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

Affordable Care Act will greatly benefit women

The Supreme Court’s ruling upholding the Affordable Care Act marks a critical victory for women’s health, and the health of all Americans. Because of this landmark decision, millions of women and families will continue to have access to affordable, quality health care — many of whom previously had inadequate coverage or no coverage at all.

At Planned Parenthood of Illinois, we understand how this law will have an unprecedented effect on women’s health. The law guarantees women direct access to OB/GYN providers without referrals, and ends discriminatory practices against women, such as charging women higher premiums and denying coverage for “pre-existing conditions.” And in just six weeks, women will gain access to birth control without a co-pay — which will have a tremendous economic impact on already stretched family budgets.

Since August 2010, more than 45 million women have already received full coverage for preventive health screenings, including mammograms and Pap tests. Now with this ruling, 17 million more women will have access to health insurance for the first time. And millions more young adults will be able to stay on their parent’s health insurance plans, just like the 3.1 million young adults who have done so since September 2010.

In Illinois alone, 469,469 women of reproductive age will now gain coverage under the Affordable Care Act by 2014.

The increased access to preventive health care and family planning under the Affordable Care Act provides immeasurable economic value to women, families and society. Not only does every dollar invested in federal family planning save taxpayers and families nearly $4, but unintended pregnancies are already costing U.S. taxpayers $11 billion a year.

Women realize that health and wellness are key to prosperity and independence. In times of economic uncertainty, it is more important than ever to stay healthy. For women, birth control isn’t a political or social issue — it’s basic health care and an economic concern. The money — up to $600 on average — that women will save on birth control each year is equal to five weeks of groceries for a family of four, nine tanks of gas in a minivan, or one semester of college textbooks.

Planned Parenthood of Illinois health centers already provide basic health care to nearly 75,000 patients every year, and to 3,321 patients in Springfield alone. Because this landmark law has been upheld, we know we’ll be able to do even more for the communities we serve in the months and years ahead.

Carole Brite

President and CEO

Planned Parenthood of Illinois

(Originally posted on July 10 in the State Journal-Register)

5 Ways Health Care Reform Will Benefit Illinois Small Businesses

Illinois has strong, vibrant neighborhoods and small businesses play a vital part in those communities. However, while small businesses are working to meet their bottom line, it can be challenging for them to afford to provide health insurance for their employees. According to the Small Business Majority, an average of 86% of small businesses owners who don't offer health coverage to their employees say they can't afford to provide it. The Affordable Care Act (ACA) has put into place reforms – some right now and some rolling out later – that will make it easier for the owners of small businesses to buy affordable insurance. Below we list five ways that health care reform will benefit Illinois small businesses and their employees.


At Ruby's Restaurant, Health Care May Be On The Table - Images by Jay Dunn

1. RIGHT NOW: Since March 2010, tax credits are being offered to small businesses owners with 25 or fewer full time equivalent employees in order to help them offset the costs of providing health insurance. Until 2014, small businesses who pay for at least half of their employees’ health care premiums will receive a tax credit to offset 35% of those premium costs. Starting in 2014, the tax credit will increase: for those small businesses who buy insurance through the insurance exchange (see #5 below), the tax credit increases to 50%. September 15th is an important deadline for filing so check out the tax credit calculator here to see if you are eligible.

2. RIGHT NOW: Small businesses often struggle with unpredictable and often steep health insurance premium increases from year to year. One of the priorities of the Affordable Care Act is to implement consumer protections so that insurance companies are more transparent and accountable with things like premium increases. As of September 1, 2011, health insurers seeking to increase their premium rates by 10 percent or more must submit their request to state or federal reviewers to determine whether they are reasonable or not. This rate review program will bring more predictability to health insurance costs and in many cases will lower costs for small business owners.

3. RIGHT NOW: Many small business owners cannot purchase affordable insurance, because they have a pre-existing condition. A pre-existing condition is a physical or mental health condition, disability or illness that you have before you enrolled in a health plan. If you or your employees are uninsured and have a pre-existing condition, you may be eligible for the Illinois Pre Existing Condition Insurance Plan, which is an insurance plan that was established by the Affordable Care Act. Questions? Call the Toll Free Number: (877) 210-9167, or email your question directly to IPXPInquiry@healthalliance.org.

4. LATER: Under the Affordable Care Act, denying health coverage or excluding benefits due to a pre-existing condition will no longer be allowed. As a result, if you have a pre-existing condition that has prevented you from buying affordable insurance for yourself and your employees, on January 1, 2014, it will not make you uninsurable any longer. This change is already in place for children under age 19.

5. LATER: The new health reform law establishes a competitive healthcare marketplace, commonly known as an “insurance exchange” run by each state or the Federal government. Slated to be up and running by the beginning of 2014 in Illinois, the Exchange will make purchasing insurance easier for individuals and small businesses by giving them the power to compare health care plans in one digital hub. The Exchange will also ensure that quality health insurance options are available – and that subsidies are also available to those who need them. These online marketplaces will create competition among insurance companies that will help to drive down the costs of insurance. More information about Illinois’ progress toward establishing an Exchange, can be found here.

If you have questions about the new health care law and how it affects you or your small business, submit your questions here and we will write you back.

An employee and customer at Ruby’s. The owners of the restaurant currently can’t afford to pay for health insurance for their employees, but that could change with the Affordable Care Act reforms