HHS Starts Accepting Applicants for High-Risk Pools for the Uninsured

BY Lea Winerman  July 1, 2010 at 1:54 PM EST

People who have been denied health insurance due to a preexisting condition can begin applying for coverage Thursday in many states, under the first major program of the new health care reform law.

The $5 billion program will fund high-risk insurance pools in every state — the money will be funneled to states according to size and need (see how much money your state is getting here).

Twenty-nine states and the District of Columbia will use the funds to run their own high-risk pools, while 21 states have chosen to have the federal government run the program for them.

The program is intended to be a stopgap measure until 2014, when the bulk of the health care reform law goes into effect — including a provision that will ban all health insurance companies from discriminating against people with preexisting conditions.

Below, you’ll find some answers to questions about the program. We’ll also have more on high-risk pools on the NewsHour next week.

Who is eligible?

Any U.S. citizen or legal resident who has been denied access to health coverage because of a preexisting health condition (such as diabetes or cancer) and who has not had health insurance for at least six months is eligible to apply.

In most states, you will have to provide a rejection letter from an insurance company to prove that you’ve been denied coverage, or a letter showing that the company would exclude your preexisting condition from the coverage. In other states — ones that require insurers to cover everyone — you will have to provide a letter showing that you’ve been quoted an unreasonably high premium.

When and where can I sign up?

That depends where you live. In the 21 states in which the federal government is going to run the program, you can apply beginning Thursday, July 1. The other 29 states and the District of Columbia, which will run their own programs, have different timelines. In Wisconsin and North Carolina, among others, residents can begin applying to the state pool July 1. But residents of California will have to wait until August and West Virginia residents until September 1.

You can find details about when and how to apply by clicking on your state on the map on the Pre-existing Condition Insurance Plan page at the Department of Health and Human Service’s new HealthCare.gov website.

How much will it cost?

That also depends on where you live and your age. But it won’t be particularly cheap. Premiums could vary from $140 to $900 per month. By law, though, the plans cannot cost more than the standard health insurance plans for healthy people in each state that offer similar coverage.

“For someone who is low-income, they may not be able to afford it,” Gary Claxton, vice president of the Kaiser Family Foundation, told the Wall Street Journal. “To someone who is middle-class, it’ll still feel expensive, but it will be like other people buying health insurance on their own.”

How many people will this cover?

That’s the question on everyone’s mind. High-risk pools are by definition expensive to run, because they cover people with costly medical conditions. Many experts believe that the $5 billion won’t be enough to fund the program until 2014, and some states chose to have the federal government administer the program because they were afraid they’d get stuck with the bill if the federal funding ran out down the line.

In a call with reporters Wednesday, Richard Popper, of the HHS Office of Consumer Information and Insurance Oversight, said he expects the program to cover about 200,000 people at any one time.

But the Congressional Budget Office has estimated that as many as 700,000 could enroll by 2013, and that the funding would not be sufficient to cover all of them. HHS has not said whether they would limit enrollment if the funding proves insufficient.