Designed to provide affordable health insurance coverage for people who are too medically risky to get it (without paying impossible amounts), state health insurance plans play an important role in America's health care system. By gathering together large groups of people who the health insurance industry refuses to cover, state health insurance creates "risk pools" that are large enough to get costs down. The result is affordable health insurance for millions of Americans who desperately need it. Nevertheless, most people are unfamiliar with state health insurance plans and how they operate. Go Insurance Rates takes a look at some of the basic questions and answers about this important social safety net.
Eligibility for State Health Plans
State health insurance plans are open to people who can't get health insurance on their own. Few if any private health insurance companies will cover preexisting conditions, which is a real problem for many. In California for example, participants in the state's Major Risk Medical Insurance Program must meet the following requirements: be state residents, be ineligible for Medicare, be ineligible for COBRA plans, and be "unable to secure adequate coverage." Additionally, while income is a factor in determining eligibility, low-income health insurance will generally come in the form of Medicaid or Medicare and not state health insurance plans.
How State Health Coverage Works
State health insurance plans are administered on a state-by-state basis. Each state that offers a plan will oversee it with a mixture of representatives drawn from the government, private industry and related consumer advocacy groups. In most cases, a contract is made with a private insurer to administer benefits.
Program Costs
State health insurance is not cheap health insurance. According to the National Association of State Comprehensive Health Insurance Plans, prices are determined by finding the state's average price for health insurance, and then charging anywhere from 125-200% of it. While this may seem high, and prices can vary substantially from state to state, nonetheless almost all state health insurance plans lose money and are heavily subsidized by local and federal government.
State Benefits
Benefits offered by state health insurance plans will vary according to location. However, by and large they tend to mirror basic plans offered by private insurers: an 80/20 co-pay system, different deductible options, and lifetime benefits that range from as low as $325,000 to $2 million. In Maryland, participants in the state's health plan can choose between four different policies. A fifth plan is available for those in need of financial help. In Washington, participants in the state's WSHIP plan can choose from a variety of prescription drug coverage plans.
If you don't qualify for any state plans and are struggling to find affordable health care coverage, fill out our online health insurance form. Within seconds you'll receive free health insurance rates and affordable insurance options that will help get you insured. Don't wait to get yourself covered.
