Availability of short-term health insurance in Pennsylvania

Yes. As of 2024, at least two insurers offered short-term health insurance in Pennsylvania.

Short-term health insurance in Pennsylvania does not have regulations pertaining to the length of time that a policy can remain in force, so the federal guidelines are used.

Trump administration rules for short-term plans that took effect in 2018 allow for initial terms of up to 364 days and total duration, including renewal, of up to 36 months.

However, in 2024, the Biden administration finalized new rules for short-term health plans. Short-term plans issued or sold on or after September 1, 2024 will be limited to total durations of no more than four months, including renewals. Initial terms will be capped at no more than three months.

Short-term health insurance in Pennsylvania is available to residents (individuals or families) who meet insurers’ underwriting guidelines.

To be eligible for short-term health insurance, an applicant generally needs to be under age 65 and not have any of the medical conditions that would cause the application to be declined.¹ But the specific requirements vary from one insurance company to another.

Short-term health insurance plans typically do not cover pre-existing conditions, and they often use post-claims underwriting (meaning that they will go back through a person’s medical records after a claim is filed, to make sure it isn’t related to a pre-existing medical condition).²

Short-term health plans are not required to cover the ACA’s essential health benefits; they often do not include coverage for maternity care, prescription drugs, or mental health care.¹ For the coverage they do provide, they generally impose dollar limits on the amount they will pay. It’s important to double-check all of the plan information before purchasing a short-term policy, to make sure that you understand the limitations of the plan.

If you’re in need of health insurance coverage in the Keystone State outside of the annual open enrollment period (November 1 to January 15), your first step should be to see whether you’re eligible 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 Pennsylvania (Pennie.com).

ACA plans are purchased on a month-to-month basis, so an eligible individual can enroll (with a premium subsidy if eligible) even if coverage is only needed for a few months before another policy takes effect.

Excluding coverage for pