High risk health insurance pools extend coverage for the sick

High risk health insurance pools extend coverage for the sick

Recently diagnosed with coronary artery disease, Barbara Becker of Sugar Hill, Ga., needs a heart catheterization and could require a stent or bypass surgery to improve blood flow. But uninsured and unable to get health coverage, the 43-year-old has been in a holding pattern — medication is all she can afford.

"When I get those angina attacks, they scare me, but I can't bankrupt my family," Becker said in June.

She recently got approval for coverage through the Pre-existing Condition Insurance Plan, created by the U.S. Department of Health and Human Services as a result of the new health care law. The federally funded high risk pools offer coverage to those who are uninsured for six months and who have a pre-existing condition — two thresholds Becker met.

The cost of insurance through a high risk pool varies, but it's comparable to what a person of average health would pay for an individual plan, says Karyn Schwartz, a senior policy analyst with the Kaiser Family Foundation.

That doesn't mean it's cheap. Plans can cost up to $900, and Becker says she'll be paying $387 per month for her plan, which could mean the difference between having a procedure she needs or ending up in the ER again in worse shape.

"I don't consider it affordable, but I'm between a rock and a hard place right now," she says.

Experts on both sides of the political aisle agree the $5 billion allotted for the high risk pools nationally won't last until 2014. So states are focusing on the sickest first.

"This includes people who have heart disease, cancer, diabetes and any other kind of chronic condition," says Sandy Praeger, Kansas Insurance Commissioner and past president of the National Association of Insurance Commissioners. "Someone with high blood pressure who was denied coverage may or may not be able to get it through a high risk pool."

Schwartz adds those who have a pre-existing condition and are worried about being denied family coverage can talk with an insurance broker about getting a "child-only" insurance policy. New regulations forbid insurers from denying coverage to anyone under 19 because of a pre-existing condition.

That means Becker will be able to get health insurance for her 10-year-old daughter, Emily, who was denied coverage repeatedly because she has Asperger's syndrome, a developmental disorder affecting socialization.

"God forbid anything happens to her," Becker says. "It's nice to know she'll be covered."

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The problem with the high-risk pool coverage is that in order to qualify, you must be without insurance for six months. I'm 50 and have pre-existing conditions of elevated cholesterol and blood pressure, and depression, for which I take a combined total of four medications. I'm afraid to drop my catastrophic coverage insurance ( the only kind I have been able to get) because I'm terrified something could happen to me, a car accident or slip and fall, or unexplained chest pains, and I would lose what is left of my dwindling IRA. For those of us caught in this particular spot, unemployed or between jobs, too young for Medicare, it's a choice between paying high monthly premiums for emergency-only coverage, or having nothing at all. So far the "socialized medicine" that opponents of the health care changes have cited, hasn't done anything to change my situation. As far as I'm concerned, too little was changed.

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