FAIRMONT — Through a new plan, AccessWV is trying provide a more affordable option to fit the needs of the medically uninsurable.
AccessWV, offered through the West Virginia Offices of the Insurance Commissioner, is a state health insurance plan for West Virginia’s high-risk pool. The program was started in July 2005, and coverage began in August of that year.
“We guarantee health coverage to people who are eligible who can’t get coverage in the regular market because of health conditions,” Alfreda Dempkowski, executive director of AccessWV, said.
She said this coverage is for people who are medically uninsurable, which means they were turned down by an insurer because of a chronic illness. Prior to AccessWV, a person unable to get health insurance for medical reasons might have been left with no coverage at all.
“It gives them an option,” Dempkowski said of the program.
AccessWV also serves people under the federal Health Insurance Portability and Accountability Act (HIPAA) and the Health Coverage Tax Credit (HCTC) program.
Persons must be West Virginia residents to receive this coverage. Individuals who have group health insurance available to them through an employer or can get Medicare, Medicaid or CHIP are not eligible.
Dempkowski said legislation requires AccessWV to charge certain amounts above the regular market. Because this coverage is for the medically uninsurable in the standard market, the usage and premium is higher, said Bill Kenny, deputy insurance commissioner.
“This is not an inexpensive plan by any means,” he said. “The plan recognizes that its participants will be utilizing medical services because they have a condition that requires that.”
Even though premiums are higher, they are lower than what people with medical conditions would be charged by a regular insurer, Dempkowski said.
“They are required to be set above the regular market, but it’s the regular market for what a healthy person would pay,” she said.
But AccessWV found that people couldn’t afford these high monthly costs. Dempkowski said the board of directors decided that it would be able to offer services to more people if it had a plan with an even higher deductible.
“At this point, more than half of our members are choosing a plan with the highest deductible because that’s what they can afford,” she said.
So the board developed a plan that had a high deductible so it could offer lower premiums. AccessWV previously had three plans, and the new plan is the fourth option available. Under the new plan, the costs would be up to 25 percent lower than the current premium, Dempkowski.
“This new plan is our least expensive,” she said.
“It’s a way of expanding the program,” Kenny said. “It’s a financially sound program. It has sufficient surplus to take on that responsibility.”
While this is a high-deductible product, people might be interested if they are just looking to protect themselves from a serious episode, Dempkowski said. Persons can sign up for the new plan now, and the first coverage will be available Jan. 1, 2009. Other states offer similar plans with high deductibles.
She said premiums are determined based on age and gender. In Marion County, the lowest premium of $131 per month would be for a male under age 25. The highest monthly premium — $630 — would be for a male at least 60 years old.
AccessWV is currently covering 641 individuals in the state, and the majority of these persons are now over age 50, Dempkowski said. Because of their medical situations, many of these people appreciate paying a lower premium. AccessWV has covered more than 1,000 people since it was established.
The program gains members slowly but steadily. This year, membership in AccessWV has grown an estimated 20 percent, she said.
“With this new plan, we do expect (the numbers) to increase,” Dempkowski said.
Kenny said the purpose of AccessWV is to provide eligible persons “with options that might better fit their needs.”
“This is the state recognizing that there are a number of its citizens that do not have coverage ... because of known medical conditions,” he said. “These citizens had no place to go. Our goal is to get more of our citizens with health care coverage. This is filling a need that the commercial market was not filling.”
For more information, call AccessWV at 558-8264 or 1-866-445-8491.
E-mail Jessica Legge at jlegge@timeswv.com.
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