Even though most Americans get their health insurance through their employer or the employer of a family member (group health insurance), some people do not have access to this type of coverage and buy their own insurance independently. The challenge arises if you have what is deemed a high-risk health condition such as certain cancers, cardiovascular conditions, neurological/central nervous system issues and immunodeficiency diseases. The aforementioned medical conditions are just some of the many conditions which are deemed high risk due to the fact that treatments are often quite frequent and expensive. In addition, many of these conditions last for long periods of time and can often lead to further medical issues which can be quite costly for health insurance companies.
How Does High Risk Coverage Work?
In most states an insurer can turn you down for individual coverage if you have a serious pre-existing medical condition. Most states are not required to have an alternative option for medically uninsurable individuals to access coverage, but most of them do. The most common way to provide individuals access to coverage is through high-risk health insurance.
Individual states offer high risk health insurance in the form of high risk health insurance pools. As of 2007, 33 states have high risk pools. The state funds the health insurance coverage and the insured in turn will pay a premium to the state insurance entity. The premiums are usually quite expensive but it is a good way to obtain coverage for your medical conditions if you fall into the high risk category. The types of conditions and medical treatments which are covered will vary depending on the type of policy and individual insurance company.
High Risk Health Coverage Options
Coverage options of high risk health insurance are very similar to those of traditional individual health insurance. They generally consist of a comprehensive major medical plan with a variety of deductible options. The most common high risk pool coverage option is a PPO plan. A large number of states also offer indemnity coverage and there are HMO and/or HSA options available to consumers in some areas. Prescription drugs, maternity, and mental health and substance abuse programs are often covered in high risk pools as well. Since these pools often serve people with severe chronic illnesses, many have exceptional disease management programs.
Is High Risk Health Coverage for You?
A high risk health insurance plan may be a good option for you if you do not have access to group health insurance or you have been turned down for individual coverage. It is important to weigh the pros and cons of a high risk pool. The obvious benefit of high risk health insurance is the security of knowing that you are covered even if you have a high risk medical condition. The main downfall associated with a high risk health insurance policy is higher premiums which are determined by your medical condition, age and location. Other drawbacks include the possibility of a long waiting period for coverage of your preexisting conditions and benefits or options may be limited. The best advice is to speak with a licensed representative who can answer your questions and help you to determine if a high risk health plan is the best choice for you.