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What is A High-Risk Health Pool?

Thanks to the new healthcare reform bill, high-risk health insurance pools will be opening up state by state. Because people with pre-existing health conditions are riskier to insure (because they already have health issues and are guaranteed to cost the health insurance company money) many of them do not have health insurance policies. High-risk pools are state subsidized insurance pools that offer insurance benefits to these high-risk individuals with pre-existing conditions.

High-risk health pools have always existed in some states, but the new insurance regulations have made it so that a new pool will be opened in every state and those individuals who have been without insurance for 6 or more months and who can’t otherwise get health insurance coverage will be able to access the pools.

While the pools are state subsidized, that doesn’t mean that they are premium free. Those who participate in them must pay a premium that is often quite expensive and for some cost-prohibitive. You might be wondering why it is important that these individuals be pooled together for insurance benefits. The reason is that by pooling them, the participants who have fewer health insurance claims can soften the financial blow of those who do have frequent claims. By pooling all individuals and premiums together, you spread the risk out among more individuals and more premiums and reduce the risk of running out of money to pay claims.

The high-risk pools set up to comply with the healthcare reform bill should offer many of the same benefits as a standard health insurance policy. They may not be luxury plans with coverage for acupuncture and massages, but they will offer benefits for preventative care, wound care, illness and hospitalization as well as medications. They are a welcome benefit to many individuals who have been without any coverage and have been ignoring their health as a result.


December 10, 2009



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