50K people with pre-existing conditions insured

Almost 50,000 people with serious pre-existing medical conditions have health insurance coverage through a joint state-federal plan authorized by the health reform law, according to a report published Thursday by the U.S. Department of Health & Human Services.

The Pre-Existing Condition Insurance Plan (PCIP)--a temporary insurance plan for high-risk patients who previously have been denied coverage based on their condition--saw a 400 percent enrollment increase between November 2010 and November 2011. And roughly 8,000 new applications were submitted each month in the second half of last year, reported The Hill's Healthwatch.

The HHS report reveals that PCIP enrollees tend to be older females with extremely high healthcare costs. A large majority of PCIP spending (78 percent) has gone toward covering only four conditions--cancer; circulatory diseases; post-surgical care, such as chemotherapy; and degenerative joint diseases, The Washington Post reported.

Although private insurers aren't involved in administering the PCIP program, they should take note of the HHS report results. Come 2014, the reform-authorized PCIP programs will cease to exist, forcing private insurers to cover these high-risk individuals whose medical bills average $29,000 in claims per year, which is twice that of those in similar state-based programs, reported LifeHealthPro.

For example, Colorado's risk pool program averages 137 hospital admissions per 1,000 enrollees per year, whereas PCIP enrollees in Colorado average 562 admissions. And in Kansas, risk pool enrollees' claims expenditures average $1,376 per member per month, but PCIP enrollees average $3,449 per member per month. "PCIP enrollees use a higher volume and intensity of services than those in existing State High Risk Pools," the report said.

To learn more:
- read the HHS PCIP report (.pdf)
- read the Washington Post article
- see the Hill's Healthwatch article
- check out the LifeHealthPro article

Suggested Articles

Blue Cross and Blue Shield of North Carolina has named Anthem executive Tunde Sotunde, M.D., as its new chief executive officer. 

Two more national insurers are waiving member cost-sharing for inpatient treatment related to COVID-19.

Healthcare providers and suppliers throughout the country can start receiving accelerated and advance payments from the Medicare program.