Skip to main content

CA PCIP Reverting to Federal PCIP on July 1

Beginning July 1, 2013, California will no longer operate the state's PCIP. 

All current CA PCIP subscribers will be required to transition to the federal PCIP in order to maintain some kind of PCIP coverage through 12/31.  Premium rates and provider network for CA PCIP will no longer be applicable.

The CA PCIP will send out a notification letter in May to provide subscribers with instructions. In June, the National Finance Center, the enrollment administrator for the federally-run PCIP, will send out an Enrollment Letter that includes information about the federally-run PCIP plan, how much it costs, and how to activate coverage. Subscribers will not need to complete a new application to qualify for the federally-run PCIP.  To activate their new coverage on July 1, and receive their PCIP ID cards by that date, subscribers must pay their first month’s premium by the deadline stated in that letter.  

If a subscriber is in the course of treatment or has received prior-authorization for services, he or she will be mailed guidance about transition of care. It is critical that he or she follow required pre-authorization of benefits procedures for hospitalization, durable medical equipment or supplies, transplants, skilled nursing, long-term acute care or rehabilitation facility admission, spinal fusion surgery or cancer treatment plans anticipated to occur on or after July 1.  This is necessary even if the subscriber was already authorized with the California PCIP. 

PCIP remains closed for all new enrollments and this transition only applies to those California residents who are currently enrolled in the CA PCIP.



  1. I have already met my deductible, do I have to meet a new one under the federal plan?

  2. One would hope that federal PCIP would carry over your deductible credit however until the migration is complete and you have confirmation of that either way, nobody knows.

  3. Do you know how this will affect the rates? I know when I looked into the federal program (before I learned of the CA program), the rates were about triple what the state rates were.

  4. according to federal customer service line, all deductibles and out of pocket limits are being reset. unbelievable.

    1. Yes. That has happened to me. I am now thousands in debt. If this is what we are to expect with health care reform. we are in deep trouble. I will be spending 13,000 out of my 19,000 income. Obviously, I am deep into my savings.

    2. This is what is happening to me. I also expect to get my surgery denied..I have contacted my congressperson and she was "disgusted". She is trying to help, but I am realistic.
      I hope your doctor can do something to get the surgery you need.
      And - I too noticed that the re-setting of the deductible was not mentioned ANYWHERE.
      We need a good lawyer for a class action suit.

  5. Ouch! That's going to hurt a lot of CA PCIP members. Wow!

  6. Has anyone gotten their transition/enrollment letter yet?

    1. I've gotten the first letter stating that I will be transitioned but I have not yet received the enrollment packet.

    2. I also received the first letter stating that I will be transitioned but no enrollment packet yet. I called the federal customer service line about a week ago asking if I will be able to keep my same providers and they told me that they were still working on that issue and they didn't have a list of CA providers at that time.

    3. I received my transition packet from federal yesterday the 13th of June. Got to get your premium in right away.

    4. I'm the anon from 6/5 - I got the letter today; thanks for responding.

  7. I'm confused. I've been reading that the new rates of payment to medical services go into effect June 15th...what is called the interim period....what is this about?

  8. ALL DEDUCTIBLES RESET TO ZERO!!!!......How do we go about filing a class action law suit. when i spoke with them this morning, i was told that the 17 state run pcip plans all have resetting deductibles, but the 23 states that were federally run already do not. even though it is the exact same program.

    TRANSITIONS doesn't mean cancel and start new, and they never mentioned the resetting deductible ahead of time because they knew the public would be pissed.

    How do we fight this? I have paid $1500 for in network and $3000 for out of network directly out of my pocket this year so i could pursue the surgery i need, and now they say F.U.



Post a Comment

Popular posts from this blog

Anthem Blue Cross (CA) Adding SilverSneakers® Fitness Program

Anthem Blue Cross (CA) announced this morning that they will be adding the SilverSneakers Fitness Program to California Medicare Supplement Plans A, F, and N.  The added benefit will begin on January 1st, 2017. 

Once approved for release into the market, more states have been added to the list as existing and new members in our marketed plans will enjoy the value-added benefits of the SilverSneakers Fitness program at no additional cost! Effective January 1, 2017, California members in our marketed plans will enjoy SilverSneakers, too.  The program offers members their choice of paths to better health. For those who enjoy a traditional workout setting, SilverSneakers offers access to more than 13,000 fitness locations across the country, including use of classes and guidance from a Program AdvisorTM. In addition, for those who can’t get to a fitness center, SilverSneakers Steps® kits focus on at-home or on-the-go general fitness, walking, strength training or yoga. And if that is not …

How Will Donald TRUMP ObamaCare?

With the election of Donald Trump as the next US President, healthcare reform and ObamaCare are on the chopping block.  There is media speculation that a transformation away from the current ObamaCare system will be rather immediate once Donald Trump is sworn into office in January.  

While changes are certainly coming, I would not expect a wholesale changeover immediately, but rather over the course of 2017.  My hope is to see an open market available at any time during the year (like it used to be) instead of an abbreviated Open Enrollment Period.  

Below are some key points to a Donald Trump-Care system and a link to his Healthcare Reform Paper which goes into more detail...

 1. Completely repeal Obamacare. 2. Modify existing law that inhibits the sale of health insurance across state lines. 3. Allow individuals to fully deduct health insurance premium payments 4. Allow individuals to use Health Savings Accounts (HSAs). 5. Require price transparency from all healthcare providers.6. Bl…

2016 Open Enrollment Has Begun

Here to kickoff the 2016 open enrollment period which will run from November 1, 2015 to January 31, 2016.  

It is important to remember that during the open enrollment period all rules regarding SEP (special election period) enrollment dates for loss of employer coverage are off of the tablle. Than means no retroactive start dates on the Covered California health exchange.

Remember during open enrollment you may sign up for any available health insurance plan either off- or on-exchange with no medical underwriting.

My site features live free instant quotes and online applications for off-exchange subscribers.

For Covered California exchange subscribers, I can take your information over the phone and set up your account on Covered CA for you.  You would need to log in with a special code I would provide upon submission of the application and select your plan/pay the initial premium via Covered CA.  

Carrier for 2016 include:

*Anthem Blue Cross PPO, Tiered PPO and HMO
*Blue Shield of Californi…