Department of Human Services

Q:   Recently, I have heard about the Pre-Existing Condition Insurance Plan (PCIP) that is currently available due to the Affordable Care Act for anyone who does not have health insurance because they have been turned down due to a pre-existing condition. Can you tell me about Missouri's PCIP program?

A:  Missourians who have had difficulty finding health coverage because of a pre-existing condition now can more easily get much more affordable coverage.  

The Pre-Existing Condition Insurance Plan was created under the Affordable Care Act to help uninsured people with a pre-existing condition get high quality care at affordable prices and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma. This health coverage program is administered at the State level in 27 states and by the Federal government in 23 States and the District of Columbia. 

Missouri has elected to run the program themselves. 

Eligible residents of Missouri can apply for coverage through the state's Pre-Existing Condition Insurance Plan program run by Missouri Health Insurance Pool.

To qualify for coverage:

·     You must be a citizen or national of the United States or residing in the United States legally.

·     You must have been uninsured for at least the last six months before you apply.

·     You must have a pre-existing condition or have been denied coverage because of your health condition.

·     The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it's to treat a pre-existing condition.

Premium range based on age is:	$167 to $728 per month
Deductibles:	$1,000, $2500, $5000
Out of Pocket Limit:	$5,950

 
                 

 

 

Also, there are in- and out-of-network doctors. So, to pay the least amount of out-of-pocket costs, an enrollee will want to see doctors within the provider network. But, they can see any doctor, and if the doctor is not within the network they will pay more.

To learn more about this program please call: 1-800-821-2231 or visit         http://www.mhip.org/federal-plan-options.html .

For more information about the PCIP program in Missouri, or in another state, including eligibility, plan benefits and rates, and how to apply, visit www.pcip.gov and click on "Find Your State." Then select Missouri from a map of the United States or from the drop-down menu. The PCIP Call Center is open from 7 a.m. to 10 p.m. Central Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).