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Maybe you just quit your job and lost your employer-sponsored health insurance benefits. Or you’re self-employed and need coverage. Or perhaps you turned 26, can no longer be on your parents’ health insurance, and need a quick fix.
Whatever your circumstances, UnitedHealthcare branded TriTerm Medical insurance, underwritten by Golden Rule Insurance Company, could be a solution to your health insurance needs.
Learn what TriTerm Medical plans cover, who can benefit from them, and what to ask before you enroll.
TriTerm Medical insurance is a short-term limited duration insurance plan, sometimes called a temporary health plan. But unlike other short-term plans, TriTerm Medical insurance lasts 3 consecutive terms. It’s available in 18 states, including Arizona, Florida, Georgia, and Texas.
In most of those states, that means it lasts 3 years minus 1 day. In South Carolina, TriTerm Medical has 3 11-month terms. In Indiana and Oklahoma, it has 3 364-day terms.
How do TriTerm Medical plans compare to other short-term medical plans?
TriTerm Medical insurance is generally the same as other short-term medical plans. But you don’t have to reapply or answer any health questions for the second or third term. That saves time and can mean less hassle for you.
“Every time you start a short-term medical plan, you have to pass the medical underwriting questions again,” says Kyle Henson, owner of Nomad Insurance in Livingston, Texas. “With TriTerm you have continuity of coverage, which would be crucial if you were mid-claim when a short-term medical term ended.”
Another big difference: TriTerm Medical covers preexisting conditions after the first term. “In the second and third year of the plan, that policy will have no preexisting-condition exclusions,” says Dave Trout, managing agent for Trout Insurance in Weaverville, North Carolina.
How do TriTerm Medical plans differ from Affordable Care Act plans?
Individual plans you purchase through the federal marketplace or your state insurance exchange must follow the rules of the Affordable Care Act (ACA). Simply put, TriTerm Medical plans and other short-term plans don’t have to. It’s important to understand some key differences so you know what you are buying.
Here are 3 key differences between TriTerm Medical and ACA coverage:
What’s covered: ACA plans must cover 10 essential health benefits, including outpatient care, emergency services, prescription medications, and preventive and wellness services. TriTerm Medical plans focus more on helping you pay for major medical expenses. Other services are included, though. Most TriTerm Medical plans include coverage for outpatient prescriptions, and, after a 6-month waiting period, some plans include limited coverage for preventive care.
When you can enroll: You can apply for an ACA plan only during the Open Enrollment Period (OEP), which is generally November 1 through January 15. The exception is if you qualify for a Special Enrollment Period or SEP because you experience a qualifying life event such as:
Losing your job
Getting divorced or legally separated
Having a baby or adopting a child
Someone on your health insurance policy dies
Moving to a different state
Turning 26 (and being removed from your parents’ insurance)
Becoming a U.S. citizen
With a TriTerm Medical insurance plan, you can apply at any time, and your coverage will begin as early as 5 days after you are approved.
Can you be denied coverage? You can’t be turned down or charged more for an ACA plan because of your health status. So, if you have a preexisting condition such as cancer, health insurance companies on the federal marketplace cannot deny you coverage.
That’s not the case with TriTerm Medical insurance and other short-term plans. These plans require you to go through medical underwriting. That’s when your insurance provider can check your medical records. They can deny coverage if you have a preexisting condition. Your monthly premium is based on several factors, including your age and whether you smoke.
How are TriTerm Medical plans similar to other health plans?
Even though they last just 3 terms, TriTerm Medical insurance has a lot in common with conventional health insurance.
“TriTerm plans are similar in their benefits as well as their user experience to traditional health insurance,” says Henson. “These plans have typical health insurance structures consisting of a deductible, coinsurance, copays, and out-of-pocket limits.”
Here’s what benefits might look like for someone with a TriTerm Medical Copay Select Max plan:
Deductible (per person, per term; max of 2 per family): $2,500, $5,000, $7,500, $10,000, or $12,500
Coinsurance (% you pay after your deductible, per term): 30%
Coinsurance out-of-pocket max (per person, per term): $4,500
Maximum benefit (per person, lifetime): $2 million
Maximum outpatient prescription covered expense (per person, per term): $5,000
Doctor’s office visit for illness or injury (per person, per term): $50 for first 4 visits
Outpatient prescription medications:
Tier 1: $25 copay, no deductible
Tiers 2-4: $500 deductible per person, per term, then:
Tier 2: $55 copay
Tier 3: $75 copay
Tier 4: 50% coinsurance
Whether or not you decide on TriTerm Medical insurance, it’s always good to review the plan’s brochure for your state to learn more about it.
Why do TriTerm Medical plans list multiple deductibles?
