States are beginning to accept applications for a new temporary high-risk insurance pool with $5 billion in federal funding from HHS.
High risk, high demand
$5 billion insurance pool opening in some states
But benefits and costs to members will vary by state, and some states are already anticipating waiting lists and enrollment caps because of the limited funding.
Colorado, New Hampshire, New Mexico, Oregon and Wisconsin are among states that began accepting applications this month, with intent to start coverage in August. Twenty-nine states plus the District of Columbia will operate their own programs, while 21 states have declined to participate so HHS will run the program in those states.
The temporary high-risk pools, a provision of the federal health reform law, are intended to offer temporary health insurance coverage to adults with pre-existing health conditions who cannot purchase insurance through the private market. Qualifying applicants must have been uninsured for at least six months, be a U.S. citizen or legal resident and have an existing medical condition. The program will sunset in January 2014, when state health insurance exchanges and other benefit programs are slated to launch, and insurers will no longer be able to deny policies because of a pre-existing condition.
Oregon is administering its own program, expected to start Aug. 1. HHS allocated $66 million to Oregon over the program's 3½-year life. Premiums in Oregon will range from $221 to $714, depending on the member's age and plan. There will be a choice of two plans: one will carry a deductible of $500, the other $750. Regence Blue Cross and Blue Shield of Oregon will administer the program.
Oregon officials said they expect to cover a maximum of 2,000 people at a time and a total of 4,000 over the life of the program. Oregon has about 516,000 uninsured adults. “We anticipate having to go to a cap or wait list by early spring or next summer,” said Don Myron, program developer for the Oregon Medical Insurance Pool. “It's just not enough funding.”
Applicants who cannot get into the HHS-funded pool will have access to an existing state high-risk pool, where premiums are about 8% higher, Myron said.
Colorado's program, called GettingUSCovered, carries lower monthly premiums than Oregon, ranging from $115 to $601 for nonsmokers. But it has a higher deductible—$2,500—and $30 copayments for primary-care visits and a $45 copayment for specialist visits. The program “brings the resources of the private sector together with the protections and resources of the public sector to solve a problem of thousands of uninsured Coloradans,” said Steve ErkenBrack, president and CEO of Rocky Mountain Health Plans, the administrator of the program.
In states where HHS is administering the program, monthly premiums range from a low of $234 in Wyoming to a high of $773 in Florida. In all states where HHS is administering the program, there is a $2,500 annual deductible except for preventive care, according to the HHS website.
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