That’s a big difference, and a lot more people are expected to sign up because it’s more affordable.” Under the new system, a 50-year-old will pay an estimated $482 to $589 a month for coverage, according to the U.S. Department of Health and Human Services. The federal government has set aside $70.7 million to run the program in Louisiana until 2014, when insurance companies will be required to cover people with pre-existing conditions.
Nationwide, $5 billion has been set aside for the program. However, Medicare economists estimate the program will run through that money by the end of 2011. And the Congressional Budget Office has estimated the program could cost $15 billion in total. Louisiana is one of about 20 states that chose to have the federal government run the new program.
In April, Gov. Bobby Jindal and Insurance Commissioner Jim Donelon wrote a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius, saying there was no reason for Louisiana, given its budget problems, to get involved in another potentially costly program.
Until Aug. 1, consumers have two options in applying for the coverage:
• Go to www.healthcare.gov, download the online application, fill it out and mail it to National Finance Center, Pre-Existing Condition Insurance Plan, P.O. Box 60017, New Orleans, LA 70160-0017.
• Call the Pre-Existing Condition Insurance Plan at 1-866-717-5826 (TTY: 1-866-561-1604) and ask the plan to mail them an application. The call center’s hours are 9 a.m. to 10 p.m.
Starting Aug. 1, consumers will be able to apply online at www.healthcare.gov.
Although the program kicked off July 1, a number of questions remain. “There is no description of benefits and no description of premium as yet, so it’s rather difficult to make a determination as a consumer on exactly what you’re purchasing,” said Leah Barron, chief executive officer of the Louisiana Health Plan.
According to DHHS, the Pre-Existing Condition Insurance Plan will cover “a broad range of health benefits,” including primary care physicians and specialists, hospitalization and prescription drugs. But Barron said it’s hard to tell how far the funding will stretch without knowing what benefits the federally run plan will include and how extensive the network’s providers list will be. Barron said the longevity of the funding will depend largely on how the benefit package is structured. Coverage with low deductibles and minimal co-payments would mean higher costs for the plan than a package with bigger deductibles and higher co-pays for doctor’s visits and prescriptions.
The Louisiana Health Plan had 1,702 people enrolled at the end of 2009 and cost $12.5 million to run, Barron said. The Louisiana Health Plan actually administers two plans, the Health Information Portability and Accountability Act, or HIPAA, plan and the high-risk pool. Both have a number of eligibility requirements but one major difference is that to get into the HIPAA plan, a person’s most recent coverage had to have come from a group plan.
The monthly premium for a person 50 to 54 years old is $489.59 in the HIPAA plan and $437.67 for the high-risk pool, Barron said. Those premiums were roughly 175 percent and 125 percent of the standard rate. The Louisiana Health Plan will continue to operate despite the new federal plan, Barron said. Barron said she doesn’t expect the federal plan to affect the Louisiana Health Plan’s current coverage numbers. “We’re certainly going to continue to have the people that we have now mainly because they’re so sick they can’t afford to drop their coverage for six months and then have access to the new pool,” she said.