Loophole in High-Risk Pools Exposed


Loophole in High-Risk Pools Exposed

Wednesday, February 1st, 2012 - 18:06
Wednesday, February 1, 2012 - 16:44
Lifetime coverage limits do not apply to all, despite appearances

When the Obama Administration unveiled the 2010 health reform law, one of the first provisions to go unto law was the rollback of lifetime insurance coverage limits. However, the application of these limits on those most prone to approach multi-million dollar limits are individuals with pre-existing conditions. To solve the problem, the law immediately created a high-risk pool, where these individuals could buy insurance without regard to their medical issues.

According to the Kaiser Family Foundation The issue is one of legislative language. The Affordable Care Act dictates that the removal of lifetime limits applies to commercial insurance products, which technically the PCIPs are not. Without the elimination of lifetime insurance limits or a vast expansion of the dollar limitation, the high-risk pools do not serve the chronically ill very well.

Nearly 45,000 people enrolled in the new pre-existing condition insurance plans known as PCIPs, which are federally run. An additional 220,000 are in the pricier, old state high-risk pools who can’t join the new PCIPs because in order to qualify people have to be uninsured for six months.