Short Term Health Insurance
A bridge during times of transition
What Is Short Term Health Insurance?
Today's families face new challenges when it comes to healthcare. We used to take for granted that most people would have traditional, long-term healthcare insurance. That's not so true anymore. If you're between jobs, recently graduated, divorced, or retired, or missed open enrollment, you could benefit from a supplemental healthcare plan that bridges any gaps you have in coverage. It's called short term health insurance. You may also have heard it referred to as gap health insurance, term health insurance, or temporary health insurance.
At Adroit Health Group, we're committed to providing flexible healthcare solutions. And, short term health insurance is one of our most valuable products for today's unique families.
It provides healthcare coverage for a limited period, typically up to 90 days. It can help you avoid any major medical costs during that period while protecting your family's health. Here's what you should know about short term health insurance, who could benefit from it, and how it works.
Note: It's important to understand that short term health insurance is not considered minimum essential coverage under the ACA and, because of this, is not ACA-compliant. Instead, it's a bridge to help you cover out-of-pocket costs during times of transition. If you purchase a short term plan, and no other ACA-compliant healthcare for the majority of a year, you may be subject to tax penalties.
Who Qualifies For Short Term Health Insurance?
Short term health insurance makes sense for people who have limited or no healthcare coverage, and only need coverage for a temporary period of time.
This may include people who are:
- In-between jobs, or recently laid-off
- Waiting to begin benefits at a new job
- Waiting for their ACA coverage to begin
- Losing coverage following a divorce
- Recently retired
- Recently graduated from college
- Under 65 and waiting for Medicare benefits
- Leaving their parent's healthcare insurance
- Without health insurance due to missing Open Enrollment with the ACA
- Priced out of ACA plans in their state
- Whose income is too high for Medicaid, but below the minimum threshold for ACA subsidies
- In an area where the ACA plans don't provide network coverage for their providers
If you don't have healthcare coverage, a short term health insurance plan can provide the security and peace of mind you need during your time of transition. They're not for everyone, but for some people, they can be a life changer.
Who does not qualify for short term health insurance?
Generally, short term health insurance does not cover people with pre-existing conditions. Because of this, short term health insurance plans are not the best option for those with chronic conditions or in otherwise poor health.
If you are declined a plan, and temporary insurance is your only option, some areas do offer "guaranteed issue." These are short terms plans with increased premium rates that allow for coverage of different conditions.
Short term health insurance may also not provide coverage for the Essential Health Benefits that are covered under all ACA plans. These Essential Health Benefits include:
- Doctor visits for illness and injury and other outpatient visits
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse disorder services
- Prescription drug coverage
- Rehabilitative and habilitative services and devices
- Laboratory tests and services
- Preventative and wellness care
- Pediatric services (including oral and vision care)
While many gap insurance plans do cover many of these areas, it's not guaranteed. Make sure you know exactly what your plan covers and what it doesn't.
If you suffer from mental health conditions, are planning to become pregnant, or have other pre-existing conditions, a short term health insurance plan may not be your best option.
How Does Short Term Health Insurance Work?
New rules may change the coverage period, but for now, gap insurance typically covers you for up to 90 days. You can apply as a single person or get coverage for your whole family.
These plans do not auto-enroll you. If you need to extend your coverage, you'll have to apply again at the end of your current term. Anything you've paid towards your deductible will reset.
Another thing to note is that you do have to apply for this insurance. And, you may not be eligible if you have certain pre-existing conditions.
Otherwise, short term health insurance works like major medical coverage, just on a temporary basis. For example, these plans pay for covered expenses when you meet your deductible. They'll typically cover some portion of preventative care, emergency care, and prescription costs. They usually have out-of-pocket maximums. You'll likely have a copay for doctor visits. Some have coinsurance costs. Many plans allow you to visit whichever doctors you like, while others have out-of-network rules.
Benefits of short term health insurance
Temporary health insurance plans are not major medical coverage, but they have unique benefits for many people.
