Healthy Access Database

Coverage for Medically Uninsurable Individuals

Some people may have trouble obtaining traditional private market individual health insurance coverage due to a serious medical condition. The different states have adopted different means of providing access to individual market coverage for people who have a catastrophic medical condition, and they are all described in this section.

Guarantee Issue Requirements
A few states require all individual market health insurance carriers to offer products to all people at any time, regardless of their health status, but most do not and instead offer the general public another alternative such as a high-risk pool. However, all states have to have at least one means of providing guaranteed-issue coverage to individuals exercising their federally mandated group-to-individual rights. It can be through the traditional private market, through a high-risk pool, or through another means. This section covers all of these state-specific provisions.

High-Risk Health Insurance Pools
The most common way states provide people with serious medical conditions with access to private individual health insurance coverage is through the creation of a high-risk health insurance pool. Consumers in these pools have access to comprehensive private coverage plans, but pay slightly more than the average individual market premium due to their health conditions. This section provides an overview of each state high-risk pool, including eligibility requirements, rate restrictions, preexisting condition requirements, covered services, cost information and contact information.

High-Risk Reinsurance Pool
Another option for providing access to private individual market coverage to people with serious medical conditions is a high-risk reinsurance pool. A reinsurance pool has many characteristics that are similar to a high-risk pool, but the individual purchaser does not buy their policy directly through the pool. Instead they buy their policies from individual insurance carriers, who then cede the high-risk policies to the pool for risk spreading.

Other State Options
Some of the other states that do not have a high-risk pool or a reinsurance pool serving their individual markets have developed alternative ways to provide medically uninsurable individuals with access to coverage. A few states do not currently have options available to these consumers.

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