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What is Short Term Health Insurance and What Does it Cover?
Short Term Health Insurance
A temporary health insurance plan for those in-between times
Short term health insurance (STM), also referred to as temporary health insurance, is a type of medical coverage that is available for shorter durations of time, such as up to three months. Temporary insurance plans have more restricted coverage than major medical but also can have a lower premium.
What Does Short Term Health Insurance Cover?
Covered expenses for temporary health insurance plans generally include the high-dollar, unexpected care and treatment you may require as a result of an illness or injury – from a serious medical event like a heart attack or stroke to a broken leg or doctor’s office visit due to illness.
Remember, these plans are highly customizable (that’s one of the perks!). The chart below describes benefits that may be covered with short term medical policies.
Individual insurance plans vary, so you’ll want to read the plan details closely to validate the coverage and benefits you’ve selected and what exclusions apply.
What STM Covers
Hospital room and board
Emergency room – anesthesiology and surgical care
Diagnostic services – X-rays, laboratory tests and analysis
Ambulance and surgical services
Doctor visits
What STM Does Not Cover
Sport-related injuries
Injuries or illness related to participating in extreme or dangerous activities
Medical costs resulting from injury from riding an ATV (dirt bike, snowmobile, go-cart), racing with a motorcycle, boat or any form of aircraft
Treatment of pre-existing conditions
Any medical expenses incurred prior to the effective date or after the expiration date of your policy
Tobacco, drug, and alcohol-related treatment expenses
Pros and Cons of Short Term Health Plans
Here are a few of the pros and cons to consider when you’re thinking about signing up for a short term health plan.
- Short term medical monthly insurance premiums are typically less than major medical premiums, 31.5% less on average.[3] However, STM has less coverage and does not qualify as an ACA plan.
- Apply year-round – There is no official open enrollment period and, in most cases, coverage begins the next day after you enroll online.
- Don’t pay for coverage you don’t need – Plans are highly customizable; you can choose from various health benefit levels.
- Keep Your Doctor – No provider network limitations means you can visit your preferred health care provider.
- Short term plans can be used alongside other supplemental insurance options such as a hospital plan, dental plan or a prescription drug card (not an insurance product).
- Plans have limited durations – Anywhere from 30 to 364 days depending on your state.
- Less coverage than major medical – Preventive care and many other essential health benefits such as annual doctor’s visits, prescription drugs, vaccinations, and pre- and post-natal care are not covered. If you think you will need any of the 10 essential health benefits guaranteed by the ACA-qualifying plans, then a short term health plan may not be right for you.
- Pre-existing conditions are not covered – Historically, short term plans have not covered pre-existing conditions.
Find Answers to Short Term Medical Insurance Questions
Short term health insurance (also referred to as short term medical or temporary health insurance), provides temporary benefits that help pay for healthcare when you don’t have major medical insurance or another plan that qualifies as minimum essential coverage under the Affordable Care Act (ACA), commonly referred to as Obamacare. Read our “Complete Beginner’s Guide” to short term health insurance to learn more.
You may want to choose short term coverage if you are between ACA plans due to:
- Being in an employer waiting period
- Missing Obamacare open enrollment
- Ineligibility from special enrollment under the ACA
- Aging off a parent’s health insurance plan upon turning age 26
Short term health insurance benefits can be used to help pay for a range of unexpected medical bills – from relatively minor events such as a doctor’s office visit due to illness, to major events such as a heart attack.
Examples of healthcare commonly covered by a short term plan include:
- Hospital room, board and general nursing care
- Emergency room visits
- Inpatient doctor visits
- Doctor office visits
- Surgical services
- Intensive or specialized care
You present your health insurance ID card at the time you receive healthcare services. Your healthcare provider bills your short term health insurance company, and that company then pays the amount your policy covers for eligible expenses. You are then billed for your portion.
Short term plans last from 30 to 364 days with duration limits varying by state.
Learn more about the removal of short term medical limits and what it means to you.
There is no open enrollment period for short term health insurance. You can enroll year-round. If your application is accepted, you can choose to begin coverage as early as the next day.
Begin the enrollment process now by comparing multiple short term plans available in your area.
Whether or not short term coverage is right for you depends upon your life stage and circumstances, your personal healthcare needs and budget.
Read what to consider when deciding whether or not short term health insurance is right for you, and call 888-855-6837 to discuss your options with an agent.
There is no one-size-fits-all plan recommended for everyone. Short term coverage comes in many designs to accommodate your healthcare needs and household budget.
Learn more about what to consider when choosing a short term plan, including premium, deductible, pre-existing condition coverage and more.
No, short term health insurance is not the same thing as Obamacare/ACA. Short term health insurance plans are not required to provide essential health benefits, are not guaranteed issue and are not subject to other provisions mandated under the ACA.
