Cheap, transitory coverage, known as short-term health insurance, can assist in covering medical expenses in the event that your insurance lapses—for example, following job loss. Despite having inexpensive premiums, short-term plans don’t provide the same level of comprehensive coverage as regular health insurance, and if you need medical attention, you may have to pay a large amount out of pocket.
We compared average costs, coverage maximums, deductibles, coinsurance, and whether or not they offered prescription drug benefits in order to identify the top providers of short-term health insurance.
The Best Short-Term Health Insurance Companies
- UnitedHealthcare, Copay Select Max – Best for Prescription Drug Benefits
- Pivot Health, Epic Base – Best for 0% Coinsurance Option
- Everest, Flex Term Health Insurance – Best for Low Out-of-Pocket Costs
- UnitedHealthcare, Hospital & Surgical – Best for Provider Network
- UnitedHealthcare, TriTerm Value – Best for Coverage Maximum
- Pivot Health, Pivot Health Choice – Best for Low Deductible Option
- Pivot Health, Pivot Health – Economy – Best for Low Premiums
What Is Short-Term Health Insurance?
In most states, short-term health insurance provides limited coverage for up to a year, with the option to renew the policy for an additional two years. Certain states prohibit short-term plans or place limitations on the duration of coverage.
In July 2023, the Biden administration declared its intention to limit short-term health insurance to a maximum of three months, with the possibility to extend coverage for an additional month.
The Affordable Care Act (ACA) does not regulate short-term health insurance plans, so they are free to refuse coverage to individuals with pre-existing conditions and are not required to provide the minimum set of “essential health benefits” as required by law. Prescription medication coverage, mental health services, inpatient and outpatient care, and maternity care are among the ACA benefits that are typical of standard health insurance. You might have problems locating a short-term health plan that provides this coverage, as short-term plans are not required to provide it.
Additionally, most short-term health insurance plans have a maximum amount that the insurer will pay for specific services or for the entire plan.
What Does Short-Term Health Insurance Cover?
Because short-term health insurance plans are exempt from the Affordable Care Act, there may be a big difference in the coverage provided by one short-term plan and another.
Plans for short-term health insurance may include:
- Preventive care
- Urgent care
- Emergency care
- Doctor visits
Short-term plans frequently do not include maternity, mental health, or drug-use care, even though standard health insurance does.
Benefits from prescription drugs are another problem. While prescription medication coverage is optional for short-term health insurance providers, these benefits are typical for regular health insurance plans. A discount card might be included in short-term plans that don’t cover prescription drug benefits. The insurance does not assist with the cost of drugs in those situations, but you may be able to negotiate a cheaper drug price than you would have if you had not had the discount card.
If you want to know what is covered and the coverage maximums, restrictions, and exclusions, you should review the details of the short-term health policy.
Pros And Cons of Short-Term Health Insurance
Short-term health insurance proponents tout its affordability, while opponents refer to the policies as “junk health insurance” due to their lack of many of the benefits associated with regular health insurance. If you require care, there could also be significant expenses. Recognize the benefits and drawbacks before purchasing short-term insurance.
Pros
- low price.
- You are not required to wait for open enrollment to apply for a short-term plan.
- If accepted, you could receive coverage the following day.
- When it comes to choosing your out-of-pocket expenses, you might have more options than with a traditional health insurance plan.
Cons:
- usually excludes coverage found in regular health insurance plans.
- Plans have a cap on the amount of coverage.
- usually excludes coverage for pre-existing conditions.
- A policy may be refused to you.
- A short-term health plan is only permitted for a restricted period of time.
Who Can Benefit From Short-term Health Insurance?
It could be wise to get a short-term health insurance plan if:
- Nowhere else can you find reasonably priced health insurance.
- You want an emergency stopgap until you get health insurance, which may happen soon because you started a new job.
