Government Healthcare

Government Healthcare

Pre-Existing Condition Insurance Plan (PCIP)/High Risk Pool

Pre-Existing Condition Insurance and High Risk Pool Plans - The Pre-Existing Condition Insurance Plan (PCIP) is a new program offered in every state under the Affordable Care Act. It can be administered by either states or the Federal government. The PCIP may be able to help you if you’ve been locked out of the insurance market while the nation transitions to 2014. In 2014, you will have access to affordable health insurance choices through a new organization in your state called an Exchange—a time when you can no longer be discriminated against based on a pre-existing condition. Available Plans in Georgia

Pre-Existing Condition Insurance Plan (PCIP)

You may qualify for this new health coverage option if you have been uninsured for at least six months, you have a pre-existing condition, and you have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company.

PCIP covers major-medical and prescription drug expenses. You’re responsible for paying premium, deductible, copayments, and coinsurance amounts. PCIP won’t cost you more just because of your medical condition. PCIP isn’t based on income eligibility like Medicaid.

To qualify you must be a citizen or national of the United States or lawfully present in the United States. Go to ‘Learn More’ for more information on how PCIP works in your state.


Individual Health Insurance – Government – Guaranteed Issue

 Pre-Existing Condition Insurance Plan: Georgia

Eligible residents of Georgia can apply for coverage through the Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.

To qualify for coverage:

  • You must be a United States citizen or reside here legally.
  • You must be without health coverage 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.

PCIP covers 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 preexisting condition.

The monthly premiums for your state are:

Age       Standard Option      Extended Option      HSA Option
0 to 18               $147           $198      $153
19 to 34               $220           $296      $229
35 to 44               $264           $356      $274
45 to 54               $338           $455      $351
55+               $470           $633      $488

View a Summary of Benefits for the Standard, Extended, and HSA plans. (PDF – 810 KB)

In addition to your monthly premium, you will pay other costs. In 2012, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your combined out-of-pocket costs for in-network and out-of-network covered services cannot be more than $7,000 per year. The maximum is even less if you use only in-network providers.

Apply for Coverage in Your State

To learn more about the PCIP in your state, visit https://www.pcip.gov/StatePlans.html.
To apply visit: https://www.pcip.gov/Apply.html.
For PCIP questions or customer service visit: https://pcip.gov/ContactUs.html.