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Risk Pools - Health Plans For The Risky Or Uninsurable

Nov 18, 2007
If you have a pre-existing condition that carries high risks for your insurance company, you may have trouble finding an affordable health plan. In fact, companies are not forced to insure you. If you are too risky, they can reject your application.

More than half of all insured people get their insurance from their companies. Group insurance plans reduce risk by sharing the cost equally. But, what if you can't get into a group plan?

States offer a type of health plan called "risk pools." Risk pools are intended to provide insurance to the uninsurable.

What Is A Risk Pool?

First, let's look at how group insurance works. Even risky individuals can be covered under group health insurance at little cost to insurance companies because everyone shares expenses and risks. When the company has to shell out extra for claims made by a certain individual, the rate of the whole group goes up.

With individual health plans, there is no group. It's just you. So, private insurance companies look at your medical history and risks. This is what determines your rate.

A risk pool is like a group of all the people within a certain state who can't get private insurance because of pre-existing conditions and other health risks. It works in much the same way as group insurance does, except that the group in this case is not the company, but all the individuals in the state who can't get insured.

Because they are obviously risky, risk pools cost more than regular insurance. This is not a government support program like Medicare or Medicaid aimed at low-income earners. Risk pools are usually quite expensive.

Does My State Have A Risk Pool?

Not every state offers risk pools, but most do. There are risk pools in Alabama, Alaska, Arkansas, California, Connecticut, Colorado, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin, West Virginia and Wyoming.

Each state's risk pool varies. You definitely have to be a resident of the state in which you apply. Other than that, the requirements are different in each state. In order to qualify, they may require that you prove that you've been rejected by an insurance provider because of a high health risk.

In most states, you can't get a risk pool health plan if you qualify for Medicare or Medicaid. Some states also have an enrollment cap, meaning that they will only accept a certain number of applicants to the program each year.

Risk pools are operated by non-profit healthcare organizations. Currently, almost 200,000 people are enrolled in risk pools, which is not a large number if you consider how many Americans are uninsured. Some states, like Tennessee, are starting to have special programs for kids and specific diseases like diabetes.

Risk pools are convenient for individuals who are having trouble getting insured. You can take out a short-term plan to cover a gap in your employment or insurance.

If you have a pre-existing condition that puts you at high risk, you may feel like you should stick with your group plan so that you can stay covered. This might mean staying at a lousy job that you would just as soon ditch otherwise. Risk pools offer you more choices for your health insurance coverage.
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