If you suddenly become uninsured, you probably want to find and enroll in new health insurance immediately. After all, life keeps happening.
Fortunately, there are three ways to get covered as soon as possible:
Short-term health insurance — also known as short-term medical insurance, STM, and short term limited duration insurance.
Individual major medical insurance — also known as ACA plans, Obamacare plans, or permanent health insurance.
Medicaid — may be known simply as Medicaid or something else in your state (e.g. Medical in California).
The best coverage for you will depend on your individual situation. As you learn about each type, factors to consider include:
Eligibility — Do you qualify for coverage?
Cost — How much can you afford to pay for a monthly premium and for out-of-pocket expenses if you need healthcare? Are ACA subsidies available for this coverage, and do you qualify for them?
Coverage length — Will you need coverage for one month, one year, or somewhere in between?
Benefits — Are you looking for the full range of benefits that a permanent health insurance plan must include? Do you need coverage for pre-existing health conditions?
Availability — How quickly do you need health insurance? Are you eligible for a special enrollment period outside of the Obamacare open enrollment period? Do you qualify for Medicaid in your state?
Whether you are without health insurance due to job loss, aging off a parent’s plan, early retirement, or other circumstances, there’s an option available to you.
Need health insurance now? Short-term health insurance provides temporary benefits quickly, if you qualify. If your application is approved, your policy can begin as soon as the next day. These plans also last as few as 30 days, which can be useful when you start a new job and need coverage during your employer’s waiting period, or have a brief gap between major medical plans.
Benefits: Short-term plans are designed to help pay for health care expenses related to injuries and unexpected illnesses, so benefits typically include doctor office visits, hospitalization, and emergency room care. Plan designs vary, though, which means you may find some will cover other types of medical expenses, like physical therapy or a couple of common preventive screenings. Additionally, some plans may include non-insurance extras such as prescription drug- or vision-care discounts.
An important note: Short-term health insurance does not meet the Affordable Care Act’s requirements for minimum essential coverage. Unlike major medical insurance, it doesn’t include all of the ACA’s essential health benefits such as maternity care or the full range of no-cost preventive services. If you need more comprehensive coverage, an ACA plan could better suit your needs.
Cost: Prices vary depending on your age, gender, and location. Typical upfront plan costs can include:
Coverage length: Your short-term health insurance could last anywhere from 30 to 364 days, depending on how long you need coverage and what the policy limits are in your state. State laws vary when it comes to maximum policy length. After all, short-term coverage is designed to be just that: short term. These plans come in handy for people who are looking for benefits that cover unexpected medical care, while also trying to keep premium costs low.
Availability: You can apply for short-term coverage any time of year. There are no open or special enrollment periods. If you need coverage immediately, you can get it as soon as the next day if your application is approved.
As with an ACA plan, you can buy short-term plans online. They are only available in the private market, though, so you likely won’t find short-term health insurance on the state and federal health insurance exchanges. Short-term plans are also not available in every state.
Eligibility: Short-term policies are not guaranteed issue, which means not everyone qualifies for coverage. When you apply for short-term coverage, you’ll need to answer a few health-related questions to determine your eligibility.
Your application could be denied based upon your health history. If you have pre-existing conditions, you may need to explore other options.
Additional considerations: There are two common types of short-term plans: open network and PPO. An open network plan allows you to visit any health care provider without network restrictions. A PPO plan will require you to visit an in-network health care provider. And depending on the policy, your claim may not be paid if you go out of network, or it may be covered at a lesser amount.
Not sure how long you’ll need coverage? In search of benefits that will help with everything from preventive care to pre-existing medical conditions? An Obamacare plan can provide you with permanent health insurance that meets the ACA’s minimum benefit requirements.
However, timing is important. The annual open enrollment for individual major medical insurance, in the private market and through the state and federal exchanges, typically runs from Nov. 1 through Dec. 15. (some states that run their own exchanges have expanded their enrollment dates for 2020 plans). When you enroll during the open enrollment period, your policy begins Jan. 1 of the new year.
If you need health insurance outside of open enrollment, you’ll need to qualify for a special enrollment period for like events like having a baby, getting married, changes in state residence, or losing other ACA health insurance coverage. You have to apply for a special enrollment period and may need documentation to verify your qualifying life event.