- You recently lost your job and are unable to pay for COBRA insurance. With COBRA, you can continue your prior group health insurance without receiving financial assistance from your previous employer, but the cost of the coverage will increase.
- In the upcoming months, you don’t anticipate needing a lot, if any, medical attention. This includes no prescription drugs or doctor visits for things like physicals, exams, or mental health care.
- You are past the age of eligibility for your parent’s health plan, seek affordable coverage, and are unable to obtain or cannot afford catastrophic health insurance via the ACA marketplace. Catastrophic health insurance has low premiums and a high initial out-of-pocket expense, much like short-term plans. It is only available to individuals under 30 or those with serious financial difficulties. One significant distinction is that, like ACA plans, catastrophic plans provide comprehensive coverage.
Who Is Eligible for Short-Term Health Insurance?
Anyone residing in a state that permits short-term health insurance plans may submit an application for coverage; however, in contrast to traditional health insurance, your application may be rejected.
Plans for short-term health insurance To determine your risk during the application process, use medical underwriting. You might be asked to respond to yes/no questions regarding medical conditions as part of that process. Your responses influence your approval status.
Short-term health plans examine your claims after you are covered to see if the services you receive are related to a pre-existing condition. They have the right to deny the claim or even cancel your coverage at any point if they discover that a pre-existing condition is contributing to your health issues.
How Do You Qualify?
If short-term insurance is permitted in your state, you can apply for a policy at any time of the year. If you obtain health insurance through your employer or through the ACA marketplace, you are not required to wait until open enrollment.
How to Choose the Best Short-Term Health Insurance Plan for You
If you’re thinking about getting short-term health insurance, keep in mind that you may be able to enroll in an ACA plan through the healthcare.gov marketplace if you’ve experienced a qualifying life event, like losing your job. This means you may have options besides short-term health insurance.
If you determine that short-term health insurance is the best option for you, there are a few things to think about to make sure you’re selecting the right plan. Consider the following questions for yourself:
- Is there a provider network for the plan? Maintaining your network within a plan may result in cost savings.
- What is the deductible amount and does the plan offer coverage in advance of the deductible being satisfied? If not, think about whether you could afford the deductible on your own. The deductibles in each plan differ significantly from one another. (ACA-compliant plans must limit annual out-of-pocket expenses to $9,100; short-term plans are exempt from these requirements.) Verify that the copay for the plan is within your means by checking it.
- Are prescriptions covered by the plan? If you can’t afford your meds out of pocket, consider whether you have enough money in savings or income.
- What is the duration of the plan and is it renewable? In addition to setting shorter policy terms than permitted by local, state, or federal law, short-term insurers have the option of making their plans renewable.
Methodology
We assessed providers according to their average monthly premium, coverage, and out-of-pocket expenses in order to determine which short-term health insurance providers were the best:
Rates for short-term health insurance (25% of total score): We compared quotes for three cities: Orlando, Florida; Phoenix; and El Paso, Texas, for a thirty-year-old woman who does not smoke. We calculated an average by taking the three lowest quotes for each plan in each city.
Maximum coverage (25% of score): A short-term health insurance plan, in contrast to regular health insurance, has a maximum coverage, which can be either annual or lifetime and represents the highest amount the insurance company will pay for a person’s medical care.
Deductible (20% of score): Companies that provide short-term health insurance frequently provide a range of health insurance deductible amounts. In our analysis, plans with more options received higher scores.
Coinsurance is the portion of your score that you pay for medical services after your plan’s deductible has been met. It is currently 15% of your score. Up until the coverage limit, the insurer pays the remaining balance. We gave those plans extra points because lower coinsurance amounts translate into lower out-of-pocket expenses.
Prescription drug coverage (15 percent of score): A lot of short-term health insurance plans merely provide members with a discount card or do not offer prescription drug benefits at all. We examined which short-term insurance policies cover prescription drugs, which do not, and which have exclusions that limit coverage to particular situations, like hospital stays.