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Short-term health insurance in Louisiana

If a short-term plan has a pre-existing condition lookback period over 12 months, the plan is limited to a six-month term (but renewals are allowed)

Short-term health plans in Louisiana

Short-term health plans duration in Louisiana

Louisiana insurance regulations (see Title 22, Section 1072) place restrictions on how insurers can exclude coverage for pre-existing conditions. But the regulations stipulate that short-term health insurance in Louisiana is not subject to the restrictions, as long as they have terms of no more than six months.

Until October 2, 2018, federal regulations limited short-term health plans to no more than three months in duration, and prohibited renewals. But the Trump administration relaxed those rules, allowing for much longer short-term plans, unless states impose their own requirements.

Other short-term coverage — including plans with terms of more than six months — can only define pre-existing conditions as those for which treatment was provided in the past 12 months (or which would have caused a prudent person to seek treatment in the past 12 months), and current pregnancy.

Specifically, this is the portion of Title 22, Section 1072 that applies here:

The provisions of this Section shall not apply to limited benefit health
insurance policies and short-term policies or contracts of a duration of six
months or less. Any policy, contract, or plan subject to the provisions of
this Section shall not contain a definition of a preexisting condition more
restrictive than the following:

(1) A condition that would have caused an ordinary prudent person to seek
medical advice, diagnosis, care, or treatment during the twelve months
immediately preceding the effective date of coverage.

(2) A condition for which medical advice, diagnosis, care or treatment was
recommended or received during the twelve months immediately preceding the
effective date of coverage.

(3) A pregnancy existing on the effective date of coverage.

Short-term health plans typically look back more than 12 months when considering whether an enrollee’s condition was pre-existing, but to do that in Louisiana, according to the terms of the statute, the plan must have a term of six months or less.

Elsewhere in Title 22, Section 1072, the statute refers to the federal definition of short-term health insurance plans. So the six-month limit on the initial term only applies if the insurer wants to define pre-existing conditions as things that were diagnosed, treated, or symptomatic more than 12 months before the application is submitted. Other than that, short-term plans in the state can follow the federal government’s rules in terms of allowable durations, and there are plans available for sale with total durations, including renewals, of up to 36 months.

Louisiana’s short-term health insurance regulations

The Trump administration’s new regulations allow short-term plans to have initial terms of up to 364 days, and total duration, including renewals, of 36 months. But the regulations are clear in noting that states may continue to have more restrictive rules.

So short-term plans in Louisiana are limited to initial terms of six months if the insurer has a pre-existing condition lookback period in excess of 12 months. But if the insurer only looks at the applicant’s past 12 months of medical history, the plans can have durations in line with the new federal rules.

Louisiana does not limit or prohibit renewals or subsequent purchases of additional short-term coverage, so people can purchase a new plan when their short-term coverage expires (assuming the existing plan is not eligible for renewal), as long as they can pass the medical underwriting for a new policy.

Insurers that offer longer short-term plans

As of late 2020, there are at least five insurers offering short-term health insurance in Louisiana with initial terms longer than six months: Blue Cross Blue Shield of Louisiana (available with a term of up to 11 months), United HealthCare, National General, Independence American Insurance Company, and Vantage (plans offered by Vantage can continue until the end of the calendar year or for 364 days, whichever comes first).

For reference, National General’s brochure confirms that the pre-existing condition lookback period is 12 months, which is also the case for Vantage short-term plans.

Some insurers have longer pre-existing condition lookback periods, so their plans are limited to six-month terms

Some insurers are limiting their short-term health insurance in Louisiana to no more than six months, including Companion Life and Everest Reinsurance.

For reference, the policy exclusion details for Companion Life and Everest Prime note that the pre-existing condition lookback period is five years (this is also the case for Standard Life, although their plans are available for online purchase with terms up to 12 months).

Which insurers offer short-term plans in Louisiana?