Typically, if you enroll by the 15th, your effective date will be the first of the following month. If you enroll after the 15th, your effective date will be the first of the next month.
These plans are designed to provide the broadest coverage, so their premiums will usually be higher than short-term plan premiums unless you qualify for a premium tax credit.
Benefits: A major medical plan must include all of the ACA’s essential health benefits and no-cost preventive health services. That means you will have coverage for things like pregnancy and ongoing mental health treatment, which are not included with short-term policies. These benefits are required for ACA plans whether they are sold in the private market or through the state and federal exchanges.
If you have health conditions that require ongoing medical care or need benefits for pregnancy and childbirth, then an ACA plan may best suit your needs.
Eligibility: Under the ACA, major medical policies are guaranteed issue. You cannot be denied coverage or charged more based upon your health history.
Cost: ACA plan premiums may be subsidized or unsubsidized. The two ACA subsidies include premium tax credits, which lessen what you pay for coverage, and cost-sharing reductions, which lessen what you pay out of pocket for covered medical expenses.
Subsidy eligibility is based on income. Premium tax credits are generally available to those with a household income up to 400% of the federal poverty level. Cost-sharing reductions are generally available to those with a household income of 100 to 250% of the federal poverty level.
You’ll probably want to enroll in an ACA plan if you qualify for a subsidy.
Coverage length: Your ACA policy will last the entire calendar year, unless you cancel it or stop paying your premiums. And your coverage is guaranteed to be renewed the following year.
Availability: You can apply for a major medical insurance plan during the annual open enrollment period or, if you qualify, during a special enrollment period. Major medical policies are available both in the private market as well as through state and federal exchanges. They are available in every state, but insurers and plans will vary by state and county.
Additional considerations: Many major medical policies require you to see in-network providers. Some may cover out-of-network care at a lesser percentage or not at all.
Many plans have "narrow networks," which are more restrictive in terms of participating providers. There are no hard and fast rules for what constitutes a narrow network plan, but the various definitions generally reflect the narrow network definition in a recent study by the Leonard Davis Institute of Health Economics: Narrow networks are those that include fewer than 25% of eligible physicians in a rating area.
This may be an important consideration if you live in a rural area and need to travel farther to seek in-network care. A narrow network reflects the range of providers you have access to, but doesn’t reflect quality of care.
Do you earn too little to qualify for an Obamacare subsidy? You may qualify for Medicaid, which is a joint federal and state program that helps with medical costs for certain populations including low-income adults, children, pregnant women, elderly adults and people with disabilities.
Those who qualify for their state’s Medicaid program may receive low-cost (in states with waivers) or no-cost health care coverage. Benefits are defined by each state, but they must meet federal guidelines.
Eligibility criteria vary by state.
Benefits: Medicaid fulfills the ACA minimum essential coverage requirements, but each state decides what benefits it provides. Some benefits are mandatory under federal law —hospital services, home health services, physician services, and laboratory services, to name a few. Optional benefits that states may choose to cover include prescription drugs, dental services, hospice, and physical therapy, among others.
Eligibility: You must meet your state’s Medicaid eligibility criteria to qualify for this coverage. You’ll have to apply and may be required to provide supporting documentation.
Under the Affordable Care Act, as of September 2019, a total of 37 states, including the District of Columbia, had expanded Medicaid coverage to those with a household income below 133% of the federal poverty level.
In all states, eligibility is based on income, household size, disability, family status, and other factors.
Cost: Medicaid may cost you little to nothing. States have the option to charge premiums and include cost-sharing for out-of-pocket spending such as deductibles, coinsurance, and copayments.
Coverage length: Your coverage will last as long as you are eligible. You may need to verify your eligibility. Coverage typically ends at the end of the month when you no longer qualify for Medicaid.
Availability: Medicaid is available year-round to those who qualify. Your coverage could begin right away on the day you apply or the first day of the month of application. Your benefits may even be retroactive up to three months prior to your application, if you’re qualified then as well.
Additional considerations: You can learn more about your state’s Medicaid program, including eligibility criteria, at Medicaid.gov.
The bottom line: Health insurance benefits can help pay for your covered medical expenses, potentially reducing what you pay out of pocket.
