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How to keep your health insurance when you move to another state

January 11, 2021
  • How do I obtain new coverage when I move to a new state?
  • If you’ll have an unavoidable gap in coverage, a short-term plan might be a good option to bridge the gap.
  • How will my health insurance provider network change when I move to a new state?

Since individual market coverage is regulated and marketed at the state level, a new plan is needed when you move from one state to another. But prior to 2014, health insurance was often an obstacle for people who wanted to move to a new state. In all but five states, individual market coverage was medically underwritten, so people with pre-existing conditions often found it difficult, expensive, or impossible to enroll in new coverage if they were going to need to purchase their own plan (as opposed to getting coverage from an employer, Medicare, or Medicaid).

Many states had state-run high-risk pools, and federal pre-existing condition insurance pools (PICP) were implemented in the years leading up to 2014. But high-risk pools could impose waiting periods for new arrivals to the state, and coverage through the risk pools was often prohibitively expensive and generally had benefit caps that weren’t always adequate.

That’s all a thing of the past, thanks to the Affordable Care Act. In every state, health insurance is guaranteed-issue for all applicants during open enrollment and special enrollment periods — and moving to a new state will trigger a special enrollment period as long as you already had coverage before your move. And the price is the same regardless of whether you have pre-existing conditions. Premiums can vary based on age, zip code, and tobacco use, so you might find that coverage in your new area is priced differently. But if you’re eligible for premium subsidies, the subsidy amount will adjust to reflect the cost of the benchmark plan in your new area.

How do I get new health insurance coverage when I move to a different state?

If you work for a large employer that has business locations throughout the country, you may find that your coverage remains unchanged with your move. But if you buy your health insurance in the individual market, you’ll have to purchase a new plan.

Individual market coverage is guaranteed-issue thanks to Obamacare, but it’s only available for purchase during open enrollment, and during special enrollment periods triggered by qualifying events. Moving to an area where different health plans are available (which includes moving to a new state) is a qualifying event, as long as you already had coverage in your prior location. (This prior coverage requirement took effect in July 2016.)

So you cannot move to a new state in order to take advantage of a special enrollment period if you were uninsured prior to the move. But as long as you had coverage before the move, you’ll have a 60-day enrollment window during which you can pick a new plan – in the exchange or off-exchange – in your new state.


It’s optional for exchanges to allow access to special enrollment periods in advance of a move (as opposed to only after the move has occurred), but there’s no requirement that exchanges offer this feature. So your enrollment period likely won’t begin until the day you move, and the earliest effective date you’ll be eligible for will be the first of the following month. (Normal effective date rules are followed in this case, which means that in most states, you need to enroll by the 15th of the month in order to have coverage effective the first of the following month; this requirement will no longer be used by HealthCare.gov as of 2022, when they will simply allow coverage to be effective the first of the month after you enroll, regardless of the date you enroll.)

That means you may end up having a gap in coverage, depending on the date you move and how far into your 60-day enrollment period you are when you select a new plan in your new state. You’ll want to find out how your current health insurance plan works in your new state; you may only have coverage for emergencies once you leave the state in which your policy was issued.

If you’re concerned about the possibility of having a gap in coverage, you could enroll in a short-term plan to cover you until your new plan takes effect. Short-term plans are not regulated by the ACA, and they don’t count as minimum essential coverage. But they’re specifically designed to cover short gaps in coverage, and they’re perfect for a situation in which your new plan will be taking effect within a few weeks and you only need “just in case” coverage in the meantime.

A short-term plan can have an effective date as early as the day after you apply, and short-term plans are available in nearly every state. Be aware, however, that they generally don’t cover any pre-existing conditions, and they can also reject your application if you have significant pre-existing medical conditions.

How will my health insurance provider network change when I move to a new state?

Particularly in the individual market, health insurers have been moving towards HMOs and narrower networks. So it’s becoming rare for plans to offer network coverage in multiple states. Be prepared for the fact that you will almost certainly have a new provider network with your new plan.

It’s also important to note that even if your health insurer is a big-name carrier that offers plans throughout the country, it will have different individual market plans in each state. So although you might have a Cigna plan already, and Cigna might also be available in the individual market in the state where you’re moving, you’ll need to re-enroll in the new plan once you move.

