While short-term health insurance benefits vary by plan and provider, its exclusions remain relatively consistent from plan to plan. If you’re curious about what is and what is not covered with short-term health insurance, keep reading. This article will give you a better idea of what you can expect from short-term health benefits so you can make the best decision for your health care needs.
Short-Term Health Plans v. ACA-Compliant Coverage
Before we get into what is and isn’t covered with short-term health insurance, it helps to understand how short-term plans differ from ACA-compliant major medical coverage. ACA-compliant major medical plans meet the requirements for minimum essential coverage and must include coverage for all 10 essential health benefits.
Short-term medical insurance is different. It is not required to comply with regulations mandated by the ACA, so it does not have to include coverage for all 10 of the ACA’s essential health benefits. It does not meet the requirements for minimum essential coverage. A short-term plan may include some benefits similar to ACA-compliant plans, such as preventative care, emergency services, and hospitalization. However, there are some services short-term plans specifically exclude (more on that below).
Additionally, changes to federal regulations allow you to keep short-term health insurance for up to one year, with the option to renew coverage for up to two years, depending on the state.* Short-term plans used to be capped at three months and still are in some states, but now it can be a longer-term option for people who don’t want all the coverage of an Affordable Care Act (ACA)-compliant major medical plan but still want some benefits.
What Doesn’t Short-Term Health Insurance Cover?
Short-term health insurance offers many benefits, but it does not have to cover all 10 of the ACA’s essential health benefits. So, what is not covered with short-term health insurance? Depending on the state of purchase, short-term insurance plans do not typically include benefits for:
- Pre-existing conditions
- Maternity care
- Mental health and substance use disorder treatment
- Dental and vision care
A pre-existing condition is an illness, injury, or condition that you have on or before the date that your health insurance plan starts.** While ACA-compliant major medical plans may not deny an individual coverage for having a pre-existing condition, short-term health insurance plans do not typically cover medical services related to a pre-existing condition.
Pregnancy, maternity, and newborn care are essential health benefits under the ACA, but because short-term health insurance is not required to comply with the ACA, it does not usually provide these benefits.
Mental health and substance use disorder treatment
Short-term health insurance does not typically cover mental health and substance use disorder services, which are essential health benefits under the ACA. These services include counseling, psychotherapy, and inpatient services.
Dental and vision care
Short-term health insurance does not include benefits for pediatric or adult dental and vision care. Pediatric dental and vision care are essential health benefits according to the ACA; adult coverage is not.
What Benefits Do Short-Term Health Plans Offer?
Short-term coverages vary by state, plan, and provider, so there isn’t a set list of benefits that all short-term health insurance plans must offer. However, a short-term medical plan through Vera Health usually includes access to the Aetna Open Choice® PPO network and benefits for:
- Doctor visits
- Urgent care
- Ground ambulance trips
- Emergency room care
- Home health care
- Child immunizations
- Physical therapy
- Diagnostic testing
- Emergency surgery
- Prescription drugs, in some states***
Is Short-Term Health Insurance Right for Me?
Your eligibility for short-term health insurance is determined through an application process. Short-term health insurance is not right for everyone, but it’s a good option for many people who want affordable, flexible health care and don’t want all the coverage available from an ACA-compliant plan.
Short-term health insurance could be a good fit for you if you:
- Do not receive health insurance from your employer
- Are between jobs or waiting for benefits to kick in at a new job
- Are waiting for your ACA health insurance plan to kick in
- Are turning 26 and aging out of your parent’s health insurance
- Cannot apply for ACA coverage because you missed Open Enrollment or do not qualify for a Special Enrollment Period
Still have questions about what short-term medical insurance does and does not cover? Wondering if you’re a candidate for short-term coverage? Vera Health can help. Call 888-499-1187 to talk to a Vera pro to learn more about your options, or use our plan builder tool to get a free quote online.
*Maximum 12-months less one day/364 days in NE.
**Pre-Existing Condition means:
A Sickness, Injury, or condition, including any related or resulting complications: For which medical advice, consultation, diagnosis, care, or treatment (includes receipt of services, supplies, or diagnostic tests) was received or recommended from a provider or prescription drugs were prescribed during the 1 year period immediately prior to the Covered Person’s Effective Date, regardless of whether the condition was diagnosed, misdiagnosed or not diagnosed; or That produced signs or symptoms during the 1 year period immediately prior to the Covered Person’s Effective Date.
- The signs or symptoms were significant enough to establish manifestation or onset by one of the following: The signs or symptoms reasonably should have allowed or would have allowed a medical provider to diagnose the condition; or
- The signs or symptoms reasonably should have caused or would have caused an ordinarily prudent person to seek medical advice, consultation, diagnosis, care, or treatment.
- A pregnancy that exists on the day before the Covered Person’s Effective Date will be considered a Pre-Existing Condition
May vary by state.
***Covered services may be subject to waiting periods, visit limitations, deductible, coinsurance, or copays, and/or benefit maximums depending on the plan you purchase.
Short Term Medical coverage is not required to comply with federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of pre-existing conditions or health benefits (such as hospitalization, emergency service, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.