While there no longer is a federal tax penalty for going without minimum essential coverage starting with the 2019 coverage year, you’d be wise to consider enrolling in a health insurance policy (some states like California still have penalties for not having coverage).
Whether you expect a gap in coverage soon or need health insurance now, it’s time to take a closer look at your options.
You can get plan quotes and apply and enroll online. But if you need more guidance, call 800-620-4519 to reach one of our licensed health insurance agents.
At some point in life, you might wind up uninsured. You may know it’s coming and have time to plan for it, or you may not. Either way, you’ll be on the hook to pay for healthcare. That’s where short-term medical insurance comes in. Also known as short-term health insurance or temporary health insurance, this type of plan provides quick, temporary insurance coverage when you’re in between major medical policies. But is a short-term health insurance plan the right choice for you? Let’s look at answers to some common questions, including how temporary health insurance works, what it covers, when it makes sense, and why it differs from major medical insurance. Once you understand the basics, you’ll be better equipped to make an informed decision. What is short-term health insurance? Short-term medical is temporary health insurance. It’s designed to be cost-effective and flexible during times of transition, allowing you to: Get covered as soon as possible. Apply online and enroll within a few minutes. Coverage is available year-round and may begin as early as the next day, if you’re eligible. Choose your policy length. Policies last from 30 days and to 364 days, depending on where you live and how long you need coverage. Access benefits right away. Coverage is typically limited to unexpected medical expenses rather than long-term healthcare needs (i.e., preventive care, maternity). The Affordable Care Act doesn’t apply to short-term health insurance, which means it isn’t guaranteed issue and does not include all of the essential health benefits that major medical insurance (aka ACA plans) must include. While short-term health insurance does not provide major medical coverage, it does have some similarities: You pay a premium in exchange for coverage. You present your plan ID and pay a copay, if required, when visiting a healthcare provider. Your provider files a claim with your short-term health insurance carrier, which pays for covered medical expenses according to your policy. You receive a bill for your portion. Like ACA plans, short-term plans typically include a deductible, coinsurance and copayment. They may or may not include a provider network. What does short-term health insurance cover? Short-term health insurance generally covers high-dollar medical expenses related to injuries and unexpected illnesses. For example, plan benefits typically include things like hospital room and board, emergency care, and surgical services as opposed to preventive care, maternity, and treatment of pre-existing conditions. Of course, not all short-term coverage is the same. Some may include benefits for a few basic preventive care services (e.g., Pap smears) or limited coverage for pre-existing conditions. Bottom line: You’ll want to shop around to see what short-term plan best suits your needs. How much does short-term medical insurance cost? The amount you'll pay for short-term health insurance coverage depends on the plan you select. Short-term plans come with less benefits than a comprehensive major medical plan, so they could cost less. As with any type of health insurance, you can generally expect to pay a lower premium for a plan with a higher deductible and limited benefits and vice versa. Adding a spouse and dependents will also increase your cost. Short-term plans are not eligible for premium tax credits or cost-sharing reductions. If you qualify for these ACA subsidies, then you’ll probably want to enroll in an ACA plan through a state or federal exchange. You can use an online subsidy calculator to see if you might qualify. Short-term health insurance vs. Major medical insurance Short-term health insurance and major medical insurance are different products designed to serve different needs. It’s not a true apples to apples comparison. At a high level, here’s what to know about each product: Short-term medical insurance plans: Provide temporary coverage with a focus on unexpected healthcare. May be purchased year-round. There are no open or special enrollment periods. Does not include all of the essential health benefits. Is not eligible for ACA subsidies (i.e., premium tax credits and cost-sharing reductions) Is not guaranteed issue. You can be denied coverage based on your health history. Is not available in every state. Major medical insurance: Provides long-term coverage with a focus on healthcare across the spectrum (e.g., preventive, pre-existing conditions, unexpected). May be purchased during