If you have a pre-existing condition

If you get your insurance through an employer plan (whether as an employee or dependent), you don't have to worry about being denied coverage because of a pre-existing medical condition. That's long been against the law. But it's a different story if you buy insurance on your own. In most states, insurers can turn you down flat, charge you much higher premiums, or offer coverage that excludes your pre-existing condition completely.

Some states require insurers to "guarantee issue" private plans to all comers, regardless of pre-existing conditions, though they might be costlier than regular plans and might be available only at certain times of the year or to certain types of applicants. Your state insurance department can supply details.

Most states have long maintained special high-risk health insurance pools to help those who can't secure individual coverage another way. But the high cost of premiums has deterred so many eligible people that the pools serve only a few hundred thousand people in the U.S.

The Pre-existing Condition Insurance Plan

The health-reform law created a government-sponsored comprehensive health-insurance program for people who have pre-existing medical conditions. It's called the Pre-Existing Condition Insurance Plan, or PCIP.

To qualify, you have to have been uninsured for at least six months and:

• Have a pre-existing condition, or
• Have been denied coverage because of your pre-existing condition, or
• Are shopping for insurance and have been offered coverage that excludes your condition.
• You also must be a U.S. citizen or in the U.S. legally.

People who already have health insurance that excludes coverage of a pre-existing condition are not eligible.

How to apply

The application process depends on whether you live in one of the 23 states (plus the District of Columbia) that have chosen to let the federal government administer their programs, or one of the 27 states that have elected to run programs on their own. This interactive map will tell you which kind of program your state has and give you contact information for the state-run programs.

If the federal government is running your state's program, you can apply directly at PCIP.gov.

What it costs

Those who qualify pay a monthly premium just as if they were buying private coverage. But the premiums are subsidized by the government. When the program started in 2010, enrollment was slower than expected, presumably because of the cost of the premiums. Since then, they have been cut. Today, the monthly premium for a federally run plan for a 50-year-old is around $200 to $560 depending on the state and the size of the deductible (which is $1,000 to $3,000). Look up the PCIP premium in your state.

When it will end

The PCIP program will last until Jan.1, 2014. On that date, under the health-reform law, all Americans will become eligible for insurance that can't discriminate or be priced differently on the basis of pre-existing conditions.