#ShortTerm #Health #Insurance #Rules #Circle #Friday #Calendar
| Short-term health insurance | ACA Market Insurance |
|---|---|
| Can deny you coverage, charge you more, or refuse to pay for certain care if you have a pre-existing health condition | It is not possible to discriminate based on pre-existing conditions |
| It may not cover things like prescription medications, preventive exams, maternity care, emergency services, hospitalization, lab work, child care, and physical therapy. | It covers all those benefits that are considered essential health benefits, and more |
| There may be no limit on what you pay out of pocket for care, or a lifetime limit instead of an annual limit | Must contain an annual limit on outside expenses; In 2025, it cannot exceed $9,200 for an individual or $18,400 for a family. |
| Not eligible for federal subsidies to pay premiums and out-of-pocket costs | Most enrollees are eligible for federal financial aid |
| You may have waiting periods before you are eligible for coverage for eye surgery or procedures to treat conditions such as kidney disease, allergies and skin diseases | There can be no waiting periods |
What to do if you are on a short-term plan now
If you purchase a short-term health insurance policy before August 31, 2024, your plan’s initial term can last up to 364 days (depending on your plan and situation). You will still have the option to renew for a total term of up to 36 months.
But if you know your plan will expire in 2025, the easiest way to avoid going without coverage is to use Marketplace plan open enrollment by December 15. This is the last day to enroll in the plan starting January 1, 2025. Then cancel your short-term plan on December 31.
Note
A Catastrophic Marketplace plan may be more similar to a short-term plan but is only available to those under 30 or with specified hardship or affordability exemptions.
Due to the new rules, if your bundled plan or a plan you purchased after August 31, 2024 expires in 2025, you may face a difficult situation getting coverage before the next open enrollment period begins in November 2025. To qualify for a Special Enrollment Period in the Marketplace (SEP), you must Missing health coverage is considered “minimum essential coverage.” Unlike workplace, Marketplace, and Medicaid plans, short-term plans do not fall within this definition.
Your only option will be to sign up for a short-term plan offered by a different insurance company, not affiliated with your current plan. After this plan expires, if you still need coverage, you can purchase another new plan. This strategy may require one or more new carriers, so you’ll need to find out if other short-term insurance companies are available in your area.
Some multi-year renewable plans (now disallowed) provided coverage for pre-existing conditions after the first year. However, when you switch to a new carrier, a pre-existing condition may leave you without insurance if the carrier denies coverage or claims.
“If someone loses coverage but can’t get into the marketplace, they may have no choice but to go without it,” said Joshua Brooker, a member of the National Association of Benefits and Insurance Professionals (NABIP).
“If they are an employer, they may be able to set up a group benefits plan for their company, but there are limits to that as well.”
What to do if you need short-term coverage
now
If you need coverage now, you may want to purchase a short-term plan to cover you through the end of the year, but you can also take advantage of open enrollment for an ACA plan for however long you need after that. You have from November 1 to December 15 to purchase an ACA plan that will begin on January 1.
You can purchase short-term health insurance at any time. As in the past, you do not need to wait for an open enrollment period for short-term insurance. The plan may take effect the day after the insurance company receives your application. You can also cancel your plan at any time.
After January 15, 2025
If you find yourself needing short-term coverage after January 15, your options are different. Let’s say you lost your job and your employer health coverage in February 2025. In the past, a 10-month short-term health insurance plan provided coverage until the next ACA open enrollment period.
But with the new rules, the plan you buy in February can only last four months, meaning it will expire in June. If you want ACA coverage after that, you’ll need to wait until the next open enrollment period on November 1, with coverage not starting until January 1, 2026.
In this case, it may be better to skip short-term health insurance coverage after you lose your employer coverage and opt for the ACA’s enrollment period, which would allow you to enroll because of losing your job, which is considered a qualifying event. You can also cancel your ACA coverage at any time.
If your employer’s COBRA plan is available and affordable, it may cover you while you wait for your new coverage to start.
The future of health insurance is short-term
Rules regarding short-term health insurance have oscillated between administrations in recent years. Under President Trump, plans were allowed to be sold for initial terms of 12 months, with renewals that could extend coverage for a total of 36 months.
The Biden administration introduced the latest STHI rules in March, which went into effect in September. Depending on who sits in the White House in 2025, these rules may change again.
#ShortTerm #Health #Insurance #Rules #Circle #Friday #Calendar
