If you’ve missed the health insurance Open Enrollment Period (OEP), or if you have had a sudden lapse in your insurance coverage, you might be stressing over how to get covered. But don’t worry, you still have options! One of your best options will be a short-term health insurance plan. These plans tend to be less expensive than traditional health insurance because they provide very limited coverage, and so they are usually meant as a stopgap for generally healthy people. So, what do these plans cover (and what don’t they cover), and what are the specific rules surrounding them?
Compared to traditional health insurance plans, which typically include a comprehensive range of benefits, short-term health insurance plans offer significantly less coverage. In fact, they are not required to provide coverage for the “10 essential health benefits” that traditional ACA-approved plans are required to cover.
That means short term health plans are not required to provide coverage for:
Pre-existing conditions
Medications
Maternity care
Mental health
Substance abuse treatment
But, with that being said, short term health plans are better than nothing, and generally provide coverage for:
What you can expect to pay for a short-term health plan will be determined by the specific plan that you choose, as it would be with any other type of insurance. You will be responsible for paying a monthly premium, in addition to:
Deductibles – As with other types of insurance, with a short-term plan, you pay for services out-of-pocket until your deductible is met. After that, your plan will start to split costs. Short-term health plans can have deductibles that are much higher than those of other, more traditional health plans.
Coinsurance – After you’ve met your deductible, your plan will cover your medical expenses in part, but you will also have to pay a percentage, known as coinsurance. For example, you might have to pay 30% of each covered medical expense, while your plan covers 70%.
Copays – This is a set fee that you may have to pay when you use a medical service. For example, you might have to pay $20 at the point of service when you go to the doctor.
Other expenses – If there are health care services that your short-term plan doesn’t cover, you might have to pay for them completely out-of-pocket. For instance, some short-term plans might not cover or only cover a certain amount of maternity care, mental health or substance use services, vision care, or dental care. If you need these services, you’d have to pay for them yourself.
One good thing about the costs of these plans is that their monthly premiums are typically much more affordable than the premiums for plans offered under the Affordable Care Act (ACA). With that being said, the reason that they are sold at a lower price is because most of the time, these plans don’t cover much, and only a portion of the monthly premium actually winds up being applied toward the cost of actual medical care.
Short Term Plans State-by-State
When it comes to the rules surrounding short term plans, every state is different. In fact, some states don’t even allow residents to buy these plans, but most allow a limited length of time to have one of these plans.
The following states allow you to have coverage with a short-term plan for 364 days, and allow you to renew up to 3 times for a total of 3 years of short-term coverage:
For more in-depth information on your state’s laws surrounding short term insurance, check out our state-by-state guides to health insurance.
Pros and Cons of Short-Term Plans
Short term plans can give you a number of advantages. But you should be aware that there are some drawbacks to this option as well. Knowing both the pros and cons of these plans will help you make an educated decision.
Pros
Affordability – The low price of these plans’ premiums is a highly attractive benefit.
Quick coverage – Plans usually go into effect within 7-14 days of enrolling.
Easy Cancellation – It is possible to terminate short-term insurance plans with little advance notice, particularly if you pay for your plan on a month-to-month basis.
Cons
Renewal Limitations – Short term plans do not automatically renew, and the number of times you are allowed to renew them is usually capped.
Coverage Limitations – In most cases, a temporary health insurance plan will not include coverage for all ten essential health benefits.
Availability Limitations – Not all states or insurance companies offer short-term plans to their customers.
Qualifying for Short Term Health Insurance
As discussed above, the majority of states permit short-term health plans, but there are a few that do not, and others that place restrictions on how long coverage can be maintained.
But even if your state permits short-term plans, you may still be denied coverage by an insurance company for health reasons. For example, you might be denied a short-term plan if you have a serious preexisting medical condition, or if you’re currently expecting a child.
In general, you will qualify for short term plans if you:
Are young and healthy.
Missed the OEP, and don’t qualify for a Special Enrollment Period
Are out of work and can’t afford COBRA or an ACA plan and need coverage in the meantime.
Are almost eligible for Medicare but do not want to enroll in a full year-long plan.
If you have a pre-existing condition, such as asthma or diabetes, you might want to steer clear of short-term plans even if you can get approved, because your premiums will be significantly more expensive, since these plans are not subject to ACA rules on preexisting conditions.
