If you’ve ever had a health insurance plan through an employer, you know that it may cover you for certain health services and not others. You may have to pay copayments or coinsurance, and you may buy supplemental insurance, like life insurance, to fill gaps in coverage.
Although all health plans help you pay for your medical services, there are some crucial differences. And understanding those differences is an important part of knowing which plan is a good fit for you.
Take TriTerm Medical insurance, underwritten by Golden Rule Insurance Company, for example. It’s a type of short-term limited duration insurance that you can enroll in if you’re between plans or looking for an alternative to shopping on the federal Health Insurance Marketplace or your state’s exchange for an Affordable Care Act (ACA) plan.
Below, find out how TriTerm Medical plans, underwritten by Golden Rule Insurance Company, differ from ACA plans.
If you just need health insurance for a few months, consider a TriTerm Medical insurance plan. Explore your options now.
TriTerm Medical vs. ACA Marketplace plans: They have different lengths of coverage
ACA Marketplace plans normally run from January 1 through December 31. You need to review them every year, but you can often keep the same plan as long as it’s still available. Generally, if you sign up after December 15, coverage won’t start until February 1 — but some states have slightly different rules, so it’s a good idea to familiarize yourself with them. (You can also call a licensed insurance agent at 1-844-211-7730 for more information.)
TriTerm Medical plans last for nearly 3 years, which is where the name “TriTerm” comes from. In most states, that means 3 years minus 1 day, although that time span can vary depending on the state. Even though the TriTerm coverage period lasts that long, it’s still considered short term limited duration medical insurance.
TriTerm Medical vs. ACA Marketplace plans: They have different enrollment periods
With ACA plans, you must enroll in a plan during its annual Open Enrollment Period (OEP). That’s normally between November 1 and January 15, though a few states have slightly different enrollment periods.
Otherwise, the only way you can enroll at a different time of the year is if you qualify for a Special Enrollment Period (SEP). That’s when you have a significant life event, such as losing your workplace health plan or moving to a community with different health plan options.
It’s worth noting that you can enroll at any time if you earn less than 150% of the federal poverty level. For 2025, the federal poverty level is $15,650 for an individual or $32,150 for a family of 4.1 You can also enroll at any time if you’re a Native American or Alaskan Native member of a federally recognized tribe.
With TriTerm Medical plans, on the other hand, you can apply for them any time you want to. And you aren’t limited to a January 1 start date. So, for instance, if your workplace health plan ends on September 30, you could start TriTerm Medical coverage on October 1.
TriTerm Medical vs. ACA Marketplace plans: They have different networks
A provider network is the group of doctors and health care facilities "that a plan contracts with to provide medical care to its members."2 Possible network types for ACA Marketplace plans include:3
- Health maintenance organization (HMO): You can only use providers in the network to receive insurance coverage. You must also choose a primary care physician (PCP) and get a referral from your PCP if you need to see a specialist.
- Exclusive provider organization (EPO): You can only use providers in the network to receive insurance coverage, but you don’t need to choose a PCP or get specialist referrals. NOTE: Emergency treatment from a non-network provider is treated as a network eligible service.
- Point of service (POS): You can use any provider, but you may save money by using in-network providers. You may need to get referrals for specialists.
- Preferred provider organization (PPO): You can use any provider, but you’ll save money by using providers in the network. You don’t need to choose a PCP or get specialist referrals.
Generally, the more restrictive the network, the lower your monthly insurance bill (or premium) may be.
TriTerm Medical plans, on the other hand, are either EPO or PPO plans, depending on the state, so you have access to nationwide providers and medical facilities.4
In some states, you can also choose to see someone who is not in network, but you’ll pay more. Specifically, you’ll pay all charges above what is considered an eligible expense plus a penalty of 25% of the eligible expense. In some states, the non-network deductible is also double the network deductible.5 (A deductible is what you pay for medical services before your insurance pays the rest.) So you’ll have to pay twice as much out of pocket before your expenses even qualify for coverage.
And in other states, no benefits are paid at all if you go out of network, unless it's for emergency care.5
TriTerm Medical vs. ACA Marketplace plans: They have differences in covered services
If you have an ACA Marketplace plan, the government requires it to cover 10 essential health benefits, including:6
- Hospitalization
- Maternity and newborn care
- Prescription drugs
- Outpatient care
- Mental health and substance use disorder
- Preventive services, including screenings
The specifics of coverage varies by plan and by state, so comparison shopping is important.
TriTerm Medical plans, on the other hand, aren’t required to comply with ACA regulations. While there’s a lot of overlap in covered benefits, it’s important to review the medical benefits, exclusions and limitations listed in the TriTerm Medical brochure. These can vary based on your state, too.
Have more questions about the benefits TriTerm Medical plans cover? Find out more, or call a licensed agent at 1-844-211-7730 to discuss your options.
TriTerm Medical vs. ACA Marketplace plans: There are differences in underwriting and guaranteed issue
ACA plans are called “guaranteed issue” plans. That’s because, by federal law, you can’t be turned down for coverage due to preexisting conditions. They’re also required to cover those preexisting conditions. This means if you already had a chronic condition, such as diabetes, asthma or cancer before your coverage started, the plan must cover care for that condition in the future.
With TriTerm Medical, your application goes through medical underwriting. That’s a process that involves a review of your medical history before it can be approved. These plans can deny you coverage based on the results of your medical underwriting. Preexisting conditions also aren’t covered until you’ve been on a plan for 12 months. (Some states have different exclusion periods.)
TriTerm Medical vs. ACA Marketplace plans: There are differences in financial assistance
Depending on your household income, you may qualify for premium tax credits to help lower what you pay monthly for your insurance when you buy an ACA Marketplace plan. You may also qualify for cost-sharing reductions, including a lower deductible, lower out-of-pocket maximums, and lower copays and coinsurance.
You’ll want to be aware that TriTerm Medical plans are not eligible for any financial assistance. But if you don’t qualify for ACA premium tax credits and other cost-sharing reductions, a TriTerm Medical plan may be an option.
To check if TriTerm Medical is available in your state, enter your zip code, or call a licensed agent at 1-844-211-7730.
Disclaimer
TriTerm short term limited duration coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.
Sources:
1. HealthCare.gov. “Federal Poverty Level.” Retrieved from https://www.healthcare.gov/glossary/federal-poverty-level-fpl/ Accessed September 8, 2025
2. CMS.gov. “What You Should Know About Provider Networks.” Retrieved from https://www.cms.gov/marketplace/outreach-and-education/what-you-should-know-provider-networks.pdf Accessed September 9, 2025
3. HealthCare.gov. “Health Insurance Plan & Network Types: HMOs, PPOs, and More.” Retrieved from https://www.healthcare.gov/choose-a-plan/plan-types/ Accessed September 8, 2025
4. UnitedHealthcare. “TriTerm Medical Insurance.” Retrieved from https://www.uhone.com/health-insurance/triterm-medical-insurance Accessed July 27, 2023
5. UnitedHealthcare. “TriTerm Medical Plans.” (For states GA, KY, NC, OK, UT). Retrieved from https://www.uhone.com/api/supplysystem/?FileName=45712P-G202012.pdf Accessed September 9, 2025
6. HealthCare.gov. “What Marketplace Health Insurance Plans Cover.” Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ Accessed September 9, 2025
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