State Risk Pools

Health insurance has always been an integral part of our financial well-being, Most of us are either covered under private health insurance, employer-sponsored group health plan or even by the government-sponsored health care programs such as Medicaid, children's health care programs and other such state programs for low-income populations. However, if you have already been treated for a medical condition or have a history of certain high-risk factors, most of the health insurers would deny coverage to you. For many people with pre-existing conditions, state risk pools are the only available option.

A state health insurance "risk pool" is a state-sponsored health insurance program that provides health insurance coverage to individuals that are unable to obtain health care from private insurance companies due to a pre-existing medical condition. Acceptable forms of proof include copies of denial letters or involuntary-termination notices and diagnosis of pre-existing chronic condition. Additionally, a risk pool can provide temporary coverage for individuals who need to fill a gap in insurance coverage.

Risk pools vary from state to state and not all states have risk pools for the uninsurable. Risk pools are established by state legislation and are usually setup as non-profit organizations.

Enrollment in a state risk pool health plan is still subject to waiting periods, premiums and set benefits, so it should not be considered free, comprehensive insurance that can be obtained immediately. Waiting periods, premiums, benefits and exclusions vary from state to state. However, individuals, who have had continuous insurance coverage in a group health plan for more than 63 days, can obtain risk pool coverage without any waiting periods. Risk pool insurance is generally expensive than the regular individual insurance, nonetheless, the state law regulates the premiums to protect the individual from paying high costs.

Because member premium payments are rarely enough to cover the cost of medical expenses for that member, risk pools require funding from outside sources. This funding source is typically outlined in the legislation establishing the risk pool and will come from sources such as taxes or assessments on health insurance companies.

It is important to keep in mind that risk pools are not created for the individuals who cannot afford health insurance. Risk pools cater to people who would not have access to any other insurance coverage owing to their medical condition. Nevertheless, some state risk pools do have a subsidy for low-income individuals with medically uninsurable pre-existing conditions.

Some states impose certain enrollment caps and limit enrollment in the high-risk pool based on the availability of funds. These states have long waiting lists of several months. Once you get in the waiting list, your time on the list can be credited to your pre-existing exclusion waiting period.

The level of coverage and premium payments for risk pools will vary by state. As a rule, the level of coverage has limitations and maximums that are lower than those offered by private health insurance companies. However, for persons with high medical bills and no other options, obtaining state health insurance through a risk pool can be a blessing.

To learn more about the risk pool health insurance program in your state, choose your state from the list above and look in the additional resources section for a link to the state's specific program. There are currently 17 states that do not have a risk pool: Arizona, Delaware, District of Columbia, Florida, Georgia, Hawaii, Maine, Massachusetts, Michigan, Nevada, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, and Virginia.

To learn more about the risk pool health insurance program in your state, choose your state from the list above and look in the additional resources section for a link to the state's specific program. There are currently 18 states that do not have a risk pool: Arizona, Delaware, District of Columbia, Florida, Georgia, Hawaii, Maine, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, and Virginia.

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