Coverage and Cost
Plans offered by high-risk pools are comparable to most major medical plans, and have a wide range of premiums and deductibles. Benefits also vary but usually include prescription coverage, maternity care and disease management. States use different systems to deliver these services, such as traditional indemnity plans and HMO styled networks, but the PPO style plan is the most popular.
However, getting coverage isn't exactly easy. It's hard to find continuous coverage from an employer health plan to a high-risk pool plan. If your pool is full, you have to be placed on a waiting list to get in. In addition to the waiting list that could potentially halt your coverage, the high-risk pool plan often doesn't immediately cover the condition which drove you to high-risk coverage in the first place. Many pre-existing conditions require a waiting period before you can get coverage for treatments relating to that condition. Normally this waiting period is about six months, but this time frame can vary depending on the state you're in and the condition you're suffering from.
What Does it Cost?
In short, these plans are expensive. While there's some federal grant money set aside for these high-risk pools, and occasionally funds are collected from taxes on hospital revenues, the majority of the expenses in the plan are paid by the members. Because this group of people are more likely than the general population to use their insurance benefits, these plans are more expensive than a similar policy from a private insurer. State laws typically cap the rates, but these caps still allow for rates between 130 percent and 200 percent of the market value. The cost you would pay to be a part of such a group would depend on your medical history, age and the guidelines set forth by your state.
For more information on high-risk health insurance pools, health insurance and similar topics, see the links below.
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More Great Links
- American Diabetes Association: State High Risk Pools
- COBRA- High Risk Insurance Pools. http://www.cobrahealth.com/statehighriskpools.html
- The Commonwealth Fund: Federal Aid to High Risk Pools. http://www.cmwf.org/usr_doc/Pollitz_highriskpools_875.pdf
- The Commonwealth Fund: Insuring the Uninsurable. http://www.commonwealthfund.org/usr_doc/achman_uninsurable_472.pdf?section=4039
- Health Administration Responsibility Project: High Risk Insurance Pools. http://www.harp.org/shrhip.htm
- Health Affairs: Using Tax Credits and State High Risk Pools to Expand Health Insurance Coverage. http://content.healthaffairs.org/cgi/content/full/hlthaff.w2.345v1/DC1
- Health Insurance Resource Center: High Risk Pool Info. http://www.healthinsurance.org/riskpoolinfo.lasso
- Insure.Com: High Risk Insurance Pools. http://www.insure.com/articles/healthinsurance/high-risk-insurance-pool.html
- National Association of Health Underwriters: High-Risk Health Insurance Pools. http://www.nahu.org/consumer/HRPGuide.cfm
- StateHealthFacts.Org: State High Risk Insurance Pool Participation. http://www.statehealthfacts.org/comparetable.jsp?cat=7&ind=360