Unfortunately, some people are denied health insurance coverage because of a medical condition or are paying an unreasonably high insurance premium. These people are considered high-risk by most health insurance companies. A large majority of states offer risk-pools to help those who may not be able to have or afford health insurance coverage because of their physical condition. It is not cheap health insurance but can be a way to obtain short term health insurance for some. Below are common questions associated with state risk-pools:
How are state risk-pools funded?
States find various ways to help fund their risk-pools such as tax on hospital revenues. The majority of the funding comes from "pooling" the eligible people together to get a better group rate for insurance similar to how a group health insurance policy from a employer works. The remaining costs are usually picked-up by tax dollars. Because there is often limited funding, it is not cheap health insurance but it can be a way for someone to get short term health insurance until they can qualify for a more reasonably priced plan.
What states offer a risk-pool?
A majority of states offer state risk-pools for health insurance coverage, but not all. The remaining states may be in the process of adding a state risk-pool. To find out if your state offers a state risk-pool contact your state insurance commissioner.
Who qualifies?
First, one must be a resident of the state they are applying in and at least one of the following must be met:
1.Proof that health insurance has been denied -or-
2.The individual applying pays more currently for insurance than the risk-pool premium -or-
3.Currently, an individual is insured but their carrier has denied payment for certain medical services or pre-existing conditions.
Can I have Medicaid or Medicare with a state risk-pool policy?
No, but some states have a high-risk plan for individuals who are eligible for Medicare.
Is there any high-risk person who cannot get coverage?
In some states, certain medical conditions and diseases are not eligible under the risk-pool. Also, inmates of public institutions are not eligible. In addition, some states limit the number of people they will allow in the risk-pool, so if that limit is met new enrollees will be denied until there is an available opening.
How do I find more information?
Contact your state insurance commissioner or view their website for more information on state risk-pools.
