Pre-Existing Condition Insurance Plan (PCIP)

State PCIP Transition

Is your PCIP Coverage Transitioning to the Federally-run PCIP in July?

Beginning July 1, 2013, operation of the Pre-Existing Condition Insurance Plan (PCIP) in 17 states, at their discretion, will transition to the federally-run PCIP program. If you have been enrolled in one of these states’ programs, you can continue your PCIP coverage through December 2013 through the federally-run program.  You will be receiving communications and instruction by mail to help ensure your seamless transition to the federally-run PCIP.  This change does not affect PCIP enrollees in the remaining 10 states that are operating their own program.


PCIP Enrollment Suspension

On February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) suspended acceptance of new enrollment applications until further notice. The suspension also became effective in the state-based PCIPs on March 2. This will help ensure that funds are available through 2013 to continuously cover people currently enrolled in the program.  PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide.  We encourage you to visit http://finder.healthcare.gov to explore your other health care options.

Note: If you lost PCIP coverage during the past 6 months because you moved out of state, you may be eligible to re-enroll in PCIP in your new state of residence. Please call 1-866-717-5826 (TTY: 1-866-561-1604), Monday – Friday, 9 a.m. to 5 p.m. EST, if you believe you are eligible.


The Health Insurance Marketplace

Starting next year, the Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – will finally have access to quality, affordable coverage.  People will be able to apply for affordable health insurance coverage choices in Health Insurance Marketplaces when open enrollment begins on October 1. The Health Insurance Marketplace will offer a choice of quality, affordable health plans. Coverage begins on January 1, 2014. Visit www.healthcare.gov/marketplace to learn more about the Marketplace.


PCIP Benefits & Premium Rates

The Pre-Existing Condition Insurance Plan (PCIP) makes health coverage available to you if you are a U.S. citizen or reside here legally, you have been denied health insurance because of a pre-existing condition, and you’ve been uninsured for at least six months. To learn more about PCIP where you live, visit PCIP in Your State.

The PCIP program covers a broad range of health benefits, including:

  • primary and specialty care,
  • hospital care, and
  • prescription drugs.  

All covered benefits are available to you, even to treat a pre-existing condition.

The program doesn’t charge you a higher premium just because of your medical condition, and eligibility is not based on income. Premiums vary by state.

State and Federal PCIP Coverage

State Program: In 10 states, a state or nonprofit organization runs PCIP, and program requirements can vary.

Federal Program: The U.S. Department of Health and Human Services, with the help of the U.S. Office of Personnel Management and the U.S. Department of Agriculture’s National Finance Center, runs PCIP in 40 states and the District of Columbia. The Federal government contracts with a national insurance plan to administer benefits in those states. The website for people currently enrolled in the program is www.pciplan.com. For general program information, visit www.pcip.gov.

Posted on: July 1, 2010

Last updated: May 21, 2013

Content last reviewed on April 1, 2014