You may have heard of them, but what is a Risk Pool?  A health insurance risk pool is a program developed by state legislatures to assist people who may be considered “uninsurable” due to having health problems.  In most cases these people are not able to obtain health insurance coverage on their own through a private health plan because they have been denied due to a pre-existing health condition or the coverage that is offered is too expensive.

A risk pool is essentially a state-created, non-profit association that is overseen by a board of directors.  Most state programs may vary a little in the type of program, but they each function similarly.  The board chooses and contracts with an insurance company to administer the program (such as collecting premiums and paying claims.)  Most risk pool plans offer some type of 80/20 comprehensive medical coverage with a variety of copayment and deductible options.

Though risk-plans may be a way to obtain health insurance coverage for those in need, there are some key points to consider. 

First, the lifetime and annual maximums may be extremely low, such as a $250,000 lifetime maximum and a $50,000 annual maximum.  It is foreseeable that patients who require significant medical attention could run out of benefits with a low annual maximum, leaving themselves to pick up the remaining medical expenses out of their own pocket.

Second, the premium could be expensive, with them ranging between 150% to 200% of a standard premium charged for private health insurance.  Some states do have laws to limit the amount of the premium rates so that they are not too exorbitant. 

Third, there are strict eligibility requirements and it is important that you check with your State Insurance Department to find out if you are eligible.  Some states don’t allow individuals to participate if they are eligible for Medicare, Medicaid or COBRA.  There is usually a high demand for these types of plans, which may create a waiting list in your state.  If you are eligible and have been approved, a waiting period may be applied.

For your convenience, we have included the phone numbers for those states that offer state risk pools.

Alabama            800-513-1384            Alaska             800-467-8725

Arkansas           501-378-2979            California          800-289-6574

Colorado           303-863-1960             Connecticut      800-842-0004

Florida               850-309-1200             Illinois               800-367-6410

Indiana               800-552-7921            Iowa                515-248-2186

Kansas               800-290-1366            Kentucky        502-564-3630

Louisiana            800-736-0947           Minnesota       612-593-9609

Mississippi          601-362-0799          Missouri          800-843-6447

Montana            406-444-8200             Nebraska        402-343-3337

New Mexico       505-271-4399            North Dakota 800-737-0016

Oklahoma           800-255-6065             Oregon             503-373-1692

South Carolina     803-788-0222          Tennessee       615-741-8642

Texas                   888-398-3927            Utah                 800-662-0876

Washington          800-877-5187         Wisconsin        608-264-7733

Wyoming            307-634-1393

Health Symphony provides general information and does not guarantee, express or implied, to the results obtained from its use.

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