Insurance Pools for High-Risk Patients To Start July 1


For those with chronic medical conditions who are finding it difficult to get affordable insurance, relief is on the way. Beginning July 1st, the federal government will start paying for new insurance programs aimed at providing affordable coverage for uninsured people with pre-existing conditions.

Currently, insurance for someone with a pre-existing condition can cost as much as 200% of the standard rate that an otherwise healthy person would pay, if the coverage is available at all.

Under the new Patient Protection and Affordable Care Act, $5 billion has been set aside for states to set up high-risk pools for people who have been uninsured for six months or longer. These pools are intended to provide a “bridge” for people most in need of medical coverage until the insurance exchanges begin operating in 2014.

The pools will have no restrictions based on pre-existing conditions. Coverage will begin immediately and there is no annual or lifetime limit. The law mandates that the premiums for coverage must be the same as the standard rate for a healthy adult in that state.


About 18 states in the US have opted to allow the federal government to run their programs, while 30 are going to run their own program instead. The states must file a proposal to the Department of Health and Human Services (DHHS) that will outline a list of pre-existing conditions that will help define who is eligible for each pool.

On July 1, the DHHS will introduce an online portal at that will include information on available health insurance in each state. Alternatively, the National Association of Insurance Commissioners has a directory of state insurance departments that can be contacted for further information on each state’s proposed plan, including the date they will begin taking applications.

While waiting for the programs to begin taking applications, Cheryl Fish-Parcham, director of health policy at Families USA, recommends that those who will likely qualify for the insurance program begin gathering official copies of medical records to prove pre-existing conditions.

Many experts worry that the $5 billion won’t be enough to last until 2014. The federal Centers for Medicare and Medicaid Services has estimated that the $5 billion will last for only two years. An analysis from the Congressional Budget Office estimates that the program may actually cost as much as three times the amount originally planned for.

“We just don’t know how many people will sign up for the new pools,” said Deborah J. Chollet, a senior fellow at Mathematica Policy Research, a public policy research company, who has studied existing state risk pools and the new plan. “Until we see what happens, there’s no way to know how long the money will last.”

This page is updated on May 18.