High Risk Health Insurance Plans

High risk health insurance plans provide affordable medical care to individuals who might otherwise be unable to receive the treatment they need for serious conditions. If you are already receiving health insurance benefits, you may be covered even if you have a pre-existing medical condition. However, if you are not covered by any other policy and you apply for an individual medical insurance plan, you may be denied coverage based on a pre-existing illness like cancer, heart disease or HIV/AIDS. Insurance providers base their decisions about medical coverage on the level of risk that an applicant presents.  With individual policies, an insurance company may decide that covering a single policyholder with a high risk condition is too costly.

Features of High Risk Plans

If you do not qualify for standard health plans, you may receive medical coverage through high risk health insurance plans. Depending on the state where you live, these plans may be administered by the state government or through private companies working in tandem with state governments. Most states offer high risk health insurance plans to their residents who are considered uninsurable by the majority of private insurers.

Also known as high risk pools, high risk health insurance plans function by pooling the needs of their applicants to achieve affordable rates. When you apply for coverage, you will typically be offered a choice of plans. As with any private health policy, it pays to compare the benefits offered by the different plans, the range of treatments provided and the cost of the policy. Once you are enrolled in a plan, you will typically receive a card that verifies your membership, along with access to the range of services covered under your policy.

High risk health insurance plans may take the form of a managed care program or an indemnity plan. Managed care programs, which give you access to a range of practitioners and services included in the plan's network, are the most common option. Many high risk health insurance plans are PPO, or Preferred Provider Organization, programs, in which your care is organized by a primary care provider and you are referred to specialists and facilities within an authorized network.

With an indemnity policy, also known as a fee-for-service plan, you pay for services as you receive them, either through a co-payment or co-insurance. Indemnity policies can offer a high degree of flexibility, because your choice of health care providers is not limited to a managed care network. An indemnity policy may be offered in conjunction with a Health Savings Account, a tax-deferred fund that can be used to cover co-payments, prescription costs, doctor visits, therapies and other qualified medical services.

With an HMO or PPO, you typically pay a monthly premium and a co-payment for physician consultations, diagnostic exams and other services. Your financial obligations vary from one plan to another, based on the requirements of the provider or your state's government. Most high risk health insurance plans offer a range of useful benefits, including chronic disease management, prescription drug coverage, mental health and substance abuse treatment and maternity benefits.

Finding Affordable Coverage

Because high risk health insurance plans are organized by state governments or in conjunction with state governments, you can access these programs by contacting the state directly or by contacting an agent or broker. Coverage for these plans is typically more expensive than standard policies, because all of the participants have conditions that require extensive treatment. To find the most affordable option in your state, compare multiple quotes before you make a final decision.

In some states, this level of coverage is not available through private insurers. In this case, you should contact the agency in your state that governs insurance to discuss your alternatives. Most states offer some form of assistance to residents who cannot find affordable coverage because of serious conditions. Only a small number of states do not offer coverage to medically uninsurable residents.

High risk health insurance plans can be a lifesaver if you've been turned down by private insurers. Most people with advanced conditions don't have the financial resources to pay for expensive medications or treatments out of pocket. State pools, in combination with private insurers, fill the gap by offering benefits to these individuals. Before you give up hope of finding the financial benefits you need to obtain the care you require, request information from a number of providers in your state.

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