How to Buy Short Term Plans
Although you may be able to enroll in a short-term plan in person in some circumstances, the most common method for purchasing short-term health insurance is doing so online. You can also contact an insurance company that specializes in selling short-term plans directly.
Because of the state regulations surrounding short term health plans, and because these plans are offered by both national and regional companies, their availability is highly dependent on the state you live in. National companies sell short term health plans in multiple states, and regional companies have more localized service areas, so you’ll need to shop around. Speak to an EZ agent about what companies in your area offer the best short-term health plans.
FAQs
Will my doctor accept short term health insurance?
It depends on the plan. Some plans require you to stay in their network of doctors, with other plans, you can choose your own doctor and hospital without being subject to any restrictions. With that being said, in this case, there may still be financial incentives for using in-network providers.
Are pre-existing conditions covered?
When you apply for a short-term health plan, you’ll have to answer a short list of questions about your health, including about preexisting conditions. There’s a chance you will be denied coverage if you have certain preexisting conditions, and even if you are considered eligible for coverage, your plan will most likely not provide coverage for treatment of your preexisting condition.
So, when applying for one of these plans, examine the policy’s wording thoroughly. It’s common practice for short-term plans to use post-claims underwriting, which means that they’ll take your word for it about your health when you sign up, but can check your records after you’ve filed a claim to make sure you weren’t lying about any preexisting conditions.
Is losing my short-term coverage considered a qualifying life event?
Since short term health plans are not ACA-approved plans that provide minimum essential coverage, losing such a policy does not warrant a Special Enrollment Period that will allow you to shop for an ACA-compliant plan outside of Open Enrollment.
So, is a Short Term Plan the Best Option?
The purpose of short-term health plans is to provide healthy people with temporary, limited protection. Therefore, those who have ongoing medical needs or who have a history of illness should avoid short term health plans. If you’ve lost your coverage, and are in-between plans and looking to cut costs, short term health coverage is the way to go. But before you make a purchase, you should think carefully about whether or not it will meet your needs.
You can get information on short term health plans by contacting EZ.Insure and speaking with a licensed agent. We’ll go over all the details with you and help you figure out if one of these plans is right for you. And if it turns out a short-term health plan isn’t the best option for you, we’ll find you something that fits your budget and your health status. Get an instant quote by entering your zip code in the box below, or to speak to an agent directly, call 877-670-3557.
Life can get hectic, and it’s easy to forget about the little things – or even the big things, like getting health insurance! And if you were one of the people who completely forgot to look into health insurance during the Open Enrollment Period (OEP), you’re probably stressing out about what you can do. But you don’t have to stress about it! There are ways to enroll in a health insurance plan outside of the OEP, so you don’t have to wait until next year to find a plan. In fact, you can still find an affordable plan that will keep you covered until the next Open Enrollment Period, with the help of an EZ agent.
Why the Open Enrollment Period Exists
Before the Affordable Care Act (ACA) was passed in 2010, insurance companies could raise insurance premiums. Or refuse coverage to a person based on their medical history and conditions. But the Affordable Care Act made it illegal for insurance companies to deny coverage. Or charge more based on someone’s pre-existing conditions. But in order to ensure that people don’t only purchase health insurance once they get sick, the ACA set up a specific time during the year when people are allowed to purchase health insurance on the ACA Marketplace – the Open Enrollment Period.
Your Options Outside of the Open Enrollment Period
While it might sound like there’s no way to get health insurance now that the OEP is over, there are actually a few ways. For example:
If you experience a major change in your life, known as a qualifying life event, you will be eligible for a Special Enrollment Period (SEP). Which allows you 60 days to enroll in a health insurance plan or change your current plan. What exactly are the qualifying life events that trigger a SEP?
A qualifying life event is a significant change in your life that would make you eligible to enroll outside of an Open Enrollment Period. These changes include:
Getting married
Getting divorced (specifically, if you were getting your health insurance through your spouse’s employer)
Having a baby, adopting a baby, or placing a child up for adoption or into foster care
Losing your spouse/partner, and being left without health insurance
Your spouse/partner losing their job (specifically if you had coverage through their employer)
Losing your job and employer-based coverage
No longer being a full-time employee eligible for workplace coverage
If you do not qualify for a Special Enrollment Period, the next step is to consider a short-term plan. These plans are much cheaper than ACA plans but do not offer as much coverage. They are worth considering, though: short-term healthcare plans provide fast, flexible insurance with many benefits. You can pick your deductible amount from many options. And you can drop coverage without a penalty for a long-term insurance option.
