Many In High Risk Pools Aren’t Protected From Lifetime Coverage Limits
Thanks to the health care overhaul, most people no longer have to worry about getting sick and running out of health insurance coverage. The law , which ran in many plans from $1 million to $2 million. Unfortunately, though, the change doesnt apply to plans that enroll some of the sickest people: those who buy coverage in so-called high-risk insurance pools because they have medical problems that make them uninsurable in the private market.

People in the pools are left out because of a wrinkle in legal language. The law to health plans and health insurance issuers as defined by the Public Health Service Act, but most of the risk pools arent licensed as an insurance issuer in their state, so from a regulatory standpoint were not equivalent to a commercial insurance product, says Amie Goldman, chair of the , an educational organization for the high-risk pools.
Those affected include some of the people who have enrolled in the new (PCIPs) established under the overhaul law and the more than 220,000 who are in the generally pricier, old high-risk pools who cant join the because in order to qualify people . It could be worse. Even though not required by law to eliminate such lifetime limits, some of the plans have opted against the caps anyway. That includes the PICPs run by the federal government in 23 states and the District of Columbia. (The other 27 states run their own PCIPs.)
And in some states, officials have moved to lift limits on occasion. Thats what happened in Kansas last year, where officials raised the lifetime limit in the state high-risk pool from $1 million to $3 million. Why? We had people bumping up against the limit, says , the states insurance commissioner.