To qualify for PCIP, you must:

• Have a pre-existing condition
• Be a U.S. citizen, or live in the U.S. legally
• Have been without health coverage for the last 6 months

You are NOT eligible for PCIP coverage if:

• You have other insurance coverage, even if it doesn’t cover your medical condition
• You’re enrolled in a state high risk pool
• You have Medicare, Medicaid, CHIP, VA or TRICARE coverage
• You have job-based coverage, including COBRA, or continuation of coverage, even if it’s about to end
• You have a limited benefit plan

Documents You Need to Show Eligibility for PCIP

When you apply in states served by the federally-run PCIP, you’ll need to provide a copy of at least ONE of these documents to show you’re eligible:

• A denial letter from an insurance company for individual insurance coverage (not health insurance offered through a job) dated within the past 12 months. Or, you may provide a letter dated in the past 12 months from an insurance agent or broker licensed in your state that shows you aren’t eligible for individual insurance coverage from one or more insurance companies because of your medical condition.


• An offer of individual insurance coverage (not health insurance offered through a job) dated within the past 12 months that you didn’t accept because it didn’t cover your medical condition. This offer of coverage must have a rider that says your medical condition won’t be covered if you accept the offer.


• If you're under age 19 or you live in Massachusetts or Vermont, a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating your name and current or past medical condition, disability, or illness. This letter must also include the name, license number, state of licensure, and original signature of the doctor, physician assistant, or nurse practitioner.


• If you’re under age 19 or you live in Massachusetts or Vermont, an offer of individual insurance coverage (not health insurance offered through a job) dated within the past 12 months that you didn’t accept because the premium was too high. This offer of coverage must show a premium that is at least twice as much as the PCIP premium for the Standard Option in your state. Check PCIP premium amounts in your state.