You can get one of these policies at any time and it will cover you for 364 days. It’s important to note that they do not have to cover pre-existing conditions. So premiums can be based on your medical history.
These plans are considered minimum essential coverage because they are not regulated by the Affordable Care Act. Because they are not subject to ACA rules, these plans do not have to cover all the ACA’s 10 essential health benefits, which include:
Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services, and chronic disease management
Pediatric services
How EZ Can Help
Missing the Open Enrollment Period is more common than you might think, so don’t feel alone. And even if you missed it, you don’t have to go uninsured. EZ.Insure wants to make sure that you are protected from any catastrophic and unexpected healthcare emergencies. We will compare all available short-term plans in your area to find a plan that gives you the most coverage with the most savings. And because we just want to make sure you are properly insured, we offer all of our services at no cost to you. We will provide you with your own personal agent who will go over your needs and find a great short-term plan that can temporarily insure you until the next Open Enrollment Period. To get free quotes, simply enter your zip code in the bar above, or to speak to a licensed agent, call 888-350-1890.
When former President Obama came into office, one of his top priorities was to make sure all Americans were insured, and thus the Affordable Care Act (ACA), or Obamacare, was enacted in March 2010. The ACA has not only made health insurance easier to get for millions of Americans, but it has also meant that now all health insurance plans must cover certain basic needs, as long as they are ACA-compliant. Knowing if your plan is ACA-compliant or non-compliant will help you to get the most out of your health insurance plan, and to know if you need to switch your plan to one that is compliant.
What Does ACA-Compliant Mean?
ACA-compliant health insurance plans are known as qualified Major Medical health plans, and cover the 10 essential health benefits with no annual or lifetime coverage maximums. These essential benefits include:
Hospitalization
Ambulatory services (visits to doctors and other healthcare professionals and outpatient hospital care)
Emergency services
Maternity and newborn care
Services to treat mental health disorders and problems with substance abuse
Prescription drugs
Lab tests
Preventive services, including things like contraception, blood pressure screening, breast cancer screening, colorectal cancer screening, obesity screening and counseling, tobacco use counseling and interventions, and breastfeeding counseling
Pediatric services for children, including dental and vision care
Rehabilitative and habilitative services
ACA-compliant plans are also guaranteed issue during the open enrollment period, which means that any pre-existing conditions will not play a role in your eligibility for a health insurance plan.
Non-Compliant Plans
Short term plans are not ACA-compliant, but are cheaper and temporary for when you can sign up for an ACA-compliant plan.
Other types of health plans that do not cover the 10 essential benefits, sometimes called traditional plans, are considered non-compliant with the ACA. Non-compliant plans include short-term health insurance, fixed indemnity plans, and healthcare sharing ministry plans. These types of plans do not have to abide by the ACA’s consumer protections and are exempt from federal regulations.
Of non-compliant plans, short-term health plans are probably the most commonly purchased, because they are generally much cheaper than ACA-compliant plans. They provide temporary coverage when you are not eligible for a major medical plan or are waiting for coverage to start. Unlike ACA-compliant health insurance plans, these plans can use your pre-existing conditions against you; short-term policies were created for healthier individuals who need some sort of emergency coverage for a short amount of time, so they only cover the basics. Therefore, people with pre-existing conditions, or who are in need of medical care should not consider a short-term health plan.
Looking For More Coverage?
ACA-compliant plans offer more coverage, and thanks to Biden’s American Rescue Plan Act, premium subsidies have been extended to more people, so everyone can save money on health insurance. Before you start doing the work of comparing plans on your own, come to EZ: we will make the process quicker and easier by comparing available plans in your area in minutes. Our licensed agents work with all the top-rated insurance companies in the nation and can go over your budget and needs, and find the best plan for you and your family. We compare plans and offer guidance at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-350-1890.
Was your fall so busy with work and holiday prep that you totally missed Open Enrollment? The Open Enrollment Period began November 1 and ended December 15, and, for some, a little over a month to sign up for health insurance is barely enough time! You were probably too busy to even begin researching plans, or maybe you were simply unaware of when you can sign up for health insurance. But no need to worry, EZ has a solution for you. You can sign up for a short-term plan, which will give you coverage until the next Open Enrollment Period.
Before we look at short term plans, you should know that the only way to get most full-coverage health insurance plans outside of Open Enrollment is if you have experienced a qualifying life event. Qualifying life events include getting married, adding a family member, moving, getting divorced, etc. Experiencing one of these events will open up a Special Enrollment Period for you. You will then have 60 days to sign up for a new plan.
