High Risk Pools

Thirty-three states have instituted government programs called “High Risk Pools” that provide health insurance coverage to “uninsurable” residents whom private insurers might turn down because of their health status. Approximately 175,000 people in the Unites States are enrolled in high risk pools. To find out if there is a high risk pool for your state, please go to www.naschip.org/states_pools.htm . For people enrolled in the programs, high risk pools offer an important source of available coverage, sometimes the only means of coverage. Furthermore, traditional individual and small group health insurance consumers benefit from the existence of a high risk pool, since the greatest risks are removed from the insurance markets.

Coverage Available:

Typically, high risk pools offer coverage similar to that sold by private insurers. Also, like private insurance companies, high risk pools will impose a waiting period of 6-12 months on coverage of pre-existing conditions. On occasion, high risk pools will waive the pre-existing condition exclusion period if you have prior coverage.

Eligibility:

Usually, there are many ways to become eligible for your state’s high risk pool. These may include the following:

• You have a qualifying condition (ie: aids, cancer, diabetes).
  
  
• You receive a notice of rejection from a health insurer.
  
  
• You have been involuntarily terminated from a health insurance plan.
  
  
• You receive a notice of benefit reduction or specific condition exclusion.
  
  
• You receive a notice of premium rate increase or surcharge exceeding the pool rate.
  
  
• You are HIPPA-eligible. Note: You are HIPPA-eligible if you have had at least eighteen months of prior continuous coverage, at least the last day of which in a group health plan, you have exhausted COBRA, you are not eligible for Medicare, Medicaid or a group health plan , you don’t have other coverage, and you apply for new coverage (such as the high risk pool) within 63 days of losing your prior coverage. If your state has designated the high risk pool for HIPPA coverage, then it will not impose a pre-existing condition exclusion period on you when you are HIPPA-eligible.
  
  

Cost to Purchase:

High risk pool premiums are always more expensive than coverage sold by private insurers. In most state high risk pools, premiums are 1.5 to 2 times higher than those charged by private insurance companies. In addition, all state high risk pools adjust premiums for age. This makes coverage particularly expensive for people in their 50s or early 60s.

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