For 3 million in the coverage gap and nearly 13 million priced out of ACA-compliant coverage, short-term health insurance could be a much-needed bridge.

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Short-term health insurance as a bridge

Temporary health plans offer refuge for millions facing premium hikes. Here's how and where you might use them to replace ACA coverage.

  • By
  • contributor
  • October 7, 2017

With recent headlines about higher individual-market health insurance rates ahead in 2018 (in large part due to the uncertainty that the Trump Administration and GOP-led Congress have caused), it’s understandable that some people are looking for coverage that isn’t ACA-compliant, but that will still provide a decent level of protection.

Trump Administration expected to reverse Obama rules that shortened duration of short-term plans

In some cases, short-term insurance is a good fit, although short-term plans are currently only available for up to three months in duration, under rules that were finalized in 2016 by the Obama Administration.

But the Trump Administration is poised to roll back that regulation. Trump is expected to sign an executive order in October 2017 that would once again allow short-term plans to be sold for terms of up to 12 months, which is what was allowed under federal guidance prior to 2017.

Some states limited short-term plans to six months prior to the Obama Administration’s intervention, and a few states didn’t allow short-term plans at all. Those rules would continue to apply even with the new executive order in place — 12 months would be the maximum duration, but states could keep it shorter than that.

Why consider short-term coverage?

There are currently about 2.6 million Americans who are caught in the coverage gap in 18 states that have refused to accept federal funding to expand Medicaid. Those consumers’ incomes are under the federal poverty level, so paying full-price for health insurance is probably a non-starter.

Millions of Americans also have incomes above 400 percent of the poverty level, but not dramatically so. And thanks to the subsidy cliff, they can be facing premiums that are 25 percent – or more – of their income, depending on where they live.

If you’re among these consumers – and you’ve looked at all the on- and off-exchange options for regular health insurance and simply cannot afford them – it’s worth at least weighing the pros and cons of short-term coverage. So here’s what you need to know:

Availability varies by state

Short-term plans are available in most states, but the type of temporary plan can vary considerably. And, in fact, there are five states (New York, New Jersey, Massachusetts, Rhode Island, and Vermont) where short-term plans aren’t available at all.

Short-term health insurance was previously defined by the federal government as a plan with a duration of less than one year, but states could impose shorter limits. In late 2016, HHS finalized their proposal to limit short-term plans to no more than three months in duration, for plans with effective dates of January 2017 or later (enforcement took effect in April 2017). That rule is expected to be reversed by the Trump Administration in October 2017, however, and the federal definition will once again allow short-term plans with durations up to 12 months.

Prior to 2017, eight states already limited short-term policies no more than six months, and those states will likely keep those rules in place. And even in the states where the under-a-year federal definition was used, the majority of available plans tended to have a maximum length of six months.

Potential savings

A lower monthly premium is the primary draw for short-term plans. My own family has the least expensive plan available through the exchange in our area of northern Colorado. We pay $863/month, and the deductible is $5,500 for one person.

But we could get a short-term plan with a $5,000 deductible for around $200/month. There are several plan designs available, and although none of them are as comprehensive as the ACA-compliant plan we have now, the trade-off is that they have much lower premiums.

For us, the downsides to short-term plans outweigh the cost savings. Under a short-term plan, we’d have to pay the ACA penalty for not having coverage, and I would lose sleep worrying about the fact that short-term plan are not renewable; you have to purchase a new plan when the first ends, so if a serious medical condition were to crop up, we’d be out of luck.

That said, I can easily see how the trade-off might absolutely be worth it for some folks. Particularly if you’re in an area where premiums are going to be sky-high in 2018, if the choice is between a short-term plan and going uninsured, a short-term plan is a far better option.

Other obvious advantages

If short-term coverage is available in your state, there are some features with obvious appeal for consumers who are in dire straits.

  • Immediacy. With short-term policies, healthy applicants can secure immediate individual and family coverage, with plans that can kick in as early as the next day. If you already know the number of days you will need to be covered, your insurer may allow you to make a single payment for the whole coverage period.
  • Costs. Short-term plans are typically offered with a selection of premiums, deductibles and benefit maximums. The policies are considerably less expensive than ACA-compliant major medical plans, so you may find that you can afford to purchase a plan with a low deductible and a high-benefit maximum.
  • Flexibility. The policies also cover a range of physician services, surgery, outpatient and inpatient care. In addition, policyholders can often choose their own doctor and hospital without restrictions, though there may be financial incentives for using in-network providers.
  • Enrollment / eligibility. The enrollment process is quick and easy, with just a handful of yes/no questions regarding major health concerns.
  • You can extend coverage. You may be able to buy another short-term plan after the first one ends, but you’ll have to reapply, as the plans are not renewable. And any medical conditions that came up while you were covered under the first plan would no longer be covered under the second plan.

