Short-term health plans in Ohio
Ohio’s short-term health insurance regulations
Bulletin 2018-05 clarifies that even non-renewable short-term health insurance in Ohio must comply with certain state requirements, including (but not limited to):
- Internal and external reviews
- Provider network details must be disclosed to the consumer
- Certain care must be covered, including mammograms, autism spectrum disorder treatment, and newborn care.
While Ohio statute does not technically define short-term health insurance plans, the policies essentially have to be non-renewable, as they would otherwise have to conform to all of the state’s rules that apply to regular individual major medical plans.
The Ohio Department of Insurance also published a consumer alert about short-term coverage in October 2018, cautioning residents to read the fine print on short-term plans and understand the out-of-pocket costs (such as the monthly premium, a deductible, or copayments/coinsurance) that they might have to pay in various scenarios.
Short-term plans duration in Ohio
The Ohio Department of Insurance published Bulletin 2018-05 in October 2018, outlining rules for short-term health insurance in Ohio. The bulletin notes that while short-term plan duration can extend up to 364 days, the plans must be “one-time” policies in order to be exempt from many of the state’s rules for sickness and accident policies. The Department confirmed that “one-time” means that the plans cannot be renewable.
Until October 2, 2018, federal regulations limited short-term health insurance plans to no more than three months in duration, and prohibited renewals. But new rules finalized by the Trump administration in 2018 allow for much longer short-term plans, unless a state imposes its own restrictions.
Which insurers offer short-term plans in Ohio?
As of mid-2020, there were at least seven providers of short-term health insurance in Ohio:
- Advant Health
- Companion Life
- Everest Insurance
- Independence American Insurance Company
- National General
- Standard Life
- UnitedHealthcare (Golden Rule)
Who can get short-term health insurance in Ohio?
Short-term health insurance in Ohio can be purchased by residents who meet the underwriting guidelines used by insurers. This generally favors applicants under 65 years old (some insurers put the age limit at 64 years) and in fairly good health.
Short-term healthcare insurance plans typically include blanket exclusions for pre-existing conditions. Accordingly, they typically do not provide adequate coverage for someone who needs ongoing treatment for a chronic condition.
If you need health insurance coverage in the Buckeye State, the first step should be to check your eligibility for a special enrollment period that would allow you to enroll in an ACA-compliant major medical plan. There are a variety of qualifying life events that will trigger a special enrollment period and allow you to buy a plan through the health insurance exchange in Ohio. These plans are purchased on a month-to-month basis, so you can enroll in one (with a premium subsidy if you’re eligible) even if you’re only going to need it for a few months before another policy takes effect.
When should I consider short-term health insurance in Ohio?
Despite the limitations of short-term coverage (e.g., exclusion of pre-existing conditions, no coverage for outpatient prescription drugs, etc.), there are times when a short-term health insurance policy might be the least costly and most realistic option to use:
- 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.
People not eligible for premium subsidies include:
- Ohioans 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 a little above the subsidy-eligible threshold, there are steps you can take to reduce it).
- People ensnared by the ACA’s family glitch.
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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.