the annual open enrollment period or a special enrollment period, if you qualify. Includes all of the 10 essential health benefits. Is eligible for income-based ACA subsidies if you buy from a government exchange and qualify. Is guaranteed issue. You cannot be denied or charged more based on your health history. Is available in every state. The decision ultimately depends on how long you need coverage, your typical healthcare needs and your financial situation. Is short-term health insurance right for you? Short-term health insurance coverage isn’t available to everyone. Applicants can be denied based on health history, and plans aren’t sold in every state. These types of plans also may not be a fit if you qualify for an ACA subsidy, have pre-existing conditions, want all of the essential health benefits (e.g., preventive care, maternity), or expect to need long-term coverage. Generally speaking, temporary health insurance tends to be a fit for healthy people who are: Between jobs with employer-based benefits. Attending college outside a parent’s health insurance plan network. Early retirement before Medicare takes effect. Aging off a parent’s health plan and not yet being enrolled in other coverage. Looking for an alternative to COBRA, if it's too expensive. In an employer waiting period before group benefits take effect. Ineligible for an ACA subsidy or Medicaid but unable to afford major medical insurance at this time. How to buy a short-term health insurance plan Short-term health insurance isn’t sold through the state and federal ACA exchanges, but it’s easy to find online. [Hint, hint: You’ve come to the right place.] The application and enrollment process is fairly straightforward: Get plan quotes. Start here to find and compare plans. Enter some basic information, including your date of birth and ZIP code, to see what plans are available to you and how much they cost. Compare your options. As you narrow your options, you’ll want to consider the following: Cost— Look at premium, deductible, coinsurance, and copayment amounts. What is most affordable for you? Benefits — What medical expenses does the plan cover? Does this amount of coverage align with your healthcare needs? Availability — What is the maximum policy length in your state and you apply for another policy once your first policy expires? Will these limits keep you covered long enough? Decide and apply. Be ready to answer a few basic health-related questions. You’ll have an answer within minutes - and you can begin coverage as soon as the following day, if your application is approved. If you don’t qualify for a short-term plan, you may want to look into other options such as an ACA plan or Medicaid. Still not sure what’s right for you? Call one of our licensed agents to talk through your options: (855) 651-5094.
If you're turning 26 soon, it's time to think about your health insurance options. Under the Affordable Care Act (ACA), you can stay on your parents' health insurance plan until age 26, but it's up to you to find coverage afterward. And although there's a lot of information about health insurance, just knowing that you have a choice is the first step. Here are seven common questions that many young adults may have concerning their health insurance. 1. Does my insurance end when I turn 26? The Affordable Care Act (ACA) allows young adults to be covered under their parents’ policy until age 26. But if you're on your parents' insurance plan, your insurance may not automatically end when you turn 26 because there are some exceptions to this rule: The ACA requires most employers to provide coverage until the end of the month that you turn 26. Some plans may cover you until the end of the year in which you turn 26. Some states even extend coverage to age 30 or 31. Check out the National Council of State Legislatures website to see your state laws. 2. How long do I have to get insurance after I turn 26? Standard ACA plans have a set enrollment period each year, but adults age 26 have a special 120-day enrollment period. That means you can purchase a medical insurance plan either 60 days before you turn 26, or 60 days after. 3. What are my insurance options? The good news is you have several choices. Let's walk through each. 1.) Enroll in your employer's plan. If you have a job, an easy way to get insurance is to join a health insurance plan offered through your employer. If you're just landing a new job, though, it's important to note that there may be waiting periods before your health insurance kicks in. 2.) Join your spouse's plan. If you're aging off of your parents' insurance but are married, you may be able to join your spouse's health plan. Just ask your spouse’s employer to add you to the plan within 30 days of your loss of coverage under your parents' plan. 3.) Shop for a plan through the Health Insurance Marketplace. You can compare and purchase ACA plans, also known as Obamacare plans. One perk of the Health Insurance Marketplace is that you can’t be denied coverage for having a pre-existing health condition. Costs for marketplace plans vary greatly, depending on your location and the level of coverage you need. Tax credits to help offset the plan's cost and make it more affordable are also available for those who qualify. 