In most states, people with preexisting medical conditions must struggle to find health insurance coverage at any price. Some lucky people can get insurance through their job, or as a dependent of someone who has health coverage available through their job. But others who are between jobs, are self-employed, or are working for a company that does not provide health coverage to employees must fend for themselves in the individual policy market. Their options are limited.
Currently, 31 states operate high risk pools, which are designed as a safety net for those people whose health condition makes it difficult or impossible for them to buy a health insurance policy. The National Association of State Comprehensive Health Insurance Plans can tell you if your state has a high risk pool.
In most states, high risk pool coverage is similar to coverage found in individual policies. Most pools offer comprehensive major medical policies which cover an array of disease-specific benefits and disease management programs for individuals with chronic illnesses. Often, enrollees have the option of choosing an HMO, PPO, or indemnity plan.
But the limitations on high risk pool coverage are also similar to those found in the individual market. In both cases, the deductibles, copays, and out-of-pocket expenses tend to be higher than those found in job-based coverage. You should also be aware that in almost every state, the pool imposes a preexisting condition exclusion period of 6 to 12 months. This means that you must wait 6 to 12 months for the pool to pay claims on the very same health condition that qualifies you for coverage in the pool in the first place. But high risk pool enrollees would have to wait through a preexisting condition exclusion period if they were buying an individual policy, too. And for those who have no other option for health insurance, high risk pool coverage is certainly better than nothing.
High risk pool coverage is always more expensive than a regular individual policy. Typically, high risk pool enrollees pay 150% to 200% of the standard rate charged by insurance companies for individual policies. Even so, state governments lose money by operating high risk pools. This is because everybody in the pool has a costly health condition -- no healthy people can absorb some of the risk.
However, even though high risk pool coverage can be expensive, it are an option you should definitely consider if you are unable to buy an individual policy due to a preexisting health condition. Ultimately, the cost of being uninsured can be far greater than the cost of your high risk pool premiums.
Source:
The National Association of State Comprehensive Health Insurance Plans. "States That Have Risk Pools."
