Considering High-Risk Health Insurance: How to Tell If It’s The Right Fit For You

If you are considering enrolling in the high-risk health insurance of your state, there are some things I’d like to discuss here so that you can make an informed decision about whether a high-risk health insurance plan is for you. Let me start with a quick definition of high-risk health insurance: It is defined as medical coverage for individuals with health conditions that prevent them from enrolling in a traditional health insurance plan.

These “high-risk pools” are options that are available to help ensure that individuals who are labeled as high-risk are still able to carry health insurance. Now, for those of you that are all set to jump on the risk pool bandwagon, I do advise you of the following negative aspects of it: is typically more expensive, is often difficult to obtain (strangely) and may also require that you have been without health insurance for the past six months. And I get the following question almost daily, so I figure I will answer it here: should I forego applying for an individual health plan and go straight to the pool? The answer is no! Most high-risk pools require getting formally declined from an individual health insurance carrier or a letter from a health insurance agent that states that you are medically ineligible for an individual health plan.

With this being said, let’s discuss situations in which high-risk health insurance is a good fit.

You Have High-Risk Health Conditions

If you have one of the conditions listed in the eligibility requirements of the pool in your state, then it is most likely that it will be a good fit for you. Conditions may be also be considered high-risk if they require costly or ongoing medical treatment in the form of prescription medicine or medical treatments and procedures. However, not all individuals that I would advise to go into the risk pools will have chronic diseases that prevent them from obtaining medical insurance. The pools may also be a good fit for those that have conditions with a high incidence of complications or require ongoing medical care, thus making it difficult to obtain coverage. Obesity and pregnancy are examples of such conditions. Health factors such as these can make it difficult for an individual to obtain healthcare while the conditions are still present. The pool is also a good option if you have a condition that is not specifically listed as an eligible condition in the eligibility requirements but was excluded from coverage when you applied for an individual health plan. In other words, if you applied for individual health plan and you weren’t declined but you got your condition excluded from coverage, high-risk health insurance is available to you as well.

You Have Pre-Existing Medical Conditions

High-risk health insurance should be a good fit for you if you have a pre-existing condition that may not be high-risk. Pre-existing conditions are health issues that are known to exist prior to an individual seeking healthcare. However, when obtaining new individual health coverage, there is typically a waiting period during which insurance will not cover medical care related to these conditions. The last thing you want is to enroll in a health insurance plan and they tell you, “we’re going to cover the very condition you’re getting health insurance for after a year.” Yeah, thanks! It is easier to get around the pre-existing condition clause if you’re in a high-risk health insurance program. The pools have special rules governing pre-existing conditions that are much easier to navigate than their corresponding individual health plans. An example of such pre-existing medical conditions that I’d advise for the risk pool are neurological conditions. Neurological conditions are usually not one of the conditions listed in the eligibility requirements of the high-risk pool but they are typically pre-existing conditions that, if you were to enroll in an individual health plan, you’d be waiting a year for coverage on.

You Can Afford To Pay Higher Premiums

The premiums can be higher when compared with individual health policies, the premiums are based on the carrier considering the fact that they are covering people with pre-existing conditions. You will be paying an average of $660/month for a 50-something year old non-smoker (in states where the federal government is running the pools), which is not affordable for everyone.

You Have Been Uninsured For Six Months

For the most part, in order to qualify for coverage in one of the risk pools, a person has to have been uninsured for at least six months. This was created to keep people from switching off of other coverage (including existing high risk pools) and then jacking up the new pools with members. For those who have conditions and have been uninsured for several months after exhausting COBRA or after an employer goes out of business and stops offering health insurance all together, a high-risk health plan will likely be a good fit for you.

If you’re considering high-risk health insurance, consider the above situations and also make sure you know your state’s plans and regulations. The pools vary by state due to rules and regulations that are at the state government level. Individual states offer high-risk pools that allow those who have been denied coverage to obtain health insurance and these pools are designed to grant medical care to those who cannot otherwise obtain it but they are not available in all states. High-risk health coverage may also be a higher cost than individual health insurance but it can still be an extremely viable option for those who cannot obtain coverage by any other means.