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If a person cannot qualify for individual coverage on their own because they are considered “uninsurable” due to a pre-existing medical condition, there is a state subsidized health plan called CoverColorado. Established by the Colorado legislature in 1991, CoverColorado is a non-profit organization whose mission is to provide a health insurance program that promotes access to health care for Coloradans whose health prohibits or substantially limits access to commercial health insurance.
Since this is a high-risk pool, the rates offered are generally higher than commercial insurance carriers. If you have been denied health insurance due to a pre-existing medical condition, or have exhausted your COBRA benefits, CoverColorado may be able to help. While CoverColorado is not a low-income plan, this may be your best option if you are unable to obtain coverage elsewhere and can afford it.
The enrollment in CoverColorado was 12,732 on December 31, 2010. Colorado is one of 34 states that have a high-risk pool insurance plan.
GettingUSCovered is the temporary federal high risk pool created in the State of Colorado under the Patient Protection and Affordable Care Act of 2010. GettingUSCovered is fully funded by enrollee premiums and federal dollars. Federal funding for this program is expected to continue through December 31, 2013; after that, other coverage options should be available under the Act to those with pre-existing conditions.
It is a comprehensive health plan for Coloradans who have been uninsured at least six months and have a pre-existing condition. While GettingUSCovered is not a low-income plan, it does not cost any more than the price of insurance for healthy individuals. There is no waiting period once an individual is accepted into the plan; medical treatment can begin upon the effective date.
GettingUSCovered expects to cover as many as 4,000 currently uninsured individuals and to continue through December 31, 2013. Enrollment may need to be limited based on federal funding. The plan is a bridge to 2014, when individuals with pre-existing conditions will be able to purchase health coverage through health insurance exchanges.
High risk pools are state plans that provide health insurance coverage for those who are unable to purchase medical insurance. Coverage is provided through a pool, which is paid for by fees assessed to the insurance companies that do business in the state. The high-risk pool is then run by a non-profit organization.
The pool offers the insurance coverage to those residents of the state who;
The typical lifetime maximum benefits in most states is $500,000 with a $500 deductible. The waiting period in most states is usually six months if the applicant has been treated for a medical problem within the last six months of the application. Generally, in most states the premium paid by the insured ranges from 125% to 150% of the standard premium rate for that of an individual health insurance policy purchased through a standard carrier.
High-risk pools are private, self-funded health insurance plans organized by the state to serve high-risk individuals who meet enrollment criteria and do not have access to group insurance. In most states, they are independent entities governed by their own boards and administrators, but in some states they function as part of the state's department of insurance.
You can apply for high-risk pool coverage through an insurance agent or directly with the state. You generally have a choice of health plan options and will receive enrollment cards and other information just like any other health plan. High-risk pools normally contract with a health insurance carrier or third-party administrator to administer paperwork and claims, so your enrollment card and other paperwork may not even appear to be produced by the high-risk pool. Once enrolled, you use your benefits just like any other consumer of private insurance coverage.
Coverage options are very similar to traditional individual health insurance offerings. It is generally a comprehensive major medical plan with a range of deductible options. The most common risk-pool option is a PPO plan, but many states also offer indemnity coverage and some states have HMO and/or HSA options available to consumers. Most pools offer coverage of prescription drugs, maternity, and mental health and substance abuse, among other services. Many have excellent disease management programs for enrollees since so many pools serve people with severe chronic illnesses.
Risk pool health insurance is more expensive than traditional individual insurance. This is fair because pool members, by definition, are those who are considered to be medically uninsurable. State laws generally cap risk pool premiums between 125-150 percent of the base individual market rate.
Example: If the average standard individual premium in a state for a 30-year old male is $100/month, a medically uninsurable male of the same age would pay $125-$150/month for comprehensive coverage in a risk pool.
Risk pool premiums are determined by your age and sometimes by where you live in the state. Pool premiums are fairly affordable nationwide because they are directly tied to the rates in each state's existing individual market.
Just like almost all individual policies, high-risk pool policies contain pre-existing condition waiting periods to prevent adverse selection. Adverse selection occurs when a person buys health insurance only after he or she has a medical problem that will require the use of benefits. However, nearly all pools will give you credit against the waiting period if you have had prior health insurance coverage within a specified number of days. The amount of the credit against the waiting period is generally proportional to the length of the prior coverage.