Data as of January 31, 2009.

Data collection and analysis by Eliza Bangit and Karen Pollitz, Health Policy Institute, Georgetown University.

Sources include state laws and regulations, interviews with state high-risk pool staff, state high-risk pool websites, and the Comprehensive Health Insurance for High-Risk Individuals: A State-by-State Analysis. National Association of State Comprehensive Health Insurance Plans, 22nd Ed., 2008/2009. Available for order at www.naschip.org.

Medically Eligible: Typically, people are considered medically eligible or uninsurable if they have been turned down, charged substantially higher premiums, or if they have been offered private coverage with an elimination rider.

HIPAA Eligible: "HIPAA Eligible" individuals are guaranteed the right to purchase individual coverage with no pre-existing condition exclusion periods when they leave group coverage. To be HIPAA Eligible, a person must have had at least eighteen months of prior coverage, not interrupted by a gap of more than sixty-three days in a row, and the last day of prior coverage must have been in a group health plan. In addition, upon leaving group coverage one must elect and exhaust any available COBRA continuation coverage or similar state continuation coverage. A HIPAA eligible individual cannot be eligible for any other group coverage or Medicare, and must apply within sixty-three days for HIPAA coverage.

HIPAA requires all coverage sold in the individual market must be available to eligible individuals, unless insurers elect to make only two policies available. Insurers can designate their two most popular individual market policies for federally eligible people, or they can designate two "representative" policies that are similar to others they sell in the individual market. These policies cannot impose pre-existing condition exclusions, but HIPAA does not limit premiums that can be charged. This is called the Federal Fallback approach.

States can adopt different approaches to guarantee access to non-group coverage to HIPAA eligible individuals and most states have done so. For example, some states require community rating from guaranteed issue HIPAA policies. Many states guarantee access to non group coverage in a high-risk pool instead of in the private health insurance market. These different approaches are called Alternative Mechanisms.

HCTC Eligible: The Health Coverage Tax Credit (HCTC) is a program that can help pay for nearly two-thirds of eligible individuals’ health plan premiums. In general, in order to be eligible for the health coverage tax credit, you must be 1) receiving Trade Readjustment Allowance benefits (TRA), or 2) will receive TRA benefits once your unemployment benefits are exhausted, or 3) receiving benefits under the Alternative Trade Adjustment Assistance (ATAA) program, or 4) aged 55 or older and receiving benefits from the Pension Benefit Guarantee Corporation (PBGC).

1. Open to individuals under the age of 65.
2. Closed to new enrollment.
3. Idaho operates a high-risk reinsurance plan.
4. The individual market in Oregon provides about 95% of HIPAA coverage through the carrier in which the individual lost group coverage. The remaining 5% enroll in the high risk pool because the carrier does not offer a HIPAA option or the individual no longer resides in the carriers service area.
5. Generally, Washingtons high risk pool is open only to medically eligibles. However, any Washington resident, including those who are HIPAA eligible, may apply if he/she resides in a county where individual health insurance are not marketed to the general public.