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Most adult Americans receive health insurance from their employers or spouse’s employer. However, according to a survey done by the United Health Foundation in 2006, nearly 16% of Americans do not have health insurance. Approximately 60% of Americans have health insurance through their employers and 27% have Medicaid. Most of the remaining have some form of individual health insurance.
Many who are not insured are forced to go without health insurance because of a pre-existing medical condition. They are considered to be too high of a risk by insurance companies to be eligible for health insurance. Individuals that have pre-existing medical problems usually find it very difficult to obtain health insurance if they are not able to rely on some sort of employer-based health care plan. They usually have very few option for obtaining health insurance, even at high costs.
For what are sometimes called the uninsurable, their only option may be to obtain insurance through a high risk pool that is state-run. These plans are designed to provide health insurance to individuals who are not able to get health insurance because of a pre-existing medical condition. 34 states currently operate a high risk pool.
The way these work is a state-run high risk pool creates a pool of individuals who are unable to get individual health insurance. All the members of the group are able to obtain health insurance through the state-sponsored program, although it is at higher rates than it would be for individuals without pre-existing medical conditions.
Usually members of high risk pools can select between PPO, HMO and FFS plans. Each type of plan offers different degrees of flexibility in terms of how individuals are able to manage their health care.
However, there are disadvantages to these types of health insurance plans. They are expensive. Members that belong to high risk pools may have to pay as much as twice what someone who qualifies for a regular individual insurance plan would.
Many high risk pools also have an exclusion period for pre-existing conditions of six to twelve months. This means you must wait for that period of time before you are eligible to make a claim for medical costs. However, the high risk pool may be the only alternative for some individuals or face not having any health insurance at all. Since the costs of not having any insurance can still be much higher than having expensive premiums, this still is an attractive option for some individuals.
In order to qualify for health insurance through a high risk pool, you will need to be a state resident and must also meet one of these conditions:
> Proof that at least one insurer has rejected you for health insurance
> Proof that your current insurance premium is higher than what could be offered by the state’s high risk pool
> Proof that your health insurance has a rider attached or is rated
Some states also have reciprocity agreements that make you eligible to apply when you were previously enrolled in another state’s high risk pool if you meet residency requirements.
Individuals who are excluded from the state high risk pools include individuals on or eligible for Medicaid or Medicare, as well as individuals who have exceeded their maximum benefits on their plan. Some states also have their enrollments capped and will only accept a specific number of individuals.
