What Happens to the Pre-Existing Condition Plans on Jan. 1, 2014?

This post is the first in a series on the Illinois State Partnership Exchange Blueprint Application, which is pending approval by the Federal Government. 

For years, health insurance carriers refused to sell coverage to individuals with pre-existing medical conditions. The Affordable Care Act (ACA) created federally funded high risk pools across the country, including the Illinois Pre-Existing Condition Insurance Plan (IPXP) so that people denied for that reason would not have to go without health insurance. Starting on January 1, 2014, the ACA bans insurance companies from denying coverage based on pre-existing conditions. As a result, IPXP will no longer be needed, and coverage under the plan will be terminated.

So what happens to the enrollees of IPXP on January 1, 2014? 

The ACA dictates that anyone currently enrolled in IPXP will be transitioned into a private insurance plan via the state health insurance exchange. This transition process will happen at the end of 2013. According to the Illinois State Partnership Exchange Blueprint Application, the state has mechanisms in place to prevent lapses in health coverage, as follows:

• Illinois will send at least three letters to IPXP enrollees containing information on the transition process;
• The state will conduct proactive outreach to IPXP participants and update the IPXP website with relevant information; and
• The Illinois health insurance exchange will have extra personnel at the call center specifically to assist with the IPXP transition.

IPXP will only extend coverage for health services until December 31, 2013, which means that all current IPXP enrollees will need to find an alternative health plan before January 1, 2014.  Claims dating from before December 31, 2013 will need to be filed in the close-out period, which will run until June 30, 2015. If deferral funding for the IPXP program has run out, however, even claims filed before that date will not be payable.

Open enrollment into the state health insurance exchange will begin on October 1, 2013, with insurance coverage beginning on January 1, 2014. If current IPXP enrollees purchase a plan during open enrollment, there should be no gaps in their health coverage. Since Illinois is still in the process of establishing its health insurance exchange, check back here for details on how and where to enroll in a health insurance exchange plan, as well as future updates on the IPXP transition process. If you have questions now, contact IPXP at (877) 210-9167, or e-mail your question directly to IPXPInquiry@healthalliance.org

Who Has Pre-existing Conditions in Illinois?

A new study by Families USA has delved deep into Obamacare's patient protection provisions, which prevent anyone from being turned down or charged exorbitant rates for a pre-existing condition.

According to the study, over one in four Illinoisans under the age of 65 (the age where they become eligible for Medicare) have a pre-existing condition that could result in denial of coverage prior to the exchanges coming into effect in 2014. That's nearly 2.9 million people!

People with pre-existing conditions live in all counties in Illinois: the proportion of people affected ranges from 24.5 percent in Lake County to 31.1 percent in Jefferson, Marion, Randolph, and Washington Counties. One common factor is that pre-existing conditions tend to become more prevalent as we age: nearly half (49.2 percent) of adults aged 55 to 64 have a pre-existing condition that could lead to a denial of coverage. Right now, the presence of a pre-existing condition at any point in your life can be a reason for health insurance companies to discriminate against you.

To me, the implications are very clear: Obamacare gives people with pre-existing conditions access to affordable insurance. In fact, 59.5% of people with pre-existing conditions in Illinois are within the threshold (below 400% FPL) where either subsidies will be available to help them purchase health insurance or they will qualify for Medicaid. That's a tremendous relief for anyone without or in danger of losing their health care.

Also, as Families USA discusses in the study, not knowing what can happen with you or your family members' health insurance can result in "job lock" where one keeps an inferior job for fear of losing their coverage. Implementation of Obamacare will relieve that fear, and it could even lead to more people taking risks that were impossible before, such as starting a new business. This can lead to a more natural flow of the labor market and towards more job creation, giving Illinois an economic boost.