Several insurers offer short-term health insurance in Louisiana, including:

  • Blue Cross Blue Shield of Louisiana (HMO Louisiana, plan is sold as Bridge Blue)
  • Vantage Health Plan
  • Companion Life
  • Everest Reinsurance
  • Independence American Insurance Company
  • National General
  • UnitedHealthcare (Golden Rule)

In most states, it’s fairly rare to see the insurers that offer ACA-compliant plans also offering short-term health plans. But two of the insurers that offer ACA-compliant plans in Louisiana (BCBSLA and Vantage Health Plan) have also started offering short-term plans. BCBSLA began offering short-term plans as of late 2018, and Vantage’s short-term plans became available as of January 2019.

The short-term plans offered by Vantage and by Blue Cross Blue Shield of Louisiana include full coverage for certain preventive and wellness services, and BCBSLA’s short-term plans also include coverage for prescription drugs. Coverage for preventive care and prescription drugs is somewhat rare for short-term plans (note that the preventive care and prescription coverage is not as extensive as it would be with an ACA compliant plan though — for example, contraceptives are not covered at all under BCBSLA’s short-term plans).

Who can get short-term health insurance in Louisiana?

Short-term health insurance in Louisiana can be purchased by applicants who can meet the underwriting guidelines the insurers use. In general, this means being under 65 years old (some insurers put the age limit at 64 years) and in fairly good health.

Short-term health plans typically include blanket exclusions for pre-existing conditions. This means they will not be adequate for residents of the Bayou State who need medical care for ongoing health conditions. And because short-term plans do not have to cover essential healthcare benefits, they often have significant limitations and gaps in the coverage, making it important to read the fine print carefully.

If you need health insurance in Louisiana, you’ll first want to determine whether you’re eligible to enroll in an ACA-compliant major medical plan (Obamacare) instead, and whether you’d qualify for a premium subsidy through the Louisiana health insurance exchange (if you’re eligible for a subsidy, the monthly premiums for an ACA-compliant plan may be much less costly than you were expecting, and even more affordable than the premiums for short-term plans). Open enrollment for these policies runs from November 1 to December 15 each year. Outside that window, you may still be able to enroll if you experience a qualifying life event that triggers a special enrollment period. Your medical history will not hinder your eligibility for these plans, but you can only purchase an ACA-compliant plan during open enrollment or a special enrollment period.

ACA-compliant plans are purchased on a month-to-month basis, so you can enroll in one even if you’ll need it for only a few months before another policy takes effect. So for example, if you know that you’ll be enrolled in Medicare or a plan offered by a new employer within a few months, you can still sign up for an ACA-compliant plan (during open enrollment or a special enrollment period) and then cancel it when your new coverage begins.

But if you can’t enroll in an ACA-compliant individual market plan or a plan offered by an employer, a short-term plan is a better option than remaining uninsured.

When should I consider short-term health insurance in Louisiana?

Excluding coverage for pre-existing conditions can make short-term policies appear more affordable than ACA-compliant policies. However, that upfront affordability can quickly be wiped out by out-of-pocket expenses (like monthly premiums and deductibles) or any costs for a healthcare service for an uncovered condition. That said, there may be situations in which it makes sense to use a short-term plan, such as:

  • If you missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period.
  • If you are newly employed and have a waiting period until you can be covered by your new employer’s health insurance plan; short-term insurance may provide a much more affordable (but less comprehensive) stopgap than COBRA or an ACA-compliant plan.
  • If you will soon be eligible for Medicare.
  • If you’re not eligible for Medicaid or a premium subsidy in the exchange, an ACA-compliant plan might be unaffordable. Some examples of who are ineligible for premium subsidies:
    • Folks who earn more than 400% of the poverty level (for 2021 coverage, that amounts to $51,040 for a single person; if your ACA-specific modified adjusted gross income is slightly above the subsidy-eligible threshold, there are steps you can take to reduce it).
    • People caught in the ACA’s family glitch.
    • People who cannot enroll in a plan through the exchange because they are not legally present in the US. Lawfully present immigrants can enroll, and can qualify for premium subsidies. But undocumented immigrants cannot enroll in a plan through the exchange at all (they can, however, enroll in ACA-compliant coverage outside the exchange, but there are no subsidies available outside the exchange).

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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