Considering High-Risk Health Insurance: How to Tell If It’s The Right Fit For You

If you are considering enrolling in the high-risk health insurance of your state, there are some things I’d like to discuss here so that you can make an informed decision about whether a high-risk health insurance plan is for you. Let me start with a quick definition of high-risk health insurance: It is defined as medical coverage for individuals with health conditions that prevent them from enrolling in a traditional health insurance plan.

These “high-risk pools” are options that are available to help ensure that individuals who are labeled as high-risk are still able to carry health insurance. Now, for those of you that are all set to jump on the risk pool bandwagon, I do advise you of the following negative aspects of it: is typically more expensive, is often difficult to obtain (strangely) and may also require that you have been without health insurance for the past six months. And I get the following question almost daily, so I figure I will answer it here: should I forego applying for an individual health plan and go straight to the pool? The answer is no! Most high-risk pools require getting formally declined from an individual health insurance carrier or a letter from a health insurance agent that states that you are medically ineligible for an individual health plan.

With this being said, let’s discuss situations in which high-risk health insurance is a good fit.

You Have High-Risk Health Conditions

If you have one of the conditions listed in the eligibility requirements of the pool in your state, then it is most likely that it will be a good fit for you. Conditions may be also be considered high-risk if they require costly or ongoing medical treatment in the form of prescription medicine or medical treatments and procedures. However, not all individuals that I would advise to go into the risk pools will have chronic diseases that prevent them from obtaining medical insurance. The pools may also be a good fit for those that have conditions with a high incidence of complications or require ongoing medical care, thus making it difficult to obtain coverage. Obesity and pregnancy are examples of such conditions. Health factors such as these can make it difficult for an individual to obtain healthcare while the conditions are still present. The pool is also a good option if you have a condition that is not specifically listed as an eligible condition in the eligibility requirements but was excluded from coverage when you applied for an individual health plan. In other words, if you applied for individual health plan and you weren’t declined but you got your condition excluded from coverage, high-risk health insurance is available to you as well.

You Have Pre-Existing Medical Conditions

High-risk health insurance should be a good fit for you if you have a pre-existing condition that may not be high-risk. Pre-existing conditions are health issues that are known to exist prior to an individual seeking healthcare. However, when obtaining new individual health coverage, there is typically a waiting period during which insurance will not cover medical care related to these conditions. The last thing you want is to enroll in a health insurance plan and they tell you, “we’re going to cover the very condition you’re getting health insurance for after a year.” Yeah, thanks! It is easier to get around the pre-existing condition clause if you’re in a high-risk health insurance program. The pools have special rules governing pre-existing conditions that are much easier to navigate than their corresponding individual health plans. An example of such pre-existing medical conditions that I’d advise for the risk pool are neurological conditions. Neurological conditions are usually not one of the conditions listed in the eligibility requirements of the high-risk pool but they are typically pre-existing conditions that, if you were to enroll in an individual health plan, you’d be waiting a year for coverage on.


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