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Health insurance risk pool - Birds eye view

Health insurance risk pool - Bird's eye view

It is quite easy to understand the rationale behind health insurance. When people make payments into an insurance pool, the healthy members are subsidizing the health care costs of people who have greater needs. In this way, people can get the health care they need without undertaking burdens that are over the top.

Why do we need health care pools? If there was no risk pool, the costs for a universal pool would be too high for the common man. In order to make health care affordable for the more or less healthy, individuals with higher health risks are allocated a separate group.

However, a high risk pool should be the last resort for a person seeking insurance. One should opt for it only if he is not receiving group covers or if the person is being denied coverage owing to a medical condition like depression, cancer, stroke etc.

High risk pools are not for people who have very low incomes. They are better off with programmes like Medicaid. These pools are most suitable for people belonging to the middle income groups with health problems. These are programmes created by state legislatures in order to ensure that the people who need it the most can buy insurance.

Although there are many common features between them, there are a number of differences in the way the different pools are run in the states. The funding of these pools depends on the actions of the state legislatures. They are subsidized so that the rates can be kept low. They rely mostly on state funds. A big problem with these pools is that there is usually a waiting period. This happens because it is at times the only option available to people who would otherwise have to go uninsured. Letís take a look at the various aspects of these pools.

  • Deductibles: There are wide choices in this area. Deductibles range between $500 and $10000. In addition to this, a HSA account can also be opened with these plans. But unfortunately, most people do not have the funds to finance a separate account.
  • Eligibility: Most conditions under eligibilities are quite strict. So, anyone with a serious illness may not be eligible. If you are eligible for any other cover, you cannot apply to this pool. This includes covers under COBRA, Medicaid or Medicare.
  • Waiting period: Usually, preexisting conditions are not excluded. But, there may be long waiting periods under this clause. The periods range between 6 months and 12 months.
  • Waivers: Waivers are allowed under different heads. This may include previous health coverage, Medicaid coverage or coverage under COBRA.
  • Wait list: As some of these pools have reached maximum enrollments, they usually have waiting periods that may go into months. But these are included in your pre existing waiting clause. So, by the time you are enrolled, your waiting clause is usually covered.

High risk pools have been in the limelight recently for various sections like public interest groups, elected officials, insurance industry groups etc. Many proposals in reforms have also been targeting these pools so that more covers can be provided to the people who are uninsured.

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