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High Risk Pools Cost and Coverage

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High Risk Pools Cost and Coverage

High Risk Pools Cost and Coverage

While talking about high-risk pool, we must know the high risk pools cost and coverage. Below is a brief discussion on high risk pools cost and coverage.


Health high-risk insurance pools offer different plans. Such plans are equivalent to most of the major health plans and have a vast array of deductibles as well as premiums. Health high-risk pools offer a broad range of benefits that may include the following:

  • Maternity care
  • Prescription coverage
  • Disease management

However, the benefits offered by these plans differ accordingly. The states use several methods to distribute such services and those are:

  • HMO styled networks
  • Conventional indemnity plans
  • PPO style plans

PPO style plans are most popular among all of them.

Nevertheless, obtaining coverage is not an easy job. It's really hard to get continual coverage from an employer health insurance plans to a health high-risk insurance plan. You will be placed on waiting list, if your risk pool is full. And, this waiting list can prevent you from getting coverage at any time. Moreover, the plans provided by the high-risk pools often do not provide instant coverage for the health condition for which you are probably driven to a high-risk pool. Most of the pre-existing health conditions need an exclusion period before you obtain coverage for that particular condition. Usually, duration of a waiting period is six months, but the duration can be changed on the basis of the state you reside as well as the condition you are suffering from.

What does high-risk pool cost?

In brief, plans from high-risk pools are costly. When there is federal grant dollars saved for such high-risk pools and seldom funds are gathered from taxes on the hospital revenues, most of the expenses in these plans are disbursed by its members. Since, individuals belong to such pools are more likely to use the insurance benefits than general people, these plans by high-risk pools are much expensive than plans from private insurance companies. State laws usually control the rates; however the laws consider rates from 130% to 200% of market value. The cost you have to pay for being a part of such groups depends on history of your health, age and the eligibility criteria determined by the state.

Hope you will find the above discussion on high risk pools cost and coverage useful.

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