You can choose your deductible based on how much you’re comfortable paying out of pocket. The higher the deductible, the lower the monthly premium.
Which TriTerm Medical plan is right for you?
TriTerm Medical plans come in 4 levels: Value, Plan 100 Max, Plan 80 Max, and Copay Select Max. What’s right for you will depend on how much you use your health coverage
Value: If you rarely seek medical care, you can save on monthly premium costs by choosing a higher deductible and higher coinsurance amount. Value plans, where available, keep monthly costs lower by eliminating benefits for preventive care and outpatient prescription medication coverage.
Plan 100 Max and Plan 80 Max: If you see your doctor once a year, you might choose the simplicity of Plan 100 Direct. This covers most eligible medical costs at 100% after you’ve met your deductible. Plan 80 Direct covers most eligible medical costs at 80% after you’ve met your deductible.
Copay Select Max: If you regularly see doctors and take prescription medications, you might consider a Copay Select plan. Under these plans, there’s a copay for doctor visits and some prescription medications without having to first meet your medical deductible.
Does TriTerm Medical insurance cover dental and vision services?
Unfortunately, no. If you want coverage for services such as annual cleanings and vision tests, you’ll need to purchase a supplemental dental or vision plan.
For TriTerm Medical insurance, what does medical underwriting involve?
A TriTerm Medical insurance plan isn’t guaranteed issue. That means you must answer medical questions when you’re applying, and you may be turned down for coverage.
“Medical underwriting is a yes/no questionnaire,” says Henson. “There are no physicals or other tests to speak of.”
Says Trout: “With a TriTerm care plan, the underwriting can be fairly specific. They can and do ask more health questions. They ask height, they ask weight, they ask tobacco status.”
Depending on your answers, underwriters will approve your application, deny it, or possibly approve it with exclusions.
Trout emphasizes the importance of answering underwriting questions honestly. If you don’t tell the truth about your medical history and something happens, it could result in denial of coverage or a claim. And that could wind up being a very costly mistake.
What doctors do you have access to on a TriTerm Medical plan?
You have access to a UnitedHealthcare national network with 1.5 million doctors and healthcare professionals and more than 7,000 hospitals and medical facilities. In some states, you can also use out-of-network providers, but you’ll have to pay the provider’s charge plus a 25% penalty and pay an additional deductible.
“The main reason I offer these plans is for the nationwide access to medical providers it allows,” says Henson. “Most ACA plans have very strict HMO networks that only cover a member locally or regionally. My clients are frequent travelers and therefore need a plan with better provider access.”
Still, that doesn’t mean your doctor will be in network for TriTerm Medical insurance. It’s always good to check with your providers to make sure they accept whatever insurance plan you purchase.
Who can benefit from a TriTerm Medical plan?
While everyone’s situation is different, TriTerm Medical plans can be appropriate for someone who’s facing a period of time where they won’t have health coverage for a year or more.
For example, you might be a young adult who’ll be off your parent’s health plan when you turn 26. Or maybe you’re 62 and decided to retire early and you aren’t yet eligible for Medicare. Anyone from ages 19 through 63 can apply for TriTerm Medical insurance. Coverage ends if you turn 65 and qualify for Medicare.
Trout says the ideal TriTerm Medical customer is someone who can handle potentially big out-of-pocket costs before their coverage kicks in. “In other words, financially they have stronger risk tolerance,” he says.
Who might not benefit from a TriTerm Medical plan?
TriTerm Medical insurance isn’t for everybody. “If a client has moderate to significant preexisting or current medical conditions, then a TriTerm plan isn’t likely to be a good fit,” says Henson. “Also, if someone qualifies for a significant federal subsidy, then an ACA plan might be more appropriate.”
Federal subsidies, or forms of government assistance, can help you with the cost of an ACA plan. Historically, those subsidies have been available for people at or below 400% of the federal poverty line (FPL). (For 2022, the FPL is $13,590 for an individual and $27,750 for a family of four.) However, the American Rescue Plan, enacted during the COVID-19 pandemic, lifted that cap for 2021 and 2022, making more people eligible for subsidies.
Trout says that wider availability of subsidies has made TriTerm Medical plans less competitive in price. That situation may change if subsidy caps return.
Where can you learn more about TriTerm Medical?
Henson suggests studying the documents that come with TriTerm Medical insurance before signing up for a plan. “I would recommend reading the policy itself, particularly the limits and exclusions, so you know what will not be covered and you know what the caps on benefits are, both annually and over the lifetime of a plan,” he says.
You can also learn more about TriTerm Medical insurance by visiting this webpage or talking with a licensed insurance agent at 1-800-273-8115.
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]. The article is provided as general information only.