PCIP has features and a structure similar to many private insurance plans. It offers three tiers of coverage, with variations in premiums, deductibles and copays for primary and specialty care (with in-network and out-of-network pricing), hospital care and prescription drugs.

In July, premiums will be reduced in 18 states, with cuts ranging from about 2 percent in Mississippi up to 40 percent in Florida, Arizona, Alabama, Kentucky and Virginia. For example, a 50-year-old enrolled in Florida's standard could pay $270 a month, with a $2,000 medical deductible and separate deductibles for medications – $500 for formulary drugs and $750 for non-formulary drugs.

PCIP is available nationally, and the plans are federally run in certain states and the District of Columbia; other states opted to run their plans using federal funds. HHS has sent a “letter of guidance” to the 27 state-run programs, encouraging them to make similar changes by recalculating premiums and easing eligibility rules, said Richard Popper, a director at the HHS Center for Consumer Information and Insurance Oversight.

A key enrollment criterium that has not changed is the waiting period. Before applying, an applicant has to have been without insurance for six months – a long time for those who have pre-existing conditions that need close monitoring, continuous treatment or other care, which has to be paid out of pocket in full without insurance coverage. People with rheumatoid arthritis, or RA, for example, risk permanent joint damage from uncontrolled systemic inflammation if their disease is active and they go without medication. Some of the most effective disease-modifying drugs for RA are the biologic injections and infusions, which can cost more than $1,000 a month.

More information about the Pre-existing Condition Insurance Plan is available online at www.pcip.gov. The site gives information on programs in each state, how to apply and benefits available. New premium costs for each state can be found at www.pcip.gov/PCIP_States.html.