Short-Term Plans Provide Coverage When You’re Between Jobs
Stacy had a year of big changes. She’d built a house of her own in her favorite neighborhood. She’d taken up hiking to get her health on track. She started taking those art classes she’d been thinking about. She was getting more serious with her boyfriend and expected to be engaged soon.
On a roll and feeling great, Stacy decided to make another big change. She decided to quit her job, take a few months off to recharge and then find a new position that better suited her. A bit of polish on her resume and a few well-placed phone calls should get her off on the right foot! Stacy was excited and nervous to take this next step, and she was confident she’d land on her feet.
She learned from her company’s HR department that she’d be able to keep her employer-provided health coverage for one month after her last official day on the job. After that, she could get COBRA, which would let her keep the same coverage she’d been used to, but at a higher out-of-pocket cost.
This was great news. But she knew from friends who’d recently been in the job market that she may need a bit longer than 30 days to find a new job with benefits. And the cost of the COBRA plan was more than she could afford at the moment. Still, even though she was healthy and didn’t take any prescriptions yet, she wanted the peace of mind of knowing that she had coverage just in case.
So, she called an agent in Florida and told him about her situation. The agent noted that Stacy qualified for a Special Enrollment Period, since she was losing coverage through her job. So they talked about all the benefits and costs of the Affordable Care Act (ACA) plans for individuals. They also discussed short-term plans, which don’t have all the benefits of the ACA plans. They provide coverage for new health conditions for one to six months, while someone waits to get more permanent coverage.
Stacy was convinced she’d have a new job with health coverage shortly. Since she didn’t have any health conditions or take any prescriptions currently, she chose to enroll in the short-term plan while she continued her job search.
Preparing for Life’s Curveballs
Stacy’s surprises weren’t over yet. A few weeks after her short-term plan coverage started, she broke her ankle while hiking. Thankfully, her new plan covered the medical care she needed to recover from the accident and be ready to start her new job in the fall.
Surprises happen. It’s important to be prepared for life’s curveballs, and health coverage is no exception. Health care expenses can take a big chunk out of a budget. Having coverage means that a person won’t have to pay the full cost out of their pocket.
How Do Short-Term Plans Work?
Short-Term plans are designed to cover emergency and unplanned care for a short time frame—to bridge the gap until someone can enroll in an ACA plan, get coverage through their job or qualify for Medicare.
Short-Term plans don’t cover all of the care and services that traditional Affordable Care Act (ACA) plans do. For example, they don’t have traditional prescription drug coverage and only cover health conditions that occur after the plan’s start date (pre-existing conditions aren’t covered).
Here are a few things to know about Short-Term plans:
- Short-Term plans are designed to provide health coverage for one to six months with the option to reapply for an additional period of time.
- They cover care for only new health conditions and emergencies that develop after the plan’s start date. (The member would pay the full cost of care for any conditions that are considered pre-existing.)
- They include a program to get special discounted prices for prescription drugs.
Short-Term plans do not cover:
- Medical care for health conditions or injuries that a member has been treated for in the past 24 months before the plan’s start date (also called pre-existing conditions)
- Adult wellness checkups and preventive care (Preventive care is covered for children up to age 17. The only covered adult preventive care is an annual mammogram.)
- Maternity or newborn coverage (A rider can be purchased to add this coverage.)
- Habilitative services, like physical, occupational or speech therapy
- Traditional pharmacy coverage with copays and coinsurance
We hope this helped you understand what’s covered by Short-Term plans. If you have questions about this blog, we’re here for you. You can call us at the number on the back of your member ID card.
Filed under: Health Education