- What is short term health insurance?
- How long does short term health insurance last?
- What kinds of short term health insurance plans are available?
- What does a short term health insurance plan cover?
- What kind of provider network does short term health insurance offer?
- What will your short term health insurance plan cost?
- When can you apply for short term health insurance coverage?
- Where can you learn more about short term health insurance and apply?
If you recently quit, lost your job, or decided to become your own boss, you might be between health insurance plans. If you no longer have health insurance, you may need to explore your options for other coverage.
No matter what your situation, not having health coverage can be risky. You may face costly medical expenses if you were to get sick and didn’t have health care coverage.
That’s where short term insurance plans can help you fill a gap between major medical insurance policies and help with medical costs.
Learn more about what short term health insurance plans offer and why you might need one.
Ready to explore short term health insurance plans near you? Shop now.
A short term health insurance plan provides you with health coverage for a limited amount of time when you have a gap between major health insurance policies, Medicare or Medicaid coverage. Short term health insurance might be a fit for you if you’re:
- Between jobs
- Self-employed and looking for a new plan
- Needing coverage because you missed the Open Enrollment Period (OEP) for Affordable Care Act (ACA) plans or aren’t eligible for an ACA Special Enrollment Period
- Starting a new job but waiting for your benefits to kick in
- Not able to qualify for Medicare or Medicaid
In other words, a short term health insurance plan helps you with coverage for a limited time.
If you were to buy a short term health plan, coverage periods vary by plan and state.
It depends on the insurance company. In many areas, you can choose from the following types of plans:
- Copay, which offers a set number of copay doctor visits, copay urgent care visits, and copay for some common prescriptions
- Plus, where your plan pays for most and you pay for some of your covered costs after your deductible
- Plus Elite, where your plan pays for covered costs after you meet your deductible and has unlimited copay urgent care visits and a copay for some common prescriptions
- Value, which offers copay urgent care visits, limited prescription coverage, and lower rates on care through the UnitedHealthcare network
- Value Direct, which offers targeted benefits for a lower cost and a prescription discount card
Choosing a type of plan often means choosing the level of monthly costs versus benefits you are comfortable with. For example, the Value plans have lower monthly premiums and higher out-of-pocket costs, while the Copay plans have higher monthly premiums but lower out-of-pocket costs. Consider many factors when deciding on the best plan for you, including how much risk you can afford to take on and how much you’re able to pay out of pocket.
How does short term health insurance compare to Affordable Care Act (ACA) plans?
Short term health insurance plans don’t meet the minimum essential coverage (MEC) standards of the ACA. They are limited duration plans designed solely to provide temporary health insurance.
If you choose an ACA plan, which depending on your state you’d get through the federal Health Insurance Marketplace or your state’s exchange, you’d have access to 10 essential health benefits. These include:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity care, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (plus counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help you gain or recover mental and physical skills if you have an injury, disability, or chronic condition)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (adult dental and vision coverage aren’t considered “essential” health benefits)
With an ACA plan, there are no lifetime or annual dollar limits on most health benefits, and you can’t be denied coverage because of a preexisting condition like cancer or type 2 diabetes.
Short term health insurance plans, on the other hand, aren’t required to comply with the same rules as ACA plans and thus have more limitations. Short term health insurance isn’t guaranteed issue, which means you have to go through medical underwriting (see next section for more details) to qualify for it. That’s not to say you won’t have access to some of the same services covered by ACA plans under a short term plans. You just need to be more aware of what is and isn’t covered and know what you are applying for up front.
So, if you don’t have employer-sponsored insurance through your job or you don’t qualify for federal assistance through the ACA or for Medicare or Medicaid, a good option may be short term health insurance.
Enrollment is always open for short term health insurance and you can often get healthcare coverage as early as the next day. Find out how.
If you apply for short term health insurance, what does medical underwriting involve?
To be eligible for short term health insurance, you’ll need to go through a medical underwriting process. That means your application and medical history will be reviewed to determine whether you have any preexisting conditions as defined by your policy, like cancer or type 2 diabetes, and you may not qualify for coverage.
When you apply for short term health insurance, you’ll fill out a medical questionnaire.
What a short term health insurance plan covers depends on the plan you purchase and the state you live in. Most short term health plans cover the following, subject to limitations and exclusions in the policy:
- Doctor office visits
- Urgent care visits
- Emergency room visits
- Inpatient and outpatient hospital services
- Prescription drugs
With each plan, you are responsible for paying a deductible, which is what you pay before the insurance company starts to pay for covered services. Additionally, some covered services may require a copay or coinsurance, which is an amount of money you pay to receive health services. Certain covered expenses are also limited to a specified number of visits or a maximum dollar amount covered.
If you have questions about what a short term health plan covers, and you already have a specific plan from your carrier, check your plan documents for details. If you are shopping for short term health insurance and have questions about what plans cover, call the company for the plan you’re considering for more information.
Does short term health insurance cover preventive care?
Some plans cover certain limited types of preventive care, subject to limitations and exclusions in the policy. These include:
- Mammography
- Pap smear
- Prostate screening
Your state may require additional coverage.
Does short term health insurance cover pre-existing conditions?
