What are High-Risk Pools?

High Risk Pools

Tara was a single mother of three. She worked two jobs to keep food on the table and a roof over her and her little girls’ heads. When she learned that she was fighting a serious form of Leukemia she believed her life was over. With time, a new way of looking at healing and a lot of time spent in doctors’ offices she had come to a place where she could safely say she was a survivor.

But that didn’t help her at all when it came to getting insurance. Unfortunately Tara didn’t belong to the group that counted themselves as those lucky enough to enjoy the security of group health insurance through an employer or a spouse’s employer. The group health insurance could have helped her get past the evil pre-existing medical condition question that blocked her from finding a financially feasible health insurance. So what is a person like Tara to do?

Despite what many think, the laws today do not protect a person that fought cancer or is facing the debilitating issues of HIV when it comes to finding a health insurance policy that will provide them meaningful coverage. If you are not able to be a part of a group health insurance program and are considered uninsurable due to a previous illness, you are regrettably not protected. States are not expected nor required to offer an insurance avenue for those that have come up against this massive wall, but there are those that do.

Of those states that offer a way for the uninsurable individuals to gain insurance is through what is referred to as “high-risk pools”. These high risk pools are the most common way that people that have faced massive illness may find a way to be insured.

High-risk pools are a savior for those like Tara. High-risk pools are a means of health insurance that is created through a private, self-funded plan that is constructed by the state. High-risk people come together under certain criteria, including the inaccessibility to group insurance. These high-risk pools come complete with a board and administrators and are sometimes connected to a state’s Department of Insurance. Within the group are various options for health insurance plans helping to connect with each individual’s needs. As is the case with all other insurances, the individuals are given information booklets and enrollment cards with the insurance plan.

High-risk pools are the best option for an individual facing a pre-existing condition for various reasons. One bonus is the ability of the pool to contract with health insurance carriers and administrators which allows the paperwork associated with high-risk pool to not show evidence, helping with anonymity. This helps with the mental component of pre-existing conditions as a person is able to appear as any other health insurance consumer does in the midst of hospital and doctor visits.

The plans that are often offered through high-risk pools look just like any other comprehensive major medical plan, including a variety of premium and deductible options. One of the most often used high-risk pool options is offered through PPO plans, though the HMO and HSA option is also viable in some states. Coverage for other aspects such as prescriptions, mental health and maternity are included as well as disease management programs.