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Understanding High-Risk Health Insurance Pools Posted: June 7th, 2010

By Shannon Lee

Shannon Dauphin is a freelance writer and novelist based near Nashville, Tennessee.

In preparation for the Patient Protection and Affordable Care Act, much has been said about high-risk health insurance pools. But what are they and what are they meant to do?

What are high-risk health insurance pools?

According to the Health Insurance Resource Center, high-risk insurance pools got their start in Minnesota in 1976. Today, those who are unable to find health insurance through a private insurer because of a pre-existing condition may be able to get medical coverage through a high-risk pool.

If you have a pre-existing condition, you may have been denied individual medical insurance in the past. Those with pre-existing conditions can join high-risk health insurance pools, which provide state-sponsored health care to those in the pool. Although it is certainly not the cheapest health insurance available, it does provide health insurance to those who might not be able to obtain coverage.

Where can you find high-risk health insurance pools?

According to the National Association of Insurance Commissioners (NAIC), at least 31 states plan to offer their own high-risk health pool coverage and 18 states have opted to allow the U.S. Department of Health and Human Services to conduct alternative programs for their residents. As of May 2010, two states, Texas and Utah, have not yet made a decision about their options for high-risk pools.

The current health care reform plan requires the development of a high-risk pool for those with existing medical conditions. The pool subsidizes premiums for those who have been without health insurance for at least six months and have certain medical conditions.

Backed by $5 billion in federal funds, the high-risk pool will provide insurance for those who can't obtain it otherwise. By 2014, all insurers have to provide guaranteed-issue coverage for individuals without adjusting the cost of insurance because of pre-existing conditions.

Will your state run a high-risk pool?

To find more information on the high-risk pools in each state, visit the NAIC website. There you can find a list of states that plan to adopt high-risk pools, as well as links to additional information on what to expect from the systems currently in place.