HHS Eases Eligibility Rules, Lowers Premiums for High-Risk Insurance

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On Tuesday, HHS Secretary Kathleen Sebelius announced that the federal government has lowered premiums for high-risk insurance pools established by the federal health reform law, National Journal reports (McCarthy, National Journal, 5/31).

The Pre-Existing Condition Insurance Plan provides coverage to individuals with pre-existing conditions prior to 2014, when the reform law mandates that private insurers accept all applicants (California Healthline, 3/17).

The announcement is a response to lower-than-expected enrollment in the pools (National Journal, 5/31). As of May, more than 18,000 U.S. residents had enrolled in the PCIP, up from about 12,500 individuals in February. However, those figures still are behind administration estimates (California Healthline, 5/10).

Details of Adjustments

According to federal officials, premiums in 18 states where the pools are run by the federal government will decline by between 2% and 40% (National Journal, 5/31).

HHS said premiums in Alabama, Arizona, Delaware, Florida, Kentucky, Minnesota, Nevada and Virginia likely will decline by 40%. Meanwhile, premiums will be 2% lower in Mississippi and 26% lower in Indiana (Kerr, AP/Washington Times, 5/31).

HHS sent letters to 27 states that run their own high-risk pools about how to achieve similar premium reductions.

Richard Popper, head of the insurance programs office at CMS, said the reductions are funded through the $5 billion allotted by the reform law for PCIP. He said no state contributions are necessary to achieve the reductions (National Journal, 5/31).

In addition, the agency reported it also has eased eligibility rules for the program. HHS said it no longer will require applicants to produce a letter from a health insurer denying them coverage. Instead, those who have been uninsured for six months only will need to provide a letter from a physician, physician assistant or nurse stating that they have a pre-existing condition to enter the pools (Levey, Los Angeles Times, 5/31). 


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