Since short term health plans don’t follow the same rules as ACA plans, they don’t generally provide coverage for preexisting conditions. Depending on the plan, it may not cover certain costs if:
- You’re currently taking medicine or getting treatment for an illness, injury or condition
- You’ve had a condition, like cancer, in the past that resurfaces
- You’re already pregnant before signing up for a plan
Does short term health insurance cover virtual doctor visits?
Many short term health insurance plans cover virtual doctor visits. If your in-network doctor office offers virtual visits, you can use that service at in-network negotiated lower rates (deductible and coinsurance payments would still apply).
If your in-network doctor doesn't offer virtual visits, you may have another option: buying a non-insurance telehealth membership.
Does short term health insurance cover dental and vision?
Generally, short term health insurance covers neither dental nor vision services, but you can purchase stand-alone dental and vision coverage. Dental insurance can provide benefits for services ranging from routine cleanings to root canals, while vision insurance can cover routine eye exams and help you pay for glasses, contacts or both.
Does short term health insurance cover prescription drugs?
Most short term health plans cover certain prescription drugs, while others offer you a prescription discount card. For plans that cover prescriptions, drugs are grouped into tiers. You’ll pay more for higher-tier drugs like name-brand drugs and specialty drugs, and less for lower-tier drugs like generics. For drugs in Tiers 2-4 under short-term medical insurance, there’s a maximum covered expense per person per term.
Many plans typically use their insurance company's national networks to provide access to care available at negotiated reduced rates from health care providers and medical facilities. That means the doctors you saw under your old employer-sponsored health insurance plan may be in network.
Does short term health insurance cover only in-network providers?
In some states, non-network providers aren't covered except in emergencies while in others non-network benefits are reduced.
Another convenient aspect of short term health insurance: You don’t have to get a referral to see an in-network specialist.
With short term health insurance, what happens if you see an out-of-network provider?
Since short term health insurance doesn’t cover out-of-network providers in some states, if you end up seeing one, it could get expensive quickly. In states that provide reduced non-network benefits, for nonemergency care you receive from a non-network provider, you’ll pay:
- All charges above what is considered an eligible expense
- A penalty of 25% of the eligible expense, which doesn’t count toward your deductible
- A deductible equal to twice the network deductible
- There is no coinsurance out-of-pocket maximum
Clearly, it makes sense to stick with in-network providers.
How do deductibles work when you have short term health insurance?
Each plan includes a per-person deductible (and sometimes a family deductible), which is the amount you must pay per term before the plan starts paying. For example, if you have a $5,000 deductible, the plan will start paying after you’ve paid $5,000 out of pocket for your covered expenses. If you have a spouse or dependent on your plan, your spouse or dependent would also have to meet the deductible. There is a maximum of 2 deductibles per family. Once 2 people on the plan have met their deductibles, the deductible is considered to be met for all remaining members on the plan.
You can choose the deductible that meets your needs, from $2,500 to $15,000, depending on the plan and how much you’re comfortable paying out of your own pocket.
How do copayments and coinsurance work when you have short term health insurance?
A copayment, or copay for short, is a fixed amount you pay for a health service. For example, you might pay a $50 copay for a doctor visit or a $25 copay for a Tier 1 drug. For most services that allow for a copay option, you are not required to meet the deductible before the plan pays. You pay the copay amount, and the plan pays the remainder for the in-network covered service. However, some covered services that allow for copays may be limited to a certain number of copay visits. Subsequent visits would be subject to deductible and coinsurance. (Note that copays don’t count toward your deductible.)
Coinsurance, on the other hand, is the percentage of a provider’s negotiated charge you pay for a service after meeting your deductible. For example, you might pay 30% of the cost of an in-network covered outpatient surgery or the cost of a Tier 2 drug. The plan would pay the remainder of the covered expenses. (Before meeting your deductible, you would be responsible for 100% of these costs.)
Do short term health insurance plans cap your health care costs?
Each short term health insurance plan has a coinsurance out-of-pocket maximum, which represents the most you must pay out of pocket for coinsurance per person, per term.
If you don’t think you’d be able to cover many out-of-pocket costs, you still have some options. In addition to choosing a plan with a lower deductible, you can also purchase a supplemental policy to help offset your deductible. For example, some hospital insurance plans may pay a set amount for each day you’re in the hospital to help with costs.
Do you have to be a certain age to buy a short term health plan?
You must be between 19-64 to purchase a short term health plan. Your coverage will end at the end of the premium period on or after your 65th birthday.
Your monthly premium will depend on the short term health plan and deductible you choose, as well as your age, gender, tobacco use and other factors.
If you’ve made up your mind to apply for a short term health insurance plan, know that you can typically apply any day of the year, and the healthcare coverage may begin quickly — possibly the next day. Unlike with ACA plans, you don’t have to wait for an Open Enrollment Period or have a qualifying life event qualifying you for a Special Enrollment Period, or SEP.
You should review the short term health insurance plan brochures for any plan you are interested in applying for because those detail the plan’s benefits, exclusions and limitations, provisions, and state-specific variations. Another easy option is to call a licensed insurance agent at 1-844-211-7730.
For informational purposes only. This information is compiled by UnitedHealthcare, and/or one of its affiliates, and does not diagnose problems or recommend specific treatment. Services and medical technologies referenced herein may not be covered under your plan. Please consult directly with your primary care physician if you need medical advice. This policy has exclusions, limitations, reduction of benefits, terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company. Product design and availability varies by state.
Compliance code:
52129-G-0425
