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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 Limited Duration Insurance like short-term medical plans can help you fill a gap in coverage and help with medical costs.
Learn more about what short-term medical plans offer and why you might need one. (Note: Short term limited duration insurance plans discussed here are UnitedHealthcare-branded Short Term Medical plans underwritten by Golden Rule Insurance Company.)
Interested in exploring a Short-Term Medical plan? Call a licensed insurance agent at 1-800-273-8115 or explore uhone.com for more information.
What is short-term medical insurance?
A short-term medical insurance plan provides you with health coverage for a limited amount of time when you don’t have health insurance, Medicare or Medicaid coverage. Short-term medical might be right for you if you’re:
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 medical plan helps you with coverage for a limited time.
How long does short-term insurance last?
If you were to purchase a short-term medical plan, you would be able to choose anywhere from a month of coverage to just under 12 months of coverage, depending on your state.
What happens to your short-term medical insurance if you get insurance through a job?
Some good news: You can cancel your short-term medical insurance plan at any time and your coverage will end the last day through which you paid your premium.
What kinds of short-term medical insurance plans are available?
It depends on the carrier. The types of UnitedHealthcare Short Term Medical insurance plans from Golden Rule Ins. Co. available to you (or if they are available at all) depending on where you live. 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
Hospital & Surgical, which offers hospital, surgical, and limited urgent care benefits only and includes a prescription discount card
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, a prescription discount card, and a discount for lump sum payment
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 the higher monthly premiums but lower out-of-pocket costs. Consider many factors when deciding on the best plan for you, including your tolerance for risk and how much you’re able to pay out of pocket.
How does short-term medical insurance compare to Affordable Care Act (ACA) plans?
Short-term 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 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)
Hospitalization (like surgery and overnight stays)
Pregnancy, maternity, and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment (plus counseling and psychotherapy)
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)
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 turned down for coverage because of a preexisting condition like cancer or type 2 diabetes.
Short-term medical plans, on the other hand, aren’t required to comply with the same rules as ACA plans and thus have more limitations. Short-term medical 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 medical plan. 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, your next best option may be short-term medical.
If you get short-term medical insurance, what does medical underwriting involve?
To be eligible for short-term medical 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 medical insurance, you’ll fill out a medical questionnaire.
What does a short-term medical plan cover?
What a short-term medical plan covers depends on the plan you purchase and the state you live in. Most short-term medical 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
With each plan, you are responsible for paying a deductible, which is the amount you pay for covered expenses before insurance pays anything. 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 plan covers, and you already have a specific plan from your carrier, check the brochure 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 medical insurance cover preventive care?
Most UnitedHealthcare-branded Short Term Medical insurance plans from Golden Rule Ins. Co. cover certain limited types of preventive care, subject to limitations and exclusions in the policy. These include:
Your state may require additional coverage.
Does short-term medical insurance cover preexisting conditions?
Since short-term medical 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 medical insurance cover virtual doctor visits?
Many UnitedHealthcare-branded Short Term Medical insurance plans from Golden Rule Ins. Co. cover virtual doctor visits in a couple ways:
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).
You could add the optional Virtual Care Benefit offered for an additional premium. This benefit gives you access to 24/7 video doctor visits for quick care for things like a cold, the flu, a sinus infection and more.
Does short-term medical insurance cover dental and vision?
Generally, short-term medical 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 medical insurance cover prescription drugs?
Most short-term medical plans cover certain prescription drugs, while others offer you a prescription discount card. 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.
What kind of provider network does short-term medical insurance offer?
UnitedHealthcare through Golden Rule Ins. Co. provides access to care available at negotiated reduced rates through national networks that have 1.5 million doctors and healthcare professionals and more than 7,000 hospitals and medical facilities. That means the doctors you saw under your old employer-sponsored health insurance plan may be in network.
Does short-term medical insurance cover only in-network providers?
In some states, non-network providers are not covered except in emergencies while in others non-network benefits are reduced.
Another convenient aspect of short-term medical insurance: You don’t have to get a referral to see an in-network specialist.
With short-term medical insurance, what happens if you see an out-of-network provider?
Since short-term medical 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 medical 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 how much you’re comfortable paying out of your own pocket.
How do copayments and coinsurance work when you have short-term medical 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 20% of 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 medical insurance plans cap your healthcare costs?
Each short-term medical 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, a UnitedHealthcare Hospital SafeGuard plan from Golden Rule Ins. Co. (available in most states) can pay you 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 medical plan?
You must be between 19-64 to purchase a short-term medical plan. Your coverage will end at the end of the premium period on or after your 65th birthday.
What will your short-term medical plan cost?
Your monthly premium will depend on the short-term medical plan and deductible you choose, as well as your age, gender, tobacco use and other factors.
UnitedHealthcare TriTerm Medical insurance from Golden Rule Ins. Co. is a form of short-term medical insurance that’s available only in some states and lasts for 3 consecutive terms — 3 years minus 1 day in most of those states.
TriTerm Medical is offered in 18 states, including Florida, Georgia, and Texas. For TriTerm Medical buyers in South Carolina, there are three 11-month terms, while in Indiana and Oklahoma, TriTerm Medical has three 364-day terms.
When it comes to TriTerm Medical, you don’t have to reapply for the second and third terms, and while preexisting conditions exclusions apply during the first term, eligible preexisting conditions are covered starting in the second term.
TriTerm Medical coverage can make sense if you know your gap in health insurance is going to last longer than a year. Here are a few types of people who might benefit from a TriTerm Medical policy:
A 26-year-old college graduate who can no longer stay on their parents’ health plan but doesn’t yet have a job with employer-sponsored benefits
A 35-year-old man who’s experimenting with the freelance lifestyle but may return to the workforce within, say, the next 3 to 5 years
A 60-year-old woman who retired early but isn’t yet eligible for Medicare
Questions? You can call a licensed insurance agent at 1-800-273-8115 or visit this page for more information.
When can you apply for short-term medical coverage?
If you’ve made up your mind to apply for either a standard one-term Short Term Medical or TriTerm Medical insurance plan, know that you can apply any day of the year, and the coverage may begin quickly — possibly the next day for a Short Term Medical plan, and as soon as 5 days in some cases for TriTerm Medical. 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.
Where can you learn more about Short Term Medical insurance and apply?
You should review the Short Term Medical 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 1-800-273-8115.
Product design and availability varies by state.
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 whichever is applicable.