If you or a member of your family are rejected or charged more for a personal health policy from a private insurance carrier because of a pre-existing medical condition, you typically become eligible for state-guaranteed personal health insurance or the new interim federal risk pool.

Federal Risk Pool

As of July 1, 2010 the Affordable Care Act has required that each state has a temporary federal risk pool in place (until 2014 when health care exchange is established).  This federal risk pool was established to help those who have had no health insurance coverage for more than 6 months and have health conditions that would not be accepted by health insurance providers.   The risk pool is a subsidized coverage for an individual covering pre-existing conditions.  Rates are minimally adjusted above the standard rates and generally more affordable than the state guaranteed issue risk pools. For more information about the “Interim” Federal Risk Pool and to find what you have available in your state Click here to go to the Interim Federal Risk Pool.

State Risk Pool

A federal law passed in 1996 (HIPAA) requires all states beginning 2006 to offer state-guaranteed personal health policies (sometimes called “state risk pool coverage”) to employees that lose their group coverage (called “HIPAA-eligibles”). Forty states go far beyond this federal mandate and offer state-guaranteed personal health policies to all of their residents with pre-existing medical conditions even if they never had an employer plan.

Click here for North Carolina

Click here for more info about State-Guaranteed Coverage in your state.

Below are the most important general facts about state-guaranteed coverage.

  • There is virtually no difference between a state-guaranteed personal health insurance policy and a traditional private-carrier personal policy-except the price. In fact, state-guaranteed coverage is typically provided by the leading private carrier(s) such as Blue Cross in each state.
  • While the federal government suggests states charge 100%-200% more than personal policy coverage for state-guaranteed coverage, the cost of state-guaranteed coverage varies widely between states. State-guaranteed coverage has nothing to do with income. It is available equally to all residents of every state who have preexisting medical conditions regardless of whether they earn minimum wage or are a millionaire, although some states offer low income assistance with premiums.
  • Most states impose a waiting period of up to 12 months before covering preexisting medical conditions, however these waiting periods do not apply to HIPAA-eligibles. A HIPAA-eligible is typically a person formerly on an employer group plan who is no longer eligible for COBRA either because of time (18-36 months) or because COBRA was not offered.  (FEDERAL RISK POOL DOES NOT HAVE PRE-EXISTING LIMITATIONS. ALL ARE EXCEPTED NO MATTER WHAT CONDITIONS)
  • If your company currently had a group plan, terminating the group plan often makes every employee “HIPAA-eligible” for a short period of time because there is no COBRA offered. Making an employee or dependent “HIPAA-eligible” can be a great gift to someone with a preexisting medical condition because it guarantees them, in all 50 states, acceptance into state-guaranteed coverage without a waiting period.

Last year 1 million of the 2 million U.S. families filing for personal bankruptcy protection did so for medical reasons. 80% of these 1 million families had group employer coverage when they first became ill-coverage they lost when they were no longer healthy enough to come to work or were needed at home to take care of a family member with an illness.

For more information on being uninsurable or any other questions please contact us.

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