The Six-Month Doughnut Hole In The Pre-Existing Condition Insurance Plan


Cross-posted with permission from The Feminist Peace Network and Reclaiming Medusa.

Will someone please explain why you have to be uninsured for six months before qualifying for the Pre-Existing Condition Plan?  Because I have a health history (and how many people my age don’t) and because I don’t work for a company that provides insurance, the chances of my being able to purchase a new individual insurance plan are probably nil, so this clause makes it impossible for me to move out of state because I would lose the coverage I have and then have to wait 6 months to get insurance which is insane.  Sorry Kentucky, you are stuck with me until this gets fixed.

May I apply for the Pre-Existing Condition Insurance Plan if I have existing health coverage?

Hard to sugar coat this flaw in healthcare reform

Hard to sugar coat this flaw in healthcare reform

You are not eligible unless you have been without health coverage for at least the last six months.  For example, if you have Medicare or TRICARE, you shouldn’t apply.  If you are uninsured and have been told that you may be eligible for other coverage programs like Medicaid and the Children’s Health Insurance Program, you should check out those programs first, as they may better meet your needs.  If you have job-based coverage, or individual insurance coverage, you aren’t eligible to apply.

May I apply for PCIP if I have COBRA or other continuation coverage?

No, even if your COBRA or other continuation of coverage is about to run out, you won’t meet the requirement to be uninsured for at least the last six months.  You also need to be meet the criteria for having a pre-existing condition and be a U.S. citizen or individual residing here legally to qualify for the Pre-Existing Condition Insurance Plan.

And as was pointed out during the long drawn out health care reform debate, women are less likely to have insurance through employment and are thus more likely to be impacted by this seriously FUBAR plan.

Like this story? Your $10 tax-deductible contribution helps support our research, reporting, and analysis.