Insuring some enrollees in the Pre-existing Condition Insurance Plan (PCIP) program — a government health insurance program for people with serious health problems — is extremely expensive.
Officials at the Center for Consumer Information and Insurance Oversight (CCIIO), the agency that oversees implementation of the PCIP program for the federal Centers for Medicare & Medicaid Services (CMS), talk about the claims cost challenges in a report posted on the CCIIO website.
The medical costs for the 134,708 enrollees averaged $32,108 in 2012, with a range of $4,276 per enrollee in the cheapest state to $171,909 per enrollee in the most expensive state, officials said.
When analysts looked at a year of PCIP claims, they found that two-thirds of the enrollees each had total claims for the year that were under $5,000.
But 4.4 percent of the enrollees accounted for half of the claims costs, and those enrollees had average expenses of about $225,000, officials said.
The costs were so high in part because many enrollees are extremely sick, with 694 having diagnoses of heart failure and about 2,200 facing cancer, officials said.