Filed Under:Health Insurance, Individual Health

CMS confirms risk pool extension

CMS Administrator Marilyn Tavenner (AP photo/J. Scott Applewhite)
CMS Administrator Marilyn Tavenner (AP photo/J. Scott Applewhite)

Obama administration officials have confirmed reports that they’ll let some people with serious health problems keep their coverage a few more weeks.

Managers of the Pre-existing Condition Insurance Plan, a temporary health insurance program for people who can’t qualify for medically underwritten health insurance, have added a notice about the extension to the PCIP website.

PCIP will let enrollees stay in the program until March 31, instead of shutting down Jan. 31, officials say in the notice.

The transitional coverage will give PCIP enrollee more times to replace their coverage, officials say.

Enrollees who want to keep their PCIP coverage will have to pay extra premiums for February and March, but the monthly rate will be the same enrollees paid for coverage for this month, officials say.

Drafters of the Patient Protection and Affordable Care Act created the program to provide individual coverage for uninsurable people until 2014. PPACA now prohibits carriers in the individual market from considering personal health information other than age when deciding whether to issue coverage or when setting rates.

PCIP enrollees have had to pay a subsidized premium comparable to what healthy consumers would pay for similar coverage in the individual market.

Originally, PCIP was set to shut down Dec. 31. In mid-December, because of concerns about exchange enrollment problems, officials at CMS said the program would remain open longer.

Kaiser Health News reported the new PCIP transition period change yesterday. Kaiser reporters attributed the news to a CMS e-mail.

In related news, CMS posted a memo aimed at managers of state risk pools.

In the memo, CMS officials are trying to offer some relief for Medicare enrollees who might lose access to the Medicare supplement benefits they are getting from the state risk pools.

The risk pools are special state-run health insurance programs designed for people who could not qualify to buy medically underwritten individual health insurance.

Many of the risk pools are now shutting down because PPACA gives people with health problems the ability to buy individual health coverage without going through a medical underwriting process.

The state risk pools provide Medicare supplement benefits, or Medigap benefits, for about 6,000 Medicare enrollees under age 65 who have disabilities or are on dialysis.

Some states give people under age 65 with Medicare an automatic right to buy supplement benefits, but other states don’t, officials say.

Normally, federal law would block carriers from selling individual coverage to Medicare enrollees, but, in states where the people losing state risk pool coverage cannot automatically buy private Medicare supplement insurance, CMS will suspend enforcement of the “anti-duplication” law until Dec. 31, 2015, officials say.

The change will give states more time to give the disabled people who are losing risk pool coverage access to Medigap insurance, officials say.

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Originally published on BenefitsPro. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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