High Risk Health Insurance in Ohio

For citizens of Ohio who suffer from chronic health conditions, high risk health insurance in Ohio becomes a major emotional and financial concern.

Health insurance is available for high risk patients.

The Status of High Risk Health Insurance in the United States

An individual who is either currently being treated for a serious health condition, or has been treated in the past for a serious chronic health condition, is considered within the insurance industry as a "high risk" customer. Prior to 1996, individuals who fell within this class were denied health insurance across the board. This meant that if a person was previously insured under an employer-sponsored health plan, was diagnosed with cancer and successfully treated, and then changed jobs and switched to a new employer-sponsored health plan, the new insurer could deny coverage for that individual based on pre-existing health conditions, or certain "exclusion" policies.

HIPAA Protects High Risk Individuals in All States

On August 21st 1996 legislation was passed called the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The United States Department of Health and Human Services continues to issue regulations and rules to enforce the act. Essentially, what the act accomplished was to ensure "portability" of medical coverage for pre-existing conditions. This means that if you were insured before you became sick, you will continue to be insured regardless of if you switch employers or health insurance companies. Even if you are unemployed (for less than 12 months), you are protected.

When the act was passed, every state in the United States was faced with figuring out how to make sure insurance providers within the state would comply. HIPAA provides a wide ranging list of additional rules pertaining to how health insurance must cover individuals, privacy rules, and other regulations. Insurance companies who do not comply face steep penalties.

What is a High Risk Pool?

HIPAA, unfortunately, has left a segment of the population unprotected. These are individuals who have been unemployed for longer than twelve months, or never had health insurance before they became sick. Most of the time individuals within this group are denied insurance due to pre-existing health conditions. Many states, in order to provide a "safety net" for this portion of the population considered uninsurable, created programs targeting the "high risk pool." These programs vary depending on the state, but they are generally state-funded programs that administer health insurance to these individuals much like a private insurance company would, but at slightly lower cost. The programs are still expensive for the insured. States depend on Medicare and Medicaid to cover lower-income families who can't afford the high-risk pool insurance.

The History of High Risk Health Insurance in Ohio

As of May, 2008, 34 states have established high risk insurance pools in order to provide healthcare options to people who can afford health insurance but are denied coverage because of existing health conditions. Ohio is one of the states which currently does not have a high risk pool.

Ohio Decides Against the High Risk Pool

In 2005, the Ohio Department of Insurance hired a contractor to conduct a study regarding whether providing a high risk pool would be an appropriate method to cover uninsured Ohioans who could afford paying premiums but are denied insurance coverage. The study reported that such a high risk pool was a "viable option," but would demand additional funding of some form, beyond premiums, in order to ensure the program's solvency. In 2006, the Department contracted for an update to the study. Since then, Ohio legislature still hasn't created a high risk pool for the state.

High Risk Health Insurance in Ohio Today

According to a May 19, 2008 update the Health Policy Institute of Ohio, the Legislature of Ohio has passed laws protecting the state's uninsured without the use of high risk pools. Some state regulations pertaining to health insurers within the state include the following rules:

• Health insurers are required to offer an open enrollment period.
• During open enrollment, the insurer can not deny an applicant based on health status, unless the applicant is already hospitalized.
• Open enrollment doesn't apply to applications already covered by Medicare or employee-sponsored plans.

In effect, the State of Ohio has mandated that insurance companies cover any Ohio resident willing to pay. But prices are extremely expensive. Typical rates for coverage, as of October of 2008, for two adults under 40 are almost $8,000 per quarter.

Additional Resources

High risk individuals who can afford the astronomical costs, can not be refused insurance coverage. However, the State of Ohio has yet to find a way to make health insurance more affordable for all of its residents. About 11 percent of the Ohio population remains uninsured, just slightly better than the national average.

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