What is a High-Risk Pool?

High-risk pools provide an important safety net for people with catastrophic medical conditions who do not have access to employer-based group health insurance, such as early retirees, self-employed individuals, and employees of businesses that do not offer health insurance coverage. In addition, in many states, high-risk pools serve as the guaranteed-issue purchasing option for individuals who wish to exercise their federal group-to-individual health insurance portability rights as provided by the federal Health Insurance Portability and Accountability Act of 1996. In a number of states, the high-risk pool also is available as a purchasing option for individuals who are eligible for the 65 percent federal health insurance tax credit provided by the federal trade Adjustment Assistance Act of 2002.

Thirty-one states already have operating pools that are open year-round and are continuously accepting new enrollees. The only pool that is closed is in Florida, and it has been closed for thirteen years due to funding issues. A legislative effort is currently underway in Florida to reopen the pool to help stabilize its private health insurance market. Furthermore, of the remaining states that do not have pools, Arizona, Georgia, Maine, Massachusetts, Nevada, New Jersey, North Carolina, Ohio and Tennessee are all actively considering moving to the high-risk pool solution.

Additional information from the National Association of Health Underwriters:

• High-Risk Pools (detailed information)
• Questions and Answers About High-Risk Pools (Word document)
• Does My State Have A High-Risk Pool?