High risk health insurance can be costly for many individuals, especially those with pre-existing conditions who are applying for new health insurance. High risk means that the individual either has a medical issue that will be expensive to treat, or has a high likelihood of developing one. Insurance companies do not want to give high risk insurance to people in these circumstances, because the companies would immediately have to begin paying for high medical expenses without realizing any profit from premiums. As a result, high risk health insurance is restricted to only a few options.
Pools
High risk health pools are one of the most common options for high risk insurance. These pools are run by states and not all states have them, but those that do have them allow individuals to participate in the programs when they have medical expenses they cannot find coverage for. These are private, self-funded programs that are organized by states and allow individuals to apply through insurance companies, the state government or medical clinics. There may be multiple health plans available in the pool, based on your condition. These pools are provided for those the insurance companies deem to be medically uninsurable because they suffer from serious conditions such as cancer or HIV.
Pool Coverage
States create regulations that govern who can apply for pool coverage and how much pools cost. With a qualifying condition, pool costs rarely go above 150 percent of normal premiums, which means a normal insurance rate of $100 per month would probably not rise above $150 per month for the high risk pool. Deductibles and other common insurance terms also apply. Most high risk pools are PPOs (preferred provider organizations), but some states use HMOs (health maintenance organizations) and offer HSAs (health savings accounts) as well.
High Risk Policies
Individuals also have the option to apply for high risk insurance policies offered solely by health insurance companies. Insurers place several limitations on these accounts to help ensure they make a profit. The plans do have limits on how much the insurance company will pay in total, and have much higher premiums than normal plans. Also, if the individual has a pre-existing condition, the company will require a waiting period, usually several months, before the coverage takes effect, to prevent people from picking up the policy right before major treatments.
Temporary Coverage
Temporary coverage is also an option for high risk individuals. These policies are common for people who are not suffering long-term conditions, but instead have issues that they may need coverage for over the next couple years, but not beyond. These plans can help save money and encourage people to get serious conditions like diabetes or high blood pressure down to manageable levels with healthy living so that they do not need to continue paying for the expensive insurance.
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