High-Risk Insurance Pools

A survey of state high-risk insurance pools. Over 210,000 Americans in 35 states purchased health insurance through this state policy alternative in 2007.

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Nearly three-fourths of the states have established high-risk insurance pools to increase health coverage options.

  • In 2009, 35 states had high-risk health insurance pools for individuals who cannot get insurance in the private market at affordable rates or because of a pre-existing medical condition.1
  • In 2007, about 210,000 people were enrolled in high-risk pools. Enrollment ranged from fewer than 350 people in Florida to nearly 29,000 people in Minnesota.1
  • A number of reasons have been given for Minnesota’s high participation rate, including low premiums and choice of numerous deductible plans.
  • Since the first high-risk pool was created in 1975, at least 1 million Americans have been insured through a high-risk pool.1
  • The number of individuals with high-risk pool coverage is very small when
  • compared to the nearly 87 million without health insurance in the last two years.2

States have designed their high-risk pools to reflect their health insurance markets.

  • All states have premium caps that limit the cost of health coverage for individuals with costly medical conditions. Most have established caps between 125 percent and 200 percent of standard market rates.1
  • Waiting periods for a pre-existing condition are typically six months, but extend to 12 months in eight states.1
  • Since individual premiums cover only about 60 percent of the costs of high-risk pools,3 states have established funding mechanisms to cover losses, most often by assessments on insurance carriers.

State policymakers are proposing expansions and using a variety of mechanisms to keep high-risk pools afloat.

  • Several states, including Arizona, Georgia, Maine, Nevada and Ohio, have recently considered establishing high-risk health insurance pools.
  • Florida recently passed legislation to create a new pool but has not provided the needed state funds. The current pool has been closed to new enrollments since 1991 due to inadequate funding.
  • Nearly one-third of the pools have reduced premiums for low-income participants4 and others have reduced rates to encourage participation.
  • Maryland raised premiums, deductibles and copayments, increased out-of-pocket maximums, lowered the lifetime maximum benefit, added a waiting period for preexisting conditions and increased funding by raising the assessment on hospitals.5
  • California put a limit on enrollment and lowered the maximum treatment benefit, and Tennessee eliminated low-income subsidies for new members.

  Download the Excel Version of the Table:  "State High-Risk Insurance Pools"


1 National Association of State Comprehensive Health Insurance Plans
2 Families USA, “Americans at Risk: One in Three Uninsured.”
3 Abbe, Bruce, “Using Tax Credits and State High-Risk Pools to Expand Health Insurance Coverage,” Health Affairs (October 2002).
4 McCormack, Thomas, “State Health Insurance High Risk Pools.”
5 Sack, Kevin. “McCain Plan to Aid States on Health Could Be Costly.” The New York Times.  July 9, 2008.

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