No, short term health insurance does not qualify as minimum essential coverage under the ACA. However, since the individual mandate tax penalty was repealed effective January 1, 2019, there is now no federally enforced financial penalty for not participating in the ACA and obtaining a qualifying major medical policy (Note that you could still be subject to a tax penalty for 2018 or earlier if you went longer than 3 months without qualifying major medical coverage during that time.)
Although short term health plans do not offer the same coverage as an Obamacare plan, they typically cost less than an unsubsidized Obamacare plan. For a comparison, see this example using rates for a 35-year-old woman living in Arizona[1]:
| Plan Type | Unsubsidized Premium | Deductible |
|---|---|---|
| Connect STM Short Term Plan* (HealtheDeals.com) | $96.00 | $5,000 |
| Lowest Cost Bronze ACA Plan** | $317.93 | $7,900 |
| Short Term Plan Savings: | $221.93 | $2,900 |
* Short Term Health Insurance does not qualify as minimal essential coverage.
** Bright Health Bronze (Plan ID: 87247AZ0010006)
The best way to find out what a short term health plan will cost you is to request a quote. It takes about 1 minute to obtain multiple plan options, then compare premium costs and coverages to find the best fit for your needs.
Short term health plans generally have more affordable premiums than major medical plans because they are not subject to ACA provisions and provide less coverage. For example, short- term medical insurance has few or no preventive care benefits.
Short term health insurance plans are designed to provide benefits that help with medical bills resulting from unexpected illnesses and injuries.
In general, the more coverage you seek, whether through an ACA plan or a short term plan, the higher the premium you will pay.
Comparison of Short Term Health Insurance and Obamacare
| What They Offer | Short Term Medical Plans | Major Medical |
|---|---|---|
| Coverage Type | Temporary, catastrophic coverage | Long-term, minimum essential coverage including the ACA’s 10 essential health benefits |
| Coverage Length | 30-364 days (duration limits vary by state) | Guaranteed Renewable |
| Premium Cost | Typically less than an unsubsidized ACA plan; cost varies by plan selected | Typically more than a short term health plan, but subsidies may reduce cost; cost varies by plan selected |
| Pre-Existing Conditions | Not typically covered; dependent on plan selected | Covered by law |
| Preventive Care Benefits | Not typically covered; dependent on plan selected | Covered by law |
| Enrollment Period | Year-round enrollment; plans start as early as the day after your application is accepted | During the annual open enrollment period, or a special enrollment period when eligible |
| Subsidies Available | No | Yes |
| Guaranteed Issue | No | Yes |
Plan availability varies by state. You can get a quote now to find out what plans are available to you through Health eDeals.
You can buy short term medical coverage from a few sources, including websites such as Health eDeals, a licensed health insurance producer and specific health insurance companies. Learn more about “Who Sells Short Term Health Insurance.” Or, get a quote now through Health eDeals.
They typically do not. However, some states require maternity coverage. Talk with a licensed producer to find out if maternity is covered in your state.
As a general rule, no, short term plans do not cover pre-existing conditions. However, some plans, like Connect Plus, have the option for additional benefits (at additional cost) to provide some coverage for certain pre-existing conditions.
Limits do apply, including a dollar limit on the benefit amount the plan will pay out for pre-existing conditions.
They typically do not. That said, there are some plans that include a few basic preventive care services such as Pap smear, mammography and prostate antigen testing. Read policy details to learn what preventive services the plan you are considering may cover or exclude, and talk with a producer to find plans with preventive care benefits.
Short term policies may include coverage for dependent children up to age 26, and child-only plans may be available to children starting at age 2. Call 888-855-6837 to speak with an agent who can help you find a plan for your family.
Typically, no. Temporary coverage sold through Health eDeals is available to adults age 18 to 64.
Outpatient prescription drugs are not typically covered by short term policies. You may consider adding a prescription drug discount program such as the Rx Paycard.
These policies do not typically cover birth control. You may consider adding a prescription drug discount program such as the Rx Paycard.
Short Term Health Insurance Resources
Related Products
Have Questions? Speak to an Agent
Speak to a licensed health insurance agent during business hours for help understanding your options and enrolling in coverage.
Independence American Insurance Company and/or Madison National Life Insurance Company, Inc. may underwrite the products referenced on this website. Legal Disclaimers.
Footnotes
- [1] Rate is for a 35-year old female non-tobacco user located in the 85001 ZIP code quoted Dec. 17, 2018. Rates vary by location, age, and sex.
- [2] Rate is for a 35-year old female non-tobacco user located in the 85001 ZIP code quoted Dec. 17, 2018. Rates vary by location, age, and sex.
- [3] Fact Sheet: Short-Term, Limited-Duration Insurance Proposed Rule. (Feb. 2018). Cms.gov. Retrieved 4 February 2020, from https://www.cms.gov/newsroom/fact-sheets/fact-sheet-short-term-limited-duration-insurance-proposed-rule