These are real benefits that people with pre-existing conditions, like me, can look forward to in 2014. In the meantime, IPXP, Illinois's temporary pre-existing conditions plan for the uninsured that was created and subsidized by Obamacare, is doing an incredible job as a stopgap measure to help us get through the next year and a half. I encourage you to spread the word about IPXP to ensure that everyone who needs to can take advantage of these benefits. As we can see from the Families study, there are a lot of Illinoisans with pre-existing conditions who have the chance to take advantage of a great program right now.

David Zoltan,
Guest Blogger, Illinois Health Matters

Scariest thing in the world

Wes Craven has certainly tried hard over the years to give us scary. Joss Whedon sprinkled it with humor. Edgar Allen Poe taught us all some lessons in horror.

Then there is real scary. The kind you don't find in books or movies. The slow fear that doesn't have a release in a moment involving some guy in a mask.

For two years, I was a diabetic without health insurance. Doesn't sound like the kind of thing John Carpenter would toss out there for 90 minutes, does it? But it is, without a doubt, the scariest thing on Earth.

I was laid off in 2008, one week precisely before Lehman Brothers crumbled and the global economy with it. While I was offered COBRA and searched desperately for some way to keep my insurance, there was nothing I could qualify for as a diabetic for less than $700 a month. Unemployment insurance only added up to about $1400 a month, so to pay for insurance, I'd have to skip rent or utilities or food.

Medicaid was no help either. Illinois is a great state, but our Medicaid system here is currently set up to help only the lowest of the low. I "made too much money" on unemployment, even as a diabetic, to qualify for the program.

Yet without insurance, insulin, the very thing I need to take multiple times a day just to live, would cost me insane amounts of money. I take two types of insulin. Each bottle of insulin lasts me about two to three weeks. Each bottle without insurance costs over $110-120. It would cost me over $450 a month just for my insulin. That doesn't begin to take into account the syringes, the other pills I take to help control aspects of my health as a diabetic, or any of the other conditions that I have related to my diabetes or not.

Taking care of my health looked impossible. I was lucky though. I had some amazing doctors and nurses that did everything they could to get me insulin, that helped me navigate the systems to eventually get set up for charity care where we could, and even cajoled a few pharmacy reps I think into making sure I survived. I would not be here but for their incredible hard work and help.

Despite all that hard work, it was still not always enough. I had to pay out of pocket once, early on when I still had a small emergency reserve of money, and visit the emergency room three times to get insulin when we couldn't get it fast enough from our various alternate sources. That's three ER visits that the state had to pay for, and therefore, in the end, you footed the bill through your tax dollars in the most inefficient way possible.

The Affordable Care Act changed all of that. I was one of the first to sign up for the "high-risk pool", IPXP here in Illinois, that was set up to help get those of us with pre-existing conditions in the individual market into plans that could help us until the health insurance exchanges start in 2014. I stood side-by-side with Governor Quinn as he announced the program to the public, and I defend it to this day as an important stop-gap measure.

Thanks to the subsidies made available through Obamacare, IPXP only costs me about $150 a month instead of the $700 I was quoted before. It'll be more now that I've celebrated my 35th birthday, going up to $200 a month, but that's still far better than not having insurance at all.

I got a job after three years of looking, one year after I got into the IPXP plan, but it was a contractor position that didn't offer benefits. I kept the IPXP plan through that year of employment, and I didn't have to worry about trying to wait until a job came along that offered health benefits. Now that I'm once again in the job market, I seamlessly have nothing to worry about from IPXP as it stays with me. This is what everyone can look forward to with the exchanges starting in January 2014.

One of the last fears I had left was washed away when the Supreme Court declared the ACA constitutional and upheld the law. (See my reaction to the ruling here) It's not the last hurdle, but it is one of the most important ones. There is no doubt now that Obamacare is the rightful law of the land and can help 32 million previously uninsured Americans just like me to ensure that health care is a right, not a privilege.

There are still challenges, and I hope you'll stand with me to ensure that I, and so many more just like me, never face that fear again. We will talk about many of those challenges in the days ahead, no doubt. Thank you for being interested in my story and for doing your part to ensure health care for all.

David Zoltan,
Guest Blogger for Illinois Health Matters