The Obama administration will allow patients in a federal high-risk pool slated to end next week to select an Obamacare exchange plan at HealthCare.gov through June 30.
The Centers for Medicare and Medicaid Services insisted in a late Thursday announcement that they were not extending the Pre-Existing Condition Insurance Plan (PCIP) for what would be the fourth time. The $5 billion temporary program for those suffering from pre-existing conditions was slated to end Dec. 31, 2013, but has been repeatedly extended.
PCIP coverage will end at its current expiration date, April 30, but patients who were a part of the high-risk pool will continue to be able to select a new health care plan on HealthCare.gov through the end of June. A CMS bulletin on the change notes that state-based exchanges will provide a similar special enrollment period.
They’ll still be guaranteed continuous health coverage, though, whether they’ve signed up for it on time or not. CMS is mandating that insurers retroactively cover the sick patients going back to May 1 — meaning insurers could be forced to pay for up to two months of care for patients who weren’t signed up for health insurance at the time.
CMS is claiming a “special enrollment period” for PCIP patients, which can only be instituted when the federal government believes the customer has experienced “exceptional circumstances.” In order to get around the provision, CMS is now defining the four-month-late end to the temporary program as an “exceptional circumstance” for all PCIP patients.
But it’s not clear why the Obama administration is still struggling to get PCIP patients insured — the health-care law created the program as a stop-gap for ailing Americans who needed health insurance immediately, and couldn’t wait until Obamacare’s regulations and exchange coverage became active in 2014. Patients who needed the coverage most desperately should have been among the first to sign up for exchange or private coverage.
The Obama administration first extended the program due to inoperable enrollment websites across the country. However, even after the Obama administration declared the websites fixed, the enrollment period was extended twice more for PCIP patients. The latest delay and its retroactive coverage could indicate that the federal government may be having a difficult time convincing the sickest Americans to step up and purchase coverage on the exchanges.
Almost 5,000 patients remaining in PCIP programs across the country, according to CMS. Some may have already signed up for coverage, but all will be eligible for the extended Obamacare exchange enrollment period.
It’s unclear whether any insurance carriers on state and federal exchanges have hit back against providing retroactive coverage, which allows patients to purchase insurance only after incurring high health care costs. PCIP patients will necessarily have a higher risk of incurring hefty medical bills.
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