And although Blue Cross Blue Shield is a household name in the health insurance market, their coverage varies from state to state. The Blue Cross Blue Shield name is licensed by 36 different health insurance carriers across the country; a Blue Cross Blue Shield plan in one state is not the same as a Blue Cross Blue Shield plan in another state.

Additional resources

You can also browse our extensive collection of state health insurance resources, and details about the health insurance exchanges in each state. If your income doesn’t exceed 138 percent of the poverty level (or even higher, if you’re pregnant or looking for coverage for your children), you’ll want to pay attention to the details about how each state’s Medicaid program works and what you need to know about switching to a new state’s Medicaid program.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post How to keep your health insurance when you move to another state appeared first on healthinsurance.org.

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Health insurance and high-risk pools

January 7, 2021

High-risk pools were, in many cases, the only coverage available pre-2014 for people with serious pre-existing conditions who didn’t have access to health insurance from an employer or the government (Medicare, Medicaid, CHIP, etc.). But they were often underfunded, the coverage was expensive, and plan choices were limited. People who used to have high-risk pool coverage are now eligible for coverage in the exchanges (or off-exchange, without subsidies), with access to the same plans that that healthy people can buy.

A brief history of high-risk pools

One of the goals of the Affordable Care Act was to make health insurance available to nearly all Americans, including those with pre-existing conditions. Although group health insurance has long been guaranteed-issue for eligible employees, people who purchased their own health insurance prior to 2014 had to go through a medical underwriting process that historically resulted in roughly 20 percent of individual health insurance applications being denied.

In order to offer a viable alternative for these applicants, 35 states established their own high-risk pools (mostly in the 1990s), generally supported by a combination of state funds, enrollee premiums, and fees assessed on private health insurance carriers.

In addition to those plans, the ACA included a provision for the Pre-Existing Condition Insurance Plan (PCIP), which created a new state or federally run high-risk pool in every state to make a bridge to 2014 and guaranteed issue health insurance. The ACA was signed into law in March of 2010, and at that point, the requirement – starting January 2014 – that all policies be guaranteed issue was still nearly four years in the future.

Now that the consumer protections in the ACA have been fully implemented, risk pools are no longer necessary the way they were in the past. Health insurance applications are no longer denied because of medical history, and people are no longer offered policies with increased premiums or exclusions based on pre-existing conditions.

HHS announced in March 2014 that PCIP insureds could keep their coverage until April 30,2014 if they had not yet enrolled in an exchange plan. (Total PCIP enrollment had dropped to around 30,000 people by January 2014, down from about 85,000 three months earlier. The majority of PCIP insureds had already transitioned to a new plan).

All PCIP coverage ended on April 30, 2014. Enrollees in those plans were able to transition to exchange plans during open enrollment, and they also had another 60-day special enrollment period that began on May 1 if they were still insured by a PCIP policy that terminated at the end of April (involuntary loss of coverage is a qualifying event that triggers a special enrollment period). By the end of June 2014, that special enrollment period had closed, although it’s highly likely that almost all of the remaining PCIP members were able to transition to a new ACA-compliant plan by that point.

But what about the 35 state-run risk pools that pre-dated the ACA? Many of them have also ceased operations or closed their pools to new applicants, but it varies from one state to another. This chart shows the 17 plans that ended coverage in the first half of 2014, along with the 18 state risk pools that were still operational for at least some existing enrollees as of mid-2014 — and some of them were still accepting new members as well.

Which states still have operational high-risk pools?

The following states have risk pools that remain operational as of 2021. Some of them are still accepting new members, although enrollees would have to meet the existing eligibility guidelines (note that some of these high-risk pools are still operational in order to provide supplemental coverage to disabled Medicare beneficiaries under the age of 65 in states where they do not have access to Medigap plans):

