High-risk patients to apply for coverage

July 23, 2010 at 12:00a.m.

Associated Press

COLUMBUS

Ohioans with pre-existing health conditions, such as cancer or diabetes, can apply for coverage under a new high-risk insurance pool beginning Aug. 1, state officials said Thursday.

The insurance pool is a key piece of President Barack Obama’s health-care overhaul. The programs will be in place until 2014 — when health-insurance companies no longer will be allowed to deny coverage to people in poor health.

Applications for Ohio’s pool will be available through a website managed by the state Insurance Department and Medical Mutual of Ohio, a nonprofit insurance company selected by the state to administer the program.

Coverage for enrollees can begin as early as Sept. 1, providing people with a range of benefits, including primary and specialty care, hospital care and prescription-drug coverage.

About 1.3 million Ohioans lack health insurance, but it’s unclear how many people may apply or qualify for the high-risk pool, said Insurance Department spokeswoman Carly Glick.

An early state estimate projects about 5,500 getting coverage through the plan, she said. The state acknowledges there could be a waiting list if demand is high.

Under the law, high-risk pools will be open to people who have been uninsured for at least six months, at a cost similar to what others pay. Applicants also must provide a certified medical record that proves a pre-existing condition.

Obama’s health-care overhaul sets aside $5 billion for the program, with Ohio getting about $152 million to help pay for part of a monthly insurance premium. Some advocates for the uninsured have expressed concern that the money will run out before 2014, when the law creates new insurance markets, called exchanges.

“Once the money is gone, the program will end,” Glick said. “It’s basically a stopgap to get us through to the exchanges.”

Medical Mutual is offering two benefit plans for the high-risk pool, one with a $1,500 deductible and another with a $2,500 deductible. Monthly rates for nonsmokers are expected to be in the range of $188 to $545 depending on the age of the enrollee and the benefits selected. Rates for smokers will be a little higher.

The rates are comparable to what other states are doing, said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio, an advocacy group.

“A pool like this is something Ohio has never had, and it will be a tremendous benefit for people who get in,” Levine said. “It’s too bad it can’t help even more people.”

Ohio is one of about 30 states that opted to run their own high-risk insurance pools. The federal government is stepping in to run risk pools in states that don’t set up their own.