Short-Term Medical Plans can provide coverage when you find yourself unable to enroll in an ACA compliant plan.
IMPORTANT: If you enroll in a Short Term Medical plan after April 1st 2017 the maximum length of coverage is 3 months! (most states)
What is Short Term Medical Insurance?
When you can’t enroll in a Major Medical plan, STM insurance is designed to fill short-term gaps in coverage (generally less than 11 months) . If you experience an unexpected injury or illness Short-Term Medical plans may protect you from a major financial hardship. When the ACA regulations went into effect these plans were exempt so there are big differences you need to be aware of before enrolling.
What Short Term Medical Insurance isn’t
It is not a long-term solution! Short Term Medical plans do not conform to ACA regulations. Short Term Medical plans are medically underwritten, and unhealthy people may not qualify. Pre-existing conditions are not covered and could result in denial of coverage. Most Short-Term Medical plans exclude any condition you’re diagnosed within the last 5 years and possibly UN-diagnosed. It does NOT provide essential minimum coverage according to the ACA rules and will not prevent you from having a tax penalty at the end of the year (the mandate expires in 2018). Typically services are not covered before your deductible is met. Some plans only pay a preset amount for a service and not the Usual, Customary and Reasonable charges, be aware of what your plan will pay or not pay before selecting a plan.
What is a Pre-existing Condition?
It sounds pretty straight forward, any condition that existed before your plan is effective is a pre-existing condition. For example, if you’ve been diagnosed with high blood pressure, it would be reasonably understood that any care related to blood pressure wouldn’t be covered. However, what isn’t commonly understood is anything related to the condition may not be covered under the pre-existing exclusion. For example, if the same person who has high Bp later has a heart attack it is highly likely that the heart attack may not be covered. Ultimately, the determination is made by the doctors treating you and is subject to review by the carrier. If your looking for an alternative plan that offers coverage for pre-existing conditions consider a medical sharing plan from Aliera.
Many employers have waiting periods of 90 days or more to enroll in group coverage. However, illnesses and injuries wait for no one! A Short Term Medical plan can keep you protected from unlimited and unmanageable medical expenses.
COBRA Becoming Unaffordable
Sometimes job searches can last longer than initially expected. Once you have enrolled in COBRA you cannot apply for a lower cost Individual or Family Plan unless it’s Open Enrollment. Once your COBRA expires after 18 months you will have a special enrollment period available. If you can no longer afford the COBRA payments you may have to go without coverage. Short Term Medical can help provide coverage during these times as well.
Missed Open Enrollment or Special Enrollment Period
Individual Health Medial Plans are only available during annual open enrollment, or for a 60 day period for special exceptions. Missing it means you have to wait for the next annual open enrollment. A Short Term Medical plan can bridge that gap.
Missed Initial Medicare Enrollment Period
Countless Medicare eligible people miss their Initial Enrollment Period. For many people this means going without insurance for a long as 15 months. If you are one of them a Short Term Medical Plan can help.
Note: For those over 65 please see the Petersen International (Lloyd’s of London) Bridge Plan. For those under 65 see the IHC Health Solutions or National General link.