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Short Term Health Insurance 101: Understanding the Basics

November 9, 2023

3 arrows painted on asphalt pointing to short-term, major medical, or Medicaid options

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 health insurance is temporary health insurance that you can purchase year round that is designed to be cost-effective and flexible during times of transition, allowing you to:

  • Get healthcare coverage within 24 hours of purchase. 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. Short term health insurance policies can last from 30 days and to 364 days and renewable, 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, prescription drugs, 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 healthcare plans generally cover 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 health insurance cost?

The amount you'll pay for short term health insurance coverage depends on the plan you select, your age, lifestyle, and the state you live in. For example, a 35 year old male non smoker in Florida can expect plans with premiums starting under $150 per month. The reason short term plans cost less than comprehensive major medical plans is because they come with less benefits.  

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. 

Short term health insurance vs. ACA Heathcare Market Place

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 health insurance plans:

  • Provide coverage for up to a year with a focus on unexpected medical events.
  • 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.

ACA Healthcare Marketplace/Individual/Family Employer Coverage:

  • ACA Marketplace health care 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

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 kind of health insurance is right for you? Call one of our licensed agents to talk through your options: (855) 651-5094.

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