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High Risk Health Insurance

High-risk individuals who are looking for health insurance can become eligible for high-risk medical insurance through their state. Currently there are thirty states with high-risk health insurance pools. These states are able to provide lower premium medical insurance for high-risk individuals through some forms of hospital taxes, state taxes, and the ability to negotiate lower premiums for high-risk medical insurance by “pooling” people into a group similar to employers.


Some of the ways you can become eligible for a state's high-risk pool are:

  • If you receive a notice of rejection from a health insurer
  • If you receive a notice of benefit reduction or specific condition exclusion
  • If you receive a notice of premium rate increase or surcharge exceeding the pool rate
  • If you have a qualifying condition (i.e. AIDS, cancer, diabetes)
  • If you are eligible for Trade Adjustment Assistance because you lost employment due to increased imports, you may be eligible for a tax credit. In some states, this tax credit can be used for the HRP
  • If you have been involuntarily terminated from a health insurance plan or
  • If you are HIPAA-eligible. Note: You are HIPAA-eligible if you have had at least 18 months of prior continuous health coverage, at least the last day of which was in a group health plan; you have exhausted COBRA; you are not eligible for Medicare, Medicaid or a group health plan; you don't have other coverage; and you apply for new coverage (such as the high-risk pool) within 63 days of losing your prior coverage. If your state has designated the high-risk pool for HIPAA coverage, then it will not impose a pre-existing condition exclusion period on you when you are HIPAA-eligible.

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