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Maybe you’ve just turned 26 and totally spaced out on picking up health insurance after you were dropped from your parents’ plan. Or you’ve retired early and need something for a few years before Medicare kicks in. Or maybe you’ve recently become self-employed but aren’t sure whether you’ll eventually return to the corporate world (and its group health insurance).
If any of these scenarios sound like you, then you may have a good health insurance choice: TriTerm Medical insurance, underwritten by Golden Rule Insurance Company. This is a form of short-term medical insurance that can last nearly up to 36 months, says Jeff Baechle, vice president of Individual Market Product Strategy at UnitedHealthOne. But it’s not necessarily for everyone. Here’s a look at some of the pros and cons.
TriTerm Medical pro: You have a variety of benefits
TriTerm Medical insurance tends to offer more benefits than most other forms of short-term health insurance, says Baechle. These benefits can include:
Some pre-existing condition coverage. After you’ve been on the plan for a year, eligible services related to some preexisting conditions may be covered.
Prescription medication benefits. There’s a $5,000 covered expense maximum benefit per person, per term for outpatient prescriptions on most plans. Some plans also have tiered pricing, which lets you get many common Tier 1 prescription medications for a simple $25 copay, with no deductible.
Preventive care. After a six-month waiting period, most TriTerm Medical plans include a $200 benefit per person, per term for preventive care wellness checks.
Covered doctor office visits. While it depends on the plan, generally you can expect a copay of $50 for your first four doctor visits per person each term with no deductible.
TriTerm Medical pro: You’ll have access to a network with a wide variety of doctors and hospitals
TriTerm Medical plans offer access to nearly 1.4 million doctors and other healthcare professionals and more than 6,500 hospitals and other medical facilities in the U.S.
“TriTerm has a broad network,” says Baechle. “It may provide access to up to 80% of all doctors and hospitals in a given area.” Chances are that if you have TriTerm Medical, there will be an in-network option for care in your town — and it may even be your current doctor.
TriTerm Medical pro: You can enroll anytime
A TriTerm Medical plan is available year-round, and your coverage can begin as early as five days after your application is received. You’ll have a variety of plans and deductible choices to choose from to help meet your specific budget and needs. Deductibles start from $2,500 to $5,000, depending on the plan.
Say you rarely go to the doctor. You may want to opt for the Value Direct plan, which keeps monthly costs lower by eliminating preventive care and prescription coverage benefits. But if you have specialists that you see frequently, you’ll want a plan such as Copay Select Max or Direct, where you pay a $50 copay for the first four doctor visits (per person, per term) and $25 for some Tier 1 prescription medications without having to meet the medical deductible first.
You can also start using benefits right away, although you’ll need to wait six months for preventive care. Each covered person has up to a $1 million or $2 million lifetime maximum benefit on all plans.
TriTerm Medical pro: It’s budget-friendly
“If your modified adjusted household income is more than $150,000 for a family of four, then you may not qualify for tax credits on the marketplace,” says Baechle. In these cases, he notes, it may be better for your wallet if you go with a TriTerm Medical plan. You should always check an Affordable Care Act (ACA) plan first to see if your situation qualifies you for premium tax credits. If you don't, a TriTerm Medical plan may be a good second option for your wallet.
That said, it’s important to know that premiums increase in the second and third terms, says Baechle. The rates could go up 16% to 25%.
TriTerm Medical con: You need to go through medical underwriting
Anyone between the ages of 19 and 63 can apply for a TriTerm Medical plan. (Coverage ends when you turn 65 and become eligible for Medicare.) But there’s no guarantee you’ll be accepted for a plan. TriTerm Medical requires medical underwriting, a process insurance companies use to try to figure out your health status. Be sure to check any plan you're interested in for its exclusions, limitations and plan provisions before you buy.
“This makes TriTerm a better option for someone who’s younger, in good health, and doesn’t anticipate having to get medical care frequently,” explains Baechle. But if you have a complex medical condition, it’s possible your application won’t be accepted. TriTerm Medical plans don’t have to guarantee coverage for preexisting conditions. One other important note: Pregnancy generally isn’t covered, says Baechle, though certain complications (such as an emergency C-section) may be.
TriTerm Medical con: It’s not available in all states
While TriTerm can be a good option for some people, it doesn’t last forever. Under federal regulations, a short-term health insurance plan’s initial term must be less than 12 months, and the plan cannot be extended beyond 36 months. “That’s why TriTerm medical plans are three terms that add up to one day less than three years,” says Baechle.
The TriTerm Medical coverage term is one day less than 3 years. In SC, plans are three 11-month terms. In IN and OK, plans are three 364-day terms. This 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.
This policy has exclusions, limitations, reduction of benefits, and 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.