A few important caveats

  • No coverage for pre-existing conditions. Even if you’re eligible for coverage based on the short list of questions I just mentioned, you will not have coverage for any pre-existing medical conditions while you’re enrolled in the plan. Short-term plans exist solely to provide coverage for medical conditions that have not yet arisen. They will not be any help at all in terms of medical conditions you already have. Be sure to check the list of exclusions on any policy.
  • It’s not comprehensive coverage. These plans weren’t designed to cover everything, and they do not provide coverage for all of the ACA’s essential benefits. They typically won’t cover your routine office visits, maternity, mental health or preventative care, and many plans exclude prescription drug coverage as well. Again, be sure to check the list of exclusions on any policy.
  • You could still pay a penalty. This is biggie. Unless you qualify for an exemption from the ACA’s individual mandate penalty, you will owe a penalty if you rely on short-term health insurance. (Everyone in the coverage gap is exempt from the penalty, as is anyone for whom the least-expensive plan in the exchange – after accounting for any available subsidies – is more than 8.16 percent of household income in 2017; this will decrease slightly to 8.05 percent of income in 2018.)
  • You could still end up facing a gap in coverage. When your short-term plan ends, you will not be eligible to purchase a regular plan in the individual market if it’s outside of open enrollment. Loss of minimum essential coverage is a qualifying event that triggers a special enrollment period, but a short-term plan is not considered minimum essential coverage. But if you know that you’re going to have a qualifying event during the year that will allow you to enroll in an ACA-compliant plan, a short-term policy might be the perfect bridge to get you there and save money on premiums. (So for example, if you’re getting married in June 2017, you’ll have access to an ACA-compliant plan at that point. And short-term plan for the first part of the year might end up being a good solution.)

How the new 2017 federal rules impact availability, and what’s likely to change under the Trump Administration

The Obama Administration’s changes to the definition of short-term health insurance were aimed at “curbing abuse” of short-term plans, as these policies were never intended to serve as a long-term solution to coverage needs.

The policies are supposed to fill in the gaps between other plans, and HHS under the Obama Administration was trying to ensure that they couldn’t continue to be used as a replacement for regular health insurance.

So as of 2017, all new short-term policies are limited to a duration of no more than three months. But policies with effective dates prior to April 1, 2017 can continue until their already-scheduled termination date.

So in many states, it was still possible to purchase a short-term policy as late as March 2017, and maintain that coverage until the end of 2017.

Although the majority of the states did allow a single short-term plan to last nearly a year prior to April 2017, most of the available plans had maximum durations of six months. In most states, you can reapply for another short-term plan after the first one ends, but you’d have to qualify again based on medical underwriting — and short-term plans with effective dates of April 2017 or later cannot exceed three months in length.

That’s likely to change, however, under the executive order that Trump is expected to sign in October 2017. The order would return the rules to the way they were prior to 2017, meaning that the federal government would allow short-term plans to be sold with durations up to 12 months. States would still be able to limit short-term plans to shorter durations, and many insurers would likely revert to the six-month maximum plan durations that they offered prior to April 2017.

Keep your ACA-compliant coverage if you can

One other factor to keep in mind: If you’re healthy enough to enroll in a short-term plan and you drop your existing coverage to do so, you’re inadvertently harming the ACA-compliant risk pool, and leaving it with sicker enrollees. If a significant number of people do this, the premium increases we’re seeing for 2018 could be repeated for 2019. If there’s any way you can remain in the ACA-compliant risk pool, we’ll all be better off in the long-run.

Obamacare has made it much easier for a lot of the previously uninsured population – including those who are temporarily uninsured – to obtain high-quality individual health insurance. The law has done a great job of providing considerable financial assistance in the form of cost-sharing subsidies and premium subsidies.

But there are still situations when a short-term policy makes a lot of sense. If you’re going to be choosing between a short-term plan versus being uninsured in 2018, that’s probably a situation where short-term coverage is a good idea.