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| High Risk Pools |  Thirty-three states have instituted government programs called “High Risk Pools” that offer health insurance coverage to “uninsurable” residents whom private insurers might turn down because of their health status. Nearly 175,000 people in the Unites States are enrolled in high risk pools. For people enrolled in the programs, high risk pools propose an essential source of available coverage, sometimes the only means of coverage. Moreover, traditional individual and small group health insurance users benefit from the existence of a high risk pool, since the greatest risks are removed from the insurance markets.
Coverage Available
Normally, high risk pools propose 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
Normally, there are a lot of ways to become eligible for your state’s high risk pool. Read the following ways:
• You have a qualifying condition (for example: aids, cancer, diabetes).
• You obtain a notice of rejection from a health insurer.
• You have been unwittingly terminated from a health insurance plan.
• You obtain a notice of benefit reduction or specific condition exclusion.
• You get a notice of premium rate increase or surcharge exceeding the pool rate.
• You are HIPPA-eligible.
Remember: You are HIPPA-eligible in such cases:
- 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 Buy
High risk pool premiums are usually more expensive than coverage provided by private insurers. In most state high risk pools, premiums are 1.5 to 2 times higher than those required by private insurance companies. Furthermore, all state high risk pools adapt premiums for age. This makes coverage especially expensive for people in their 50s or early 60s.
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