What are high-risk pools for health insurance?

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Health care is a universal need, but it is not always universally affordable–especially for high-risk health insurance citizens with pre-existing medical conditions. Often, premiums are higher for these people, and they are left vulnerable because of an inability to pay higher premiums.

The government and different private institutions have attempted to solve that issue, in various ways. High risk health insurance pools are one of these ways.

What are High Risk Health Insurance Pools?

“Riskiness” is how health insurance companies decide how expensive your insurance premium, or payable, will be–or if they will cover you at all. The healthier you are, the lower-risk you are, and the more eligible you are for health insurance at a cheaper premium. The less healthy you are, meaning you have a pre-existing medical condition, the less eligible you are for cheaper health insurance–or for any kind of health insurance at all, no matter how much it is needed. This is both the irony of health insurance, and the practical side of it.

As a result, high-risk insurance pools were created. These pools were health insurance plans made specifically for persons with pre-existing medical conditions. This theoretically kept regular premiums down, and kept high-risk premiums separate, making them affordable through Federal subsidies. But they continued to be unaffordable and unattainable for most high-risk applicants.

To try and manage that situation, the Affordable Care Act (ACA), also known as Obamacare, instructed health insurance companies not to withhold health insurance from any applicant, no matter how “risky” they were. They could also only charge up to 3 times the regular premium for high-risk applicants. This, along with the expanded Medicaid coverage, brought many applicants under health insurance coverage who would otherwise have been uninsurable.

Several states found a way to make the Affordable Care Act work even better, by creating Federal-subsidized high-risk pools. Most notably, Pennsylvania only opened its high-risk health insurance pools when Obamacare was implemented. Right away, in 2010, it became the state with the highest enrollment in that pool. The reach of the ACA enabled the state to open these pools to provide affordable premiums specifically for persons who had pre-existing medical conditions and were therefore uninsurable.

In recent months, as open enrollment draws near (or begins, for some), high-risk insurance pools are coming back into the news. As part of the GOP’s ongoing attempts to privatize health insurance and let the marketplace dictate premiums, they mean to repeal and replace the ACA without shutting anyone out of the health insurance system. As a result, they need to address the fact that many who had gained insurance through Obamacare would no longer be able to afford health insurance premiums.

One of their proposals is to bring back high-risk health insurance pools, and increase the Federal budget for subsidies, so that applicants with pre-existing medical conditions would still have somewhere to turn in their search for health insurance.

How Can You Find and Register for High-Risk Health Insurance Pools in Your Area?

First, verify that you fall into the high-risk pool. This is not so easy, as pre-existing medical conditions may fall under everything from asthma to a stroke. However, some research and a quick inquiry will soon let you know which bracket you fall under.

Next, check what kind of health insurance your state or area offers through a Google search. As an example, for consistency’s sake, let’s look at different types of health insurance in Pennsylvania.

  • Private insurance companies list the cities and areas they serve.
  • The different types of health insurance in Pennsylvania are enumerated, such as employment-related insurance, personal health insurance, insurance with financial assistance, for children, with Medicare, and so forth.
  • It looks at the specific relationship of the state of Pennsylvania and the Affordable Care Act.

Third, look closer into existing subsidies or plans under financial assistance programs or the Affordable Care Act. This will help you consider whether or not high-risk health insurance pools are right for you.

Make Your Choice

If you have decided to find health insurance in a high-risk pool, you may start to compare which state or private programs deliver the best high-risk health insurance plan for your projected needs. It might seem like a long process, but careful planning is a gift in the longer run.