4.) Get a short-term health insurance plan. Short-term health insurance provides temporary benefits quickly. Your policy can begin as soon as the next day, if you're approved. Plus, short-term plans are flexible: They can last as little anywhere from 30 to 364 days, which can be useful when you have a gap in coverage. 4. Does an ACA plan make sense for me? ACA plans can be a good option for health insurance once a young adult has aged out of their parents' insurance. If you have a chronic health issue, are planning on becoming pregnant, need more health service options, or want the assurance of a plan with the 10 essential benefits, ACA plans may suit you well. By law, all ACA plans must offer 10 essential health benefits with no annual cap on the benefit amount: Ambulatory outpatient services Inpatient hospital services Maternity and newborn care Emergency care Prescription drugs Mental health and substance use disorder services, including behavioral health services Rehabilitative and habilitative services Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care (some variation state by state) 5. Does a short-term insurance plan make sense for me? Short-term health insurance, also known as temporary health insurance, is a medical plan that provides you with health insurance coverage for a set period - anywhere from one to 12 months, depending on individual state rules. Some states offer short term insurance plans while others don’t, so it's essential to compare what's offered in your specific area. The big thing to know is that a short-term health insurance plan is entirely different than an ACA plan. Think of a short term health insurance plan as an option outside of the ACA, not an alternative to an ACA plan. For example, short-term plans are not required to cover the 10 essential health benefits, but they may be a good transitional fit if you're aging out of your parents' insurance, maintaining good overall health, and aren’t sure where life is taking you next - whether it’s a getting new job, entering the gig economy, preparing for grad school, or backpacking across America. Short-term plans several common medical services for many young adults, such as: Hospitalization Emergency room visits Doctors/specialists visits X-rays Lab tests 6. What are the costs of a short-term health insurance plan? To better understand the costs and potential savings associated with short term health insurance plans, you should get familiar with these terms: -Premium: the monthly amount you'll pay for your health insurance coverage. Short-term plans generally offer lower premiums than ACA-compliant plans, and you may have the option to choose a higher deductible plan with a lower premium. -Deductible: the amount that you have to pay towards your medical bills before your insurance company will contribute any money. -Copayment/Coinsurance: the percentage of your medical costs that you actually have to pay after hitting your deductible. Then, your insurance company will pay for the remaining percentage. So let's say your coinsurance amount is 20%: You'd pay 20% of the medical bill, while your insurance company will pay the remaining 80%. -Out-of-pocket maximum: the total out-of-pocket amount that your insurance plan requires you to spend your medical expenses each year. Once you have met this amount, your insurer will pay 100% of all your covered medical expenses up to the plan's annual benefit limit. An out-of-pocket expense is any medical service that you have to pay for with your money. Deductibles and copayments/coinsurance are considered out-of-pocket expenses, but your monthly premium is not. So if your plan does have an out-of-pocket maximum, you won't have to pay for any plan-covered medical services after you reach the set amount for your out-of-pocket expenses. Here's an example: If your plan has an out-of-pocket maximum of $8,000, you've reached your out-of-pocket maximum once you've contributed that exact amount: $8,000. From then on, your insurance company will pay 100% of any plan-covered medical services for the remainder of the plan year, up to your plan’s annual limit. So if you're going to your primary care doctor or hospitalized for a few days, you won't have to pay any additional money as long as the service is included in your coverage plan. 7. What's the best option for me? A few factors come into play such as plan costs, your health situation, and your specific healthcare needs. The bottom line: The best thing to do is to simply shop around and compare plans as you age out of your parents' insurance plan. Just be sure to read the fine print so you understand what's covered and what's not, as well as your deductible amount and how much you’ll pay out of pocket.
