Affordable health insurance for the individual, the family and the self-employed

Risk pools for the Medically-Uninsurable

Health insurance risk pools are state programs for the medically uninsurable

According to a 2007 report by United Health Foundation, 15.9 percent of all Americans are uninsured. State-sponsored risk pools are aimed at a small slice of those Americans: those who can afford to buy health insurance, but are denied affordable health insurance coverage by private companies because of a pre-existing medical condition.

In a nutshell,
here's the problem:

A majority of people -- nearly 60 percent according to the U.S. Census Bureau -- get health care through their employer under group health insurance programs. Another 27 percent of the population are covered by government sponsored health care, through Medicaid, children's health care programs, military health care, native American health care programs and various state programs for low-income people.

Those left over are the self-employed or those working for very small companies which do not provide health insurance benefits. If that describes you, you must directly purchase coverage directly through private health insurance companies. If you and your family have always been healthy, you'll be able to pick from a variety of plans available in your state with various benefits and costs. However, if you've already had any medical conditions, or other high-risk factors, you may be unable to find a health insurance company that will insure you at any price.

Why is this? Health insurance companies are in business to make money. They don't want to sell insurance to people who are most likely to utilize it. At the end of the day, what determines their profitablity is that they need to take in more dollars in premiums than they pay out in benefits and administration costs. When a health insurance company sells a policy to a business it gets all that businesses' employees, healthy and sick -- state laws require it to do so. The insurance company uses complicated formulas by actuaries to set their pricing, based on the fact that the premiums paid by the healthy employees will help pay for the costs of those employees who are not.

If you are buying a policy direct from an insurance company, your policy is individually underwritten, which means you are essentially a group of "one" when the health insurance company determines how likely it is to take in more premium dollars from you than it pays back in benefits. It is in essence making a "bet" on you not getting sick; if it appears to be a bad bet in your case, they simply won't make it.

That's where state sponsored risk pools come in. Began in 1976 In Minnesota, these plans create a pool out of all the individuals that private insurance companies do not want to sell policies to as individuals, then provide a state-sponsored health insurance plan these individuals can buy into, albeit at a higher cost than if they were able to qualify for a private plan. Currently 34 states offer some form of risk pool, covering about 183,000 people. That may not seem like a lot when you look at America's total number of uninsured, but for many people it's the difference between stuck in a deadend job to keep its benefits or able to switch jobs to better your family or even to become self-employed.

State risk pools vary greatly in plans, benefits, eligibilty and funding. Some do an excellent job in providing alternatives for their citizens while others do very little. At their core, risk pools are state-created, nonprofit association that -- in most states -- does not require tax dollars for its operational purposes. The risk pools can be a temporary stopping point for individuals who are denied health insurance for medical reasons. Risk pools often help individuals fill a gap in insurance coverage.

State health insurance risk pools Web sites and phone numbers

Thumbs up on offering a risk pool.;

Alabama Health Insurance Plan
Toll-free 1-800-513-1384 or (334) 353-8924

Thumbs up on offering a risk pool.;

Alaska Comprehensive Health Insurance Association
Toll-free 1-888-290-0616

Thumbs up on offering a risk pool.;

Arkansas Comprehensive Health Insurance Plan
Toll-free 1-800-285-6477

Thumbs up on offering a risk pool.;

California Major Risk Medical Insurance Program
Toll-free 1-800-289-6574 or (916) 324-4695

Thumbs up on offering a risk pool.;

CoverColorado
(303) 863-1960 or toll-free 1-866-787-9129 (M-F 8am–5pm)

Thumbs up on offering a risk pool.;

Connecticut Health Reinsurance Association
Toll-free 1-800-842-0004 (M-F 9am-4pm EST)

Thumbs up on offering a risk pool.;

Florida Comprehensive Health Association (closed to new enrollees since 1991)
(850) 309-1200

Thumbs up on offering a risk pool.;

Idaho Individual High Risk Reinsurance Pool
(link is to a PDF on program)
Toll-free 1-800-721-3272 (In-state only)

Thumbs up on offering a risk pool.;

Illinois Comprehensive Health Insurance Plan
Toll-free 1-866-851-2751 (in-state only) or (217) 782-6333

Thumbs up on offering a risk pool.;

Indiana Comprehensive Health Association (click "guest" for access, then choose "ICHIA")
Toll-free 1-800-552-7921 or (317) 614-2000

Thumbs up on offering a risk pool.;

Health Insurance Plan of Iowa
Toll-free 1-877-793-6880 (M-F 8am-5pm CST)

Thumbs up on offering a risk pool.;

Kansas Health Insurance Association
Toll-free 1-800-362-9290 (M-F 8am-5pm)

Thumbs up on offering a risk pool.;

Kentucky Access
Toll-free 1-866-405-6145

Thumbs up on offering a risk pool.;

Louisiana Health Plan
Toll-free 1-800-736-0947 or (504) 926-6245

Thumbs up on offering a risk pool.;

Maryland Health Insurance Plan
Toll-free 1-888-444-9016 (M-F 8am-5pm)

Thumbs up on offering a risk pool.;

Minnesota Comprehensive Health Association
Toll-free 1-866-894-8053

Thumbs up on offering a risk pool.;

Mississippi Comprehensive Health Insurance Risk Pool
Toll-free 1-888-820-9400

Thumbs up on offering a risk pool.;

Montana Comprehensive Health Association
Toll-free 1-800-447-7828

Thumbs up on offering a risk pool.;

Nebraska Comprehensive Health Insurance Pool
(402) 343-3574 or toll-free 1-877-348-4304 (M-F 8am-4:30pm)

Thumbs up on offering a risk pool.;

New Hampshire Health Plan
Toll-free 1-877-888-6447

Thumbs up on offering a risk pool.;

New Mexico Medical Insurance Pool
(505) 622-4711

Thumbs up on offering a risk pool.;

Comprehensive Health Association of North Dakota (North Dakota health insurance risk pool)
Toll-free 1-800-737-0016 or (701) 277-2271

Thumbs up on offering a risk pool.;

Oklahoma Health Insurance High Risk Pool
Toll-free 1-800-255-6065 or (913) 362-0040

Thumbs up on offering a risk pool.;

Oregon Medical Insurance Pool
Toll-free 1-800-848-7280 or (503) 225-6620 (M-F 8am-5pm)

Thumbs up on offering a risk pool.;

South Carolina Health Insurance Pool
Toll-free Phone 1-800-868-2500, ext. 42757, or 1-803-788-0500, ext. 42757 

Thumbs up on offering a risk pool.;

South Dakota Risk Pool
605-773-3148 (ask for a Risk Pool representative)

Thumbs up on offering a risk pool.;

Tennessee's Tenncare Program
1-888-486-9355

Thumbs up on offering a risk pool.;

Texas Health Insurance Risk Pool
1-888-398-3927

Thumbs up on offering a risk pool.;

Utah Comprehensive Health Insurance Pool
Toll-free 1-800-705-9173 or (801) 442-6660

Thumbs up on offering a risk pool.;

Washington State Health Insurance Pool
Toll-free 1-800-877-5187

Thumbs up on offering a risk pool.;

West Virginia Health Insurance Plan
1-866-445-8491

Thumbs up on offering a risk pool.;

Wisconsin Health Insurance Risk Sharing Plan
Toll-free 1-800-828-4777

Thumbs up on offering a risk pool.;

Wyoming Health Insurance Pool (scroll down)
(307) 634-1393

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