Understanding High Risk Health Insurance and Your Options:

If you have a pre-existing condition, or your insurance company feels that you have specific factors, you may be labeled as "high-risk." What does this mean and how will it affect your health insurance?

First, many health insurance companies will not provide insurance policies to people with pre-existing conditions or high-risk factors. It can be almost impossible to find a health insurance plan through traditional means. Second, if you can find a health insurance plan that will provide coverage, your premiums and deductibles may be quite high.

Are there any options for people who happen to fall into a "high-risk" group? Thanks to a new type of insurance plan, the answer is yes. This plan is known as a state pool and is very similar to group health insurance. The majority of states in the US are now offering these group pools to their residents, making insurance easier to obtain and keeping rates much lower.

How does a state pool work?

A state pool works by combining several high-risk individuals, or people with pre-existing conditions into a group, similar to group health insurance plans offered by businesses. Once everyone is in this pool, the overall premiums go down and the costs are much easier to manage.

Is everyone eligible for a state pool?

If you have health insurance, and the premiums are higher than what you would pay in the state pool, you will be eligible for coverage. If you do not have a current health plan and fall into a high risk category, or if you have a pre-existing condition you will also be eligible. However, if your current premiums are less than what is being charged in the state pool you will not be eligible. Most states also block inmates of public institutions from joining a state pool as well.

In addition, if you have health insurance, but you have been denied coverage for services provided for a pre-existing health problem, you would also be eligible for coverage in a state pool.

States may also limit the amount of people who may be enrolled in the state pool. This means that if their maximum number of policy holders has been reached, you will need to wait for an opening to come available before you can join your state's pool.

Can I still use my Medicare or Medicaid with a state pool?

As of this time, the majority of states do not allow persons who currently have Medicare to enter into a state pool. However, there are some states that are now providing other options for Medicare and Medicaid recipients.

If you have questions about your state's pool for high-risk individuals and people with pre-existing conditions, you can check with your state's insurance commissioner for more information.

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