--by Lisa Kaplan Howe, Policy Director, NH Voices for Health
2014 is a big year for those of us closely watching – and eagerly awaiting – full implementation of the new health law. That’s when many of the major changes under the law go into effect – including additional health insurance consumer protections for adults with pre-existing health conditions and significant health care needs, creation of the health insurance Exchange marketplaces, and increased access to Medicaid coverage, premium tax credits and cost-sharing reductions for working families. However, it’s important not to lose sight of the many provisions that have already gone into effect and are helping people across New Hampshire. An example of that is the Pre-Existing Condition Insurance Plan (PCIP) - also known as the federally-qualified high risk pool. Through this, Granite Staters with pre-existing conditions who can’t get affordable coverage through commercial insurers, can purchase insurance coverage.
The federal PCIP creates a bridge to 2014, when this program will no longer be necessary. The new health law will require all insurers to sell coverage to anyone who applies regardless of their health status and history and will prohibit insurers from charging higher premiums for people with pre-existing health conditions. Recognizing the value of the federal PCIP to New Hampshire residents, providers and the state’s health care system, New Hampshire was the first state in the nation to create and enroll residents in the program.
New Hampshire’s state high risk pool (the New Hampshire Health Plan - NHHP) was already in existence prior to the passage of the new health law, and neither the federal PCIP nor the state NHHP offers free coverage. However, thanks to funding from the Federal government (which fully funds the PCIP), the premiums for the federal PCIP are no more than a person would pay for commercial insurance coverage – that makes them 25% less expensive than state NHHP premiums, making coverage significantly more affordable for Granite Staters with significant health care needs.
Many of the same insurance plans are offered both through the state NHHP and the federal PCIP, but there are some important differences that people should bear in mind. First is the difference in price, although subsidies are available to make NHHP premiums more affordable for low- and moderate- income enrollees. In addition, only Granite Staters with pre-existing conditions who have been uninsured for 6 months are eligible for the federal PCIP. Enrollees in the state NHHP may be subject to up to a 9 month waiting period for coverage of pre-existing conditions. Lastly, third parties – including hospitals – can pay federal PCIP premiums on behalf of an enrollee. For hospitals treating uninsured patients with significant health-care needs, this may easily make more financial sense to pay to enroll those individuals in PCIP coverage and avoid expensive uncompensated care. There are also some differences in the enrollment process for each plan.
The New Hampshire Health Plan is working to ensure as much coordination as possible between the federal PCIP and the state NHHP. To learn more about both high risk pools, to understand which plan you or someone you know may be eligible for and which is a better fit, and for information about how to enroll, you can visit www.nhhp.org – or, to talk to someone who can guide you through your options and the process, call 877-888-NHHP (6447).