High Risk Pools Are a Good Answer, But Obamacare DESTROYED Them

A benefits consultant in Kansas received this inquiry –

I’m a trucker with Type 2 diabetes. My wife and kids are on a plan with the school district but if she would have added me, premium would be over $1400 a month. So I applied through Exchange. They told me I had to submit verification of income and I offered to fax them or email them my income tax. They said they didn’t get it and I missed the deadline so I don’t have coverage, what are my options?

First of all he should never have been considered for a subsidy since his wife has affordable coverage for HERSELF offered at work (family glitch that was never really a glitch).

Let’s look at his options

  1. He can’t go on wife’s plan because he missed the employer open enrollment
  2. Must wait until January effective to apply through Exchange (with no subsidy) or through her employer
  3. Most STM [short-term medical] will decline due to Type 2 diabetes and even if accepted won’t cover his per-ex condition or meds. Found one carrier in his zip who will do a guaranteed issue for up to $100,000 max benefit but no pre-ex covered
  4. Christian sharing ministries won’t cover pre-ex or meds but would take him if not a smoker. He is a smoker

Slim to no options for medical coverage until 2019.

Pre ACA I could have written a policy in the high risk pool with premium about the same or less than what the Exchange without subsidy rates are now. Group plan would have been less expensive to join.

Beverly Gossage


HSA Benefits Consulting

Senior Fellow for IWV

Past President and current Legislative Chair GKCAHU

Eudora, KS
Individual and Group health and life insurance plans, Medicare, Disability, Critical Illness, Accident

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