Affordable health insurance for the individual and the family, medical insurance

Risk pools for the medically uninsurable
aid those turned down for health insurance

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 helping a small slice of those Americans: those who can afford to buy health insurance, but who 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 employers under group health insurance programs. Another 27 percent of the population is covered by government-sponsored health care, through Medicaid, children's health care programs, military health care, and various state programs for low-income populations.

Those left over are the self-employed or those working for very small companies that don't 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 been treated for some medical conditions, or have a history of certain high-risk factors, you may be unable to find a health insurance company that will offer you comprehensive health insurance 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 business' employees, healthy and sick (as required by state laws). The insurance company uses complicated formulas by actuaries to set their pricing, based on the idea that the premiums paid by the healthy employees will help pay for the costs of those employees who are not.

"One" is the loneliest number

If you are buying a policy direct from an insurance company, your policy is individually underwritten. That means that you're 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 you appear to be a "bad bet," they simply won't make the bed.

That's where state-sponsored risk pools come in. Risk pools – started in Minnesota back in 1976 – create pools of all the individuals denied coverage by private insurance companies, then provide state-sponsored health insurance plans 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, and these risk pools cover 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, risk pools are the difference between being stuck in a dead-end job in order to hold on to benefits or having the option to switch jobs – or even to become self-employed.

Some state risk pools are good. Others? not so good.

Some risk pools do an excellent job of providing alternatives for their citizens, while others do very little because their plans are not designed well, or are not funded properly by their states – or they're simply unaffordable. At their core, risk pools are state-created, nonprofit associations that – in most states – doe not require tax dollars for their operational purposes. A risk pool can be a temporary stopping point for individuals who are denied health coverage – or for individuals who need to fill a gap in insurance coverage.

State risk pools and where to contact them


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.; North Carolina Health Insurance Risk Pool (NCHIRP)
Toll-free 1-866-665-2117

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

News Stories on RIsk Pools

Under Senate Finance Committee Plan, High-Risk Insurance Pools Get Funding Boost

The NewsHour (PBS) – Until recently, self-employed writer Candace Talmadge, of Lancaster, Texas, was pleased with the health insurance she purchased through a small business association.

Rendell announces initiatives to help struggling families

Philadelphia Inquirer – Arguing that Pennsylvania families “need help now” to weather the recession, Gov. Rendell yesterday said he would redirect millions of dollars for health insurance, mortgage assistance, home-heating assistance, and job-counseling programs. Click here to see Pennsylvania’s State Health Guide.

When COBRA is de-fanged

Health Insurance Resource Center BLOG – They say everything is bigger in Texas, and sadly, they’re dead-on when it comes to this depressing statistic: that no other state in the nation has a larger percentage of residents who don’t have health insurance. According to the United Health Foundation’s 2008 report, America’s Health Rankings, 24.9 percent [...]

Read more news stories on Risk Pools

Turned down for health insurance?

A new option for those told they can't buy health insurance

Mini-meds – also called "defined benefit" health plans – are guaranteed-issue health insurance, which means anyone can buy them regardless of pre-existing health conditions. There is no underwriting and no health questions are asked.

Seem too good to be true? It's because these plans have defined limits on coverage, which means less risk for the insurance company. They pay set amounts and are not designed to provide catastrophic coverage.

Benefits of mini-meds for consumers

  • With no deductibles or co-insurance to satisfy, mini-meds provide you with first-dollar coverage and typically offer negotiated discounts through PPOs.
  • Mini-meds are simple to understand. They provide scheduled benefits for inpatient and outpatient services. For example, you can choose a plan that pays $1,000 a day for hospital coverage for the first 100 days.
  • They can be good coverage for your everyday needs such as doctor visits or even longer-term hospitalizations as outlined above.

The biggest drawback is that in the case of a serious illness, you may reach the yearly coverage cap, at which point you'll need to pay all costs out of pocket. Still, for many people this may be one of the few options they have to manage their annual health care expenses, and ought to be considered.

As with all insurance decisions, read the fine print and consult several sources of information before making a buying decision.

If you are eligible for Cobra you should exhaust that first, and if you have a risk pool available in your state, make sure to look into it.