federal reform: high-risk insurance pools

legislation helps the uninsured in every state

By Steve Anderson
healthinsurance.org™ editor

The Department of Health and Human Services has announced that it will lower premiums for temporary high-risk pools in 18 states and ease eligibility standards in 23 states and the District or Columbia to make expand enrollment in the Pre-Existing Condition Insurance Plan (PCIP) that was created by last year's Patient Protection and Affordable Care Act.

Premiums will be lowered by up to 40 percent in 18 states where the PCIP is administered by the federal government to bring the premiums closer to the rates in each state's individual health insurance market. Find out how the changes to PCIP premiums affect each of the 18 states.

At the same time, the HHS will ease PCIP eligibility requirements for those states and five others – plus the District of Columbia. Starting July 1, 2011 applicants will no longer have to wait for their carrier to provide a letter denying them coverage. Also, those applying for PCIP coverage will only have to provide a letter from their medical provider, stating that the applicant has had a medical condition, disability or illness.

Risk pool applicants will still need to have been without health coverage for six months, a requirement that has been targeted as a possible factor in PCIP enrollment that has been much lower than expected. About 18,000 Americans were enrolled as of late May.

The premium and eligibility changes do not apply to 27 other states – those states that opted to run their own PCIP program. HHS sent those states letters informing them of the opportunity to modify their own PCIP premiums.

Coverage will be available through the risk pools until 2014, when consumers will have access to affordable health coverage through insurance exchanges also established by the landmark health reform legislation.

traditional state risk pools

why were state high-risk insurance pools created?

By Chuck Smith-Dewey
healthinsurance.org™ founder

A majority of Americans – nearly 60 percent according to the U.S. Census Bureau – get employer-sponsored health coverage under group health insurance. Another 27 percent of the population is covered by government-sponsored health care – through Medicare, Medicaid, children's health care programs (CHIP), 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 should be able to do a quick online search for health insurance quotes and then choose from the variety of plans and benefits available in your state. However, if you've already been treated for a medical condition, 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.

According to a 2007 report by United Health Foundation, 15.9 percent of all Americans were 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 insurance carriers because of a pre-existing medical condition.

Risk pools – started in Minnesota back in 1976 – created pools from 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. Prior to passage of health reform, 34 states offered some form of risk pool, and these risk pools covered about 183,000 people.

At their core, risk pools are state-created, nonprofit associations that – in most states – do 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.

Some risk pools have done an excellent job of providing alternatives for their citizens, while others have done very little because their health insurance plans are not designed well, or are not funded properly by their states – or they were simply unaffordable. The risk pools created by the Affordable Care Act are intended to remedy these shortcomings.

state risk pools and where to contact them

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New Mexico Medical Insurance Pool
(505) 622-4711

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

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

Oklahoma Health Insurance High Risk Pool
Toll-free 1-877-885-3717

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

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

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

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

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

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

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

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

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

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