  • Alaska (2021 rates)
  • California (2020 rates; in 2015, coverage still had lifetime and annual benefit maximums, so enrollees could be subject to the ACA’s penalty for not maintaining minimum essential coverage; that issue was fixed by 2016 however, and MRMIP now provides minimum essential coverage).
  • Idaho (no longer available for consumers to purchase, but still operational as a reinsurance program for the state’s insurers)
  • Illinois (enrollment in traditional and high-deductible plan options ceased in 2014; by 2019, there were only 94 people enrolled)
  • Iowa (2021 rates)
  • New Mexico (2021 rates; membership had dropped to under 3,000 by 2020, from a high of more than 10,000, although NMMIP continues to offer coverage, they are working towards a “depopulation” goal, and encouraging members to seek coverage under Centennial Care or a QHP in the exchange)
  • North Dakota (2020/2021 rates).
  • South Carolina 
  • Washington (non-Medicare coverage will terminate at the end of 2021; as of January 2014, new enrollments in non-Medicare coverage are only permitted if there is no ACA-compliant individual market plan available in the applicant’s county, and that is not the case anywhere in Washington)
  • Wyoming (the pool is currently only providing supplemental coverage for Medicare enrollees who are under age 65).

Bridging the gap

The ACA’s temporary Pre-Existing Condition Insurance Plans (PCIP) were initially run by state governments in 27 states and by the federal government in 23 states and the District of Columbia. By July 2013, 17 states that had been operating their own PCIP had turned their plans over to the federal government. New-member enrollment ceased in early 2013, and all PCIP coverage ended on April 30, 2014.

The PCIP program was well-intentioned but struggled financially from the outset, with lower enrollment and higher costs than originally projected. In order to help keep the program afloat as long as possible, HHS made some changes along the way.

In 2011, eligibility requirements were eased in order to increase enrollment. Premiums were also lowered by up to 40 percent in 18 states where the PCIP is administered by the federal government, to bring the premiums closer to the rates in each state’s individual health insurance market.

In the face of higher-than-expected costs, however, the government increased enrollees’ maximum out-of-pocket annual expenses for 2013 from $4,000 to $6,250. The rate increase took effect on January 1, and applied to plans administered by the federal government, which impacted enrollees in 40 states and the District of Columbia.

Risk pools by the numbers

Roughly 135,000 people enrolled in PCIP plans nationwide between 2010 and 2013. To qualify, people had to have been without health insurance for at least six months and must have a pre-existing health condition or have been denied coverage as a result of a health condition.

The PCIP program’s high cost was attributed in part to the fact that the population served is disproportionately older. More than seven in 10 people enrolled were age 45 and above.

Nearly four in ten claims paid in 2012 were for one of four diagnoses: cancers, ischemic heart disease, degenerative bone diseases, and the follow-up medical care required after major surgery or cancer treatments. In 2012, the average cost per person was $32,108. However, just 4.4 percent of enrollees averaged costs of $225,000 accounting for more than half of all claims paid.

Now that PCIP enrollees have transitioned to the private marketplace (either on or off-exchange) or to Medicaid, their medical expenses are being pooled with a much larger group of people, including healthy insureds. This helps to spread the costs over a larger population and better manage the health care costs of the sicker individuals who were covered by PCIP policies between 2010 and 2014.

High-risk pools are still favored in GOP health care reform proposals

House Republicans published a health care reform proposal in June 2016 that outlined their vision of the path forward, and it included a return to high-risk pools. Their plan called for $25 billion in federal funding for high-risk pools. States would partner with the federal government to run the pools; premiums would be capped, and enrollment waiting lists would not be allowed. (Pre-ACA, some states had high-risk pools that were no longer accepting applicants, due to enrollment caps.)

Although the GOP plan called for significant federal funding for the risk pools, it’s worth noting that the ACA-created CO-OPs were originally supposed to be established via $10 billion in federal grants. But the CO-OPs ended up receiving a quarter of that amount, and as short-term loans, rather than grants. Lawmakers also changed the rules at the end of 2014 to retroactively make the ACA’s risk corridors program budget-neutral, which meant that health insurers only received about $362 million out of the $2.87 billion they were supposed to receive for the 2014 risk corridors program (2015 funding also fell far short). As a result of the risk corridor shortfalls, numerous health insurers – mostly smaller carriers, like the CO-OPs – ended up closing at the end of 2015.

So while $25 billion in federal funding would help with the sustainability of high-risk pools, there are certainly questions in terms of why high-risk pools were so underfunded in the ’90s and ’00s, where the money would come from if it wasn’t available for the CO-OPs and risk corridors programs, and whether it would actually be $25 billion in reality by the time all was said and done.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post Health insurance and high-risk pools appeared first on healthinsurance.org.

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