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Health insurance pools for people with pre-existing conditions


health insuranceStarting in 2014, health insurance companies won't be able to deny you coverage or jack up your premiums because you have a pre-existing condition.

Until then, though, states and the federal government are setting up temporary high-risk insurance pools for people who need insurance now and can't get it.

Enacted through heath care reform, the new Pre-existing Condition Insurance Plan is open to people with pre-existing conditions who have gone without insurance for at least six months. States can operate their own plans, or have the federal government operate the plans for them.

The concept isn't new. Minnesota and Connecticut set up the first state-run high-risk insurance pools in 1976, according to the Kaiser Family Foundation. As of January, 34 states (see sidebar) operated similar "high-risk pools" of their own to provide health insurance to uninsurable residents. The Pre-existing Condition Insurance Plan builds on what states were already providing, but doesn't replace those efforts. In some states, you may be able to choose which high-risk plan is best for you -- the older state high-risk insurance pool or the new Pre-existing Condition Insurance Plan.


States with high-risk health pools:

Washington, Oregon, California, Alaska, Montana, Wyoming, Utah, Colorado, Arizona, New Mexico, Texas, North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa, Missouri, Arkansas, Louisiana, Wisconsin, Illinois, Mississippi, Indiana, Kentucky, Alabama, New Hampshire, New Jersey, Connecticut, West Virginia, Maryland, North Carolina, South Carolina, Florida.

States without high-risk health pools:

Idaho, Nevada, Oklahoma, Michigan, Ohio, Tennessee, Georgia, Maine, Vermont, New York, Massachusetts, Rhode Island, Pennsylvania, Delaware, Virginia, Hawaii.

Source: Kaiser Family Foundation

California, for instance, continues to operate its own high-risk health insurance plan, called the Major Risk Medical Insurance Program, along with the new federally funded Pre-existing Condition Insurance Plan. Each program has slightly different eligibility rules, annual deductibles, annual and lifetime caps and monthly premium costs. Those who are already enrolled in the state’s high-risk pool can't qualify for the federal program. But those who apply now for either program will have their application reviewed for both. If you qualify for both, you can choose which program works best.

The Pre-existing Condition Insurance Plan provides a wide range of benefits, including primary and specialty care, hospital care and prescription drugs - including for treatment of pre-existing conditions. You won’t be charged higher premiums due to existing medical conditions and eligibility is not based on income.

To qualify for the federally funded program, you must be a U.S. resident or legal resident, you must have been uninsured for at least six months and unable to buy health insurance coverage due to a pre-existing condition. States vary in how they determine whether you have a pre-existing condition and have been denied coverage. Some states might determine you've been denied if you couldn't find insurance you could afford. Contact the program in your state to get details about eligibility. The U.S. Department of Health and Human Services provides a handy Pre-existing Condition Insurance Plan map.

If your state’s plan is run by the federal government, you can apply here. To enroll, you must submit a completed and signed application form, a copy of documentation of citizenship or legal residence in the United States and a copy of a letter from an insurance company, dated within the past six months denying your application for coverage or excluding coverage of your medical condition.

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