Benefits of short term health insurance include:
- Healthcare coverage, when you need it most: Whether you recently lost your job, graduated from college, retired, or divorced, short term healthcare coverage provides the peace of mind you need during life's transitions
- More affordable for some: Since it's a limited solution, gap insurance can be much more cost effective than traditional healthcare coverage, at sometimes the tenth of the price of ACA plans
- Immediate coverage (once approved): For many, you can begin to use plan benefits as early as the next day after you apply
- No enrollment period: Unlike ACA plans, you can usually apply for short term health insurance plans at any time during the year
- Avoid out-of-network issues: Many short term health insurance plans allow you to visit any qualified healthcare provider you choose
- Drop coverage whenever you need to: If you get coverage through a new job or have any other life change, you can typically stop your short term healthcare coverage immediately
If you want to learn more about the benefits of temporary insurance, give us a call at 1 (800) 269-3563 or send us an email. The Adroit Health Group customer service team is here to help you make sense of your short term health insurance options.
Short term health insurance vs. ACA plans
It's difficult to compare short term health insurance to ACA plans because who needs them and when is so different. At a minimum, here are the major differences you should know.
|Short term Healthcare||ACA Plans|
|Guaranteed acceptance into the plan?||No, you must be approved for coverage||Yes|
|Is there coverage for preexisting conditions?||No||Yes|
|Provides coverage for all ten Essential Health Benefits (including mental health services, pregnancy, and more)?||Generally no, but some plans may have limited coverage||Yes, to be ACA-compliant plans must cover ten Essential Health Benefits|
|Includes preventative care?||If included, limited||Yes|
|Prescription drug coverage?||Included in some plans||Yes|
|Network rules?||Typically, you have full access to qualified healthcare providers||Depends on your network|
|What are the monthly costs||Often lower than ACA plans, but you may be subject to a tax penalty||Generally more expensive, but you may be eligible for tax subsidies|
|Availability of coverage?||Can be immediate||Only during Open Enrollment|
Do I Need To Get Short Term Health Insurance?
It could be time to start looking into temporary health insurance if you:
- Have recently lost your healthcare coverage
- Are generally healthy
- Missed Open Enrollment for an ACA plan
- Are priced out of ACA plans
- Only need healthcare coverage for a short period of time
Thankfully, you can apply for short term health insurance plans and begin coverage as soon as the very next day.
How to lower costs
When you apply for coverage, you'll see the amount you have to pay each month. This is called your premium. If costs are a concern, there are some choices you can make to lower your premium costs.
For example, you can:
- Pay your total premium up-front, for some plans
- Choose a higher deductible rate
- Choose a plan with only the benefits you need (such as prescription drug coverage, copays, or network coverage)
Do remember, though, that these plans are not ACA-compliant. That means you may have to pay penalties on your taxes if you have no other major medical coverage during the year. In 2017, that penalty was 2.5% of your yearly household income or $695 per adult (whichever is higher).
However, you can possibly get an exemption to the ACA tax penalty if you:
- Go without ACA-compliant coverage for three months or less during the year
- Don't file taxes because your income is below the tax filing threshold
- Only had access to ACA-compliant coverage that cost you more than 8% of your household income
These rules are always-changing and complicated, so talk to a tax professional for more information.
How we’re different at Adroit Health Group
At Adroit Health Group, we're committed to making healthcare a little bit easier for today's families. Our plans are customizable. You'll be able to pick the levels of coverage, out-of-pocket maximums, and deductibles that work for your family's budget and needs.
You save money. We provide peace of mind if the unexpected happens.
We also have individual and family healthcare options in over 40 states. Our short term health insurance plans are underwritten by Companion Life Insurance Company, which has an A+ (Superior) rating for overall financial strength and ability to meet contractual obligations with A.M. Best. Our plans generally cover hospitalization and professional health services after you've met your deductible.
The information on this page is only the beginning of how we can help with your temporary health insurance needs at Adroit Health Group. Your costs and benefits will depend on what coverage you decide on and your family's health history.
If you have questions, give us a call at 1 (800) 269-3563 or send us an email. Our customer service team is always here to help you make sense of your short term healthcare options.