If you're a college student, you have several health insurance options. While many students stay on their parents' health insurance plans, others opt for choices like student health insurance plans or short-term health insurance plans. When shopping around, the first step is to understand your school's health insurance requirements. As examples, they can vary depending on if you're a part- or full-time student, and they can also require you to be covered by a specific type of plan if you're enrolled and living on campus. This is mind, let's walk through some of your options. #1. Stay on your parents' plan By law, you have the right to stay on your parent's health insurance plan until you turn 26 years old. If you're on your parents' insurance plan through their jobs, your coverage will end the month of your birthdate. But if your parents purchased insurance through the Health Insurance Marketplace, you will be covered until the end of the year. Marketplace plans are government-mandated insurance plans that comply with the Affordable Care Act (ACA) requirements for individual and family health plans. Keep in mind that there's a set "open enrollment period" when you can add or drop health insurance. The specific dates vary from year to year, but the open enrollment period usually begins in November and ends in December in most states. Note, some states offer extensions and allow individuals over age 26 to stay on their parent's insurance under certain conditions. Your state ACA marketplace can provide you with more information. #2. Enroll in an ACA plan The Affordable Care Act - also referred to as Obamacare - was signed into law by then-President Barack Obama in March 2010. It was enacted to ensure that every American has access to medical insurance, regardless of their medical history. As a college student, you have the option to compare plans and sign up for insurance coverage through the ACA Health Insurance Marketplace. Note, these plans are required to cover the 10 essential health benefits, so their level of coverage might be more extensive than some of the other options we're covering. As examples, an ACA plan might be a good choice if you have a specific medical condition like diabetes, or if you're pregnant or anticipate becoming pregnant. #3. Look for student health insurance options Another option for college students is a student health insurance plan offered through your college or university. These plans are generally inexpensive and offer a range of coverage options. You might even find this option appealing because it counts as a school associated fee, meaning it can be covered by student loans or other school funding. You can check out your school's website, or contact your school's financial aid department to find out if student health insurance is available. #4. Buy a short-term health insurance plan Short-term health insurance plans tend to attract college students because they typically have a lower premium than other health insurance options - a good fit for college students on a budget. But short-term plans can also have limited coverage. So if you're looking into a short-term plan, it's important to consider the full picture beyond the cost: Doctor office copays: Are doctors office visits important to you? Urgent care copays: Do you anticipate visiting an urgent care clinic during your coverage period? Prescription drug benefits: Are you currently on medication? Student-athlete accident benefits: If you're a college athlete, short term health insurance that does not cover intercollegiate sports? Physical therapy benefits: Do you anticipate needing therapy in the future? Not all short term health plans offer one or all of these benefits, though, so shop wisely. Depending on the plan, short-term health insurance provides coverage for preventive care, doctor visits, urgent care, and emergency care. And although many don't offer prescription drug coverage, they may offer prescription discount cards to help you with drug costs. Another important variable to weigh is whether or not you have a pre-existing health condition. If you do have one, you can be denied short-term health coverage. Though some short-term providers may allow you to buy a plan, but you'll have to pay out-of-pocket for any medical treatment you receive as a result of a pre-existing condition. And these additional out-of-pocket expenses coupled with the policy premium can quickly add up. In 2018, the Kaiser Family Foundation issued the following stats about short-term plans: 43% didn’t cover mental health services 62% didn’t cover substance abuse treatment 71% didn’t cover outpatient prescription drugs None of the plans covered maternity care So it's good to know the facts. But while short-term health insurance plans don't cover everything, they do have several benefits: There's no enrollment period. You can enroll at any time, and coverage can begin as soon as the next day. They have a flexible length of coverage. Your coverage period can range from one month to 364 days, with policy renewal of up to three years, depending on your state’s rules. They're a security blanket. Short-term plans will cover you in the event of an accident or illness, so you aren't faced with paying large medical bills out of pocket. They're widely accepted among health professionals. You should be able to find health professionals who accept short-term insurance plans. Some insurance carriers have a preferred network with special negotiated pricing and an extensive network of physicians. They offer choice. You can typically select providers and physician services you're already familiar with, depending on plan options. Some states even offer short-term health insurance for up to three years, so you may be able to lock in guaranteed renewability if the insurance company offers it. Short-term health insurance coverage can vary depending on age, state, and gender, so what works for one person may not be a good option for the next. Keep in mind that short-term health coverage is currently not offered in 10 states, but you can shop around to find other insurance plans are available in your area. Also, plan rules like coverage and renewal terms, coverage for pre-existing conditions, and coverage for specific medical services vary state-by-state, so getting a personalized quote is an important part of the process. The last important call out: Be sure that the coverage you’ve selected is the coverage required by your school. Some schools require full-time students to carry a major medical plan that complies with the ACA, rather than a short-term medical plan. Interested in getting a quote? Getting a quote is an easy, hassle-free task. For starters, you're not required to commit to a short-term health insurance plan when getting a quote, and there's no contract involved once you do apply. After answering a few basic questions, you'll learn about specific coverage options available in your area - a good tool especially if you're going to college out of state. Then, you should take time to look over the information, talk it over with your parents/family, and pick the plan that works for you. Choosing health insurance might be one of your first major financial decisions in life, so we're here to help you make an informed choice. Our plan comparison tool gives you the power to search for plan options and set filters based on the monthly costs, deductibles, and benefit maximums. Shop around to get the right coverage and price that works for you.