If you do not qualify for a Special Enrollment Period, the next step is to consider a short-term plan. These plans are much cheaper than ACA plans, but do not offer as much coverage. They are worth considering, though: short-term healthcare plans provide fast, flexible insurance with many benefits. You are able to pick your deductible amount from many options. And you are able to drop coverage without a penalty for a long-term insurance option.
You can get one of these policies at any time and it will cover you for 364 days. It is important to note that they do not have to cover pre-existing conditions, so premiums can be based on your medical history. These plans are considered minimum essential coverage, because they are not regulated by the Affordable Care Act. Because they are not subject to ACA rules, these plans do not have to include the ACA’s 10 essential health benefits, such as:
Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services, and chronic disease management
Pediatric services
Choosing a short term health insurance will save you money. However, make sure you know what you are purchasing, and make sure that it is the right choice for you.
EZ will find an affordable plan that will save you the most money.
Get Insured While Saving
Missing the Open Enrollment Period is more common than you might think, so don’t feel alone. Even though you missed it, you do not have to go uninsured. EZ.Insure wants to make sure that you are protected from any catastrophic and unexpected healthcare emergencies. We will compare all available short-term plans in your area to find a plan that gives you the most coverage with the most savings. And because we just want to make sure you are properly insured, we offer all of our services at no cost to you. We will provide you with your own personal agent who will go over your needs and find a great short-term plan that can temporarily insure you until the next Open Enrollment Period. To compare quotes, simply enter your zip code in the bar above, or to speak to a licensed agent, call 888-350-1890.
Having health insurance is necessary for keeping you protected in the event of an emergency or accident. A full-coverage plan is usually your best bet, but in some cases you might decide to opt for a short-term plan. For example, if you missed Open Enrollment and need a plan quickly you might choose one of these plans for convenience. Or, if you are healthy and rarely visit the doctor, you might choose one of these plans to save money on premiums, since they are usually less expensive than traditional plans.
Insurance companies are no longer allowed to medically underwrite you during the sign-up process, but short-term plans can.
Unfortunately, if you are not careful when picking out your short-term health plan, you might end up dealing with post-claims underwriting. Some insurance companies bait consumers into choosing their short-term plans, only to turn around and use this tactic to deny customers their insurance payouts after a claim is made. To avoid post-claims underwriting, you have to know what it is; you should also work with a reputable agent to know that you have the right plan from the right insurance company.
Medical Underwriting
Before the protections of the Affordable Care Act (ACA), major medical health insurance plans could force customers to undergo the medical underwriting process before choosing whether to insure them. This meant that you would have to fill out a questionnaire based on your pre-existing health conditions, and if you were considered high-risk, they could deny you coverage or charge you a higher premium based on your medical history.
Although the ACA ended medical underwriting for major medical health insurance plans in 2014, it still applies to short-term health insurance plans and Medicare Supplement Plans if someone enrolls after their Initial Enrollment Period.
Post-Claim Underwriting
Short-term health plans are not subject to any ACA regulations, so with these plans, insurance companies can still use the underwriting process to choose who they want to insure and how much to charge for coverage. But in some cases, instead of being thorough in the underwriting process, insurance companies that offer short-term plans will not fully evaluate the risk of a customer before agreeing to insure them. Instead, the insurance company will evaluate the risk of the customer after a claim is made. This is called post-claims underwriting, and it can end up costing you thousands in medical expenses.
When using post-claims underwriting, insurance companies will look for a reason to deny claims by asking questions that should have been asked before the policy was sold. Generally the insurance company will do this to try and take your premium payments without intending to pay out on your claims. They will issue you a policy with little to no investigation, giving you a simple application with yes or no answers. For example, they might simply ask you if you are in good health; if you check yes, then, once you file a claim, they will investigate your prior health issues and will use your answer against you. If you have a stroke, for example, while covered by the plan, the insurance company might investigate your actual health status prior to the stroke and would use any information they found to deny your claim.
Avoiding Post-Claims Underwriting
Unfortunately, some health insurance companies that offer short-term plans still engage in the practice of post-claims underwriting. To avoid being swindled into buying one of these plans, there are some steps you can take. Before signing up with a company, examine their application and ask questions if you don’t understand it. This may not be enough, though; the best way to make sure that you are fully insured and protected is to work with an insurance agent. EZ.Insure works with some of the top rated-companies in the country, and will go through the application process with you. Our agents are honest and will make sure that you understand your policy, and that you won’t have any rugs pulled out from under you when you file a claim. We might even be able to find a health insurance plan that is not allowed to medically underwrite at a more affordable price than that of a short-term plan!
Avoid confusion and any possibility of being denied coverage in the future by working with an EZ agent. Our agents are highly-trained, honest, and work with your best interests in mind. To get free quotes on plans in your area, simply enter your zip code in the bar above. Or to speak directly to an agent, call 888-350-1890.
Buyer’s remorse- it happens to the best of us. It can even happen to you after you sign up for a health insurance plan. Now that Open Enrollment has ended and you have signed up for a plan, have you reviewed it and come to the conclusion that you don’t really like it? Maybe you felt rushed or pressured into buying a plan before Open Enrollment ended; whatever the case, know that you don’t have to stick with that plan. EZ.Insure can help you change plans if you live in one of the states that has an extended Open Enrollment. If you don’t live in one of these states, we can help find you another option.
Extended Open Enrollment Periods
The Open Enrollment Period (OEP) is from November 1 to December 15, but some states have an extended OEP. These states are:
California– Nov. 1, 2020 to Jan. 31, 2021
Colorado- Nov. 1, 2020 to Jan. 15, 2021
D.C.- Nov. 1, 2020 to Jan. 31, 2021
Massachusetts– Nov. 1, 2020 to Jan. 23, 2021
Nevada- Nov. 1, 2020 to Jan. 15, 2021
New Jersey- Nov. 1, 2020 to Jan. 31, 2021
New York– Nov. 1, 2020 to Jan. 31, 2021
During this time, one of our licensed agents can help you change plans. We will review all available plans in your area, compare quotes and coverage, and find a plan that meets all of your needs – and we won’t make you feel rushed to choose!
Special Enrollment Qualifying Events
When it comes to health insurance plans, you have two options: a private plan or a Marketplace plan. Private plans, like Marketplace plans, meet all the requirements of the ACA, such as including pre-existing conditions and providing free preventive care. Also like Marketplace plans, private health insurance plans have to be purchased during the Open Enrollment Period, unless you qualify for a Special Enrollment Period (SEP).
Getting divorced is considered a qualifying life event for a Special Enrollment Period.
To qualify for a SEP, you must experience a qualifying life event. These events include:
Getting married
Having a baby, adopting a child or placing a child up for adoption or into foster care
If your state does not offer an extended Open Enrollment Period, and you have not experienced a qualifying life event that would qualify you for a Special Enrollment Period, you still have options. For example, you can look into a short-term health insurance plan. Not only are these plans affordable, but their coverage is flexible. Short-term plans can be sold year round and can cover you for up to a year, which will provide you with at least some health insurance until the next Open Enrollment Period. Or, if you are happy with your short-term plan, you can re-apply for another short-term plan. Although these plans are not required to cover the 10 essential health benefits that ACA plans are required to, they are good options for those who are looking for convenient and affordable coverage.
If you are under 30 and qualify for a hardship exemption, then you can sign up for a catastrophic plan at any time. Hardship exemption means that due to financial hardship or other hardships, such as the death of a family member, you are unable to afford health insurance coverage. Many people are unaware that these plans are an option. These plans:
Cover all the essential benefits defined by the ACA
Have high deductibles
Cover at least 3 primary care visits per year before the deductible is met (copays can apply for these visits, but part of the cost will be paid by the insurance company, even if you haven’t met your deductible).
A fire or other natural- or human-caused disaster that results in substantial property damage
Beat Buyer’s Remorse
Purchasing a health insurance plan that you later regret is not the end of the world. You still have options. If you live in one of the states with an extended deadline, great! You can purchase a Marketplace plan or private health insurance plan through one of our agents. If you do not live somewhere that has an extended Open Enrollment Period, then consider a short-term plan or a catastrophic health plan. You do not have to stick with the plan you currently have and continue to pay monthly premiums for a plan that doesn’t meet your needs, or is too expensive.
Your best bet? Speak to an EZ agent! Our agents are highly trained in the health insurance industry and work with the top-rated companies in the nation. To see all of your options and find out how to save money, simply enter your zip code in the bar above. We will provide you with free instant quotes within minutes. Or to speak directly with an agent, call 888-350-1890.
