​Short Term Medical or ACA Health Insurance

WHAT ARE YOUR HEALTH INSURANCE OPTIONS
Whether a marketplace plan, COBRA coverage, or a short-term medical plan is best for you depends on what the monthly costs will be for what you want from a health plan. Choosing the correct health insurance takes both researching your options and taking into consideration your individual situation. You should think about both your health and finances when making this decision.

Looking for Individual Health Insurance, You Need to Figure Out:
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  • How often do you go to the doctor on average each year
  • Your health care needs over the coming year will they change or stay the same
  • Do you have any chronic health conditions (if so this means you need comprehensive care which is ACA coverage)

​You’ll also want to figure out your financial situation:

  • How much you can afford monthly for health insurance coverage
  • Can you afford high deductibles – Co-insurance and copays each year

​After exploring these topics, you can figure out what’s the best health plan for you. Coverage through the ACA Marketplace is one way to get coverage. Each year the ACA has an "Open Enrollment Period" from November 1st until December 15th (sometimes this is extended to January 15th) where you can sign up for coverage for the following year with “Guaranteed Acceptance”. There are certain situations like: having a child, changing jobs, losing your health insurance coverage at work, moving to another state where you many qualify for a "Special Enrollment Period" and can enroll in coverage anytime through out the year and not have to wait for open enrollment..

Another option that the federal government expanded in recent years is "Short Term health plans. These plans can be lower in cost but, if you have any health issues or expect to need many health services in the next year, you may want to find an inexpensive ACA plan. Short Term health plans will not cover pre-existing conditions.
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​Six Mile, SC 29682
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ACA Health Insurance is True Major Medical Coverage

An ACA plan covers you regardless of previous injuries or pre-existing conditions like chronic illnesses. You cannot be turned down for coverage. Most working-age Americans have an employer-based health insurance coverage, but an ACA plan is an option for you or your spouse if:
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  1. Your employer does not offer health insurance
  2. You are self-employed

ACA Coverage is required to have 10 essential health benefits:
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  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder
  • Prescription drugs
  • Rehabilitation services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services, including oral and vision care

Each year there is an Annual Open enrollment for the ACA health coverage from November 1st until December 15th.  During these 6 weeks you can keep the coverage you have now or you can enroll in another plan. You can do all this because during this time period you cannot be turned down due to a previous pre-existing health problem. If someone has a chronic health problem and has medical concerns, they should absolutely be on ACA health insurance through the Marketplace.

 Short-Term Health Plans can be "An Alternative to COBRA coverage"

People sometimes mistake short-term plans as an ACA plan alternative. Which they are not, because they do not offer "Guaranteed Acceptance" with comprehensive major medical coverage. In SC the longest time period you can be covered consecutively with short-term insurance is 33 months and this is with United Healthcare. Short-term plans have been around for over 20 years. They’re seen as plans to help people who face unexpected accidents or illnesses. They’re not meant as a long-term health insurance plan to cover people with long-standing health issues.

Instead, you may want a short-term plan if you’re out of work or started a new job and don’t have health benefits yet. During this time you should only need coverage for a few months. Laid-off workers often choose expensive COBRA plans to keep coverage for up to 18 months after leaving a job. COBRA plan are very expensive because former employers are no longer kicking in any money to help pay for any of the coverage. So, you can see that a short-term medical plan might be a more affordable stop-gap then COBRA until you get another health insurance plan.

When comparing ACA vs. Short Term plans, it’s important to know that short-term plans are not meant for people with chronic health conditions. Instead, they’re in place for “unexpected accidents or illnesses" while you are in between jobs and have no health insurance coverage.  Unlike ACA plans, short-term plans don’t have to accept every applicant. They can  reject you if you have pre-existing conditions as they would consider you a risk. For instance, short-term plans often won’t give you coverage if you have pre-existing conditions like diabetes, heart problems, kidney failure and recent cancer. Even if you get approved for a short-term plan, it may not cover services found in an ACA plan. One example is that short-term plans don’t have to cover the 10 essential health benefits found in the ACA.

Short-term plans can exempt coverage of those services or place limits on them. An example is prescriptions. Short-term plans may cover medication if you go to the hospital for an unexpected condition. However, the plan likely won’t cover a prescription for pre-existing asthma. Instead, you’d have to pay that all yourself. One good thing about Short Term plans is if you are in good health most plans can start coverage as soon as the next day. Remember we are your local health insurance agency and we are here to answer all your questions.

Remember, we are your local health insurance agency and, have over 35 years experience to help you choose the right coverage.   Contact us to learn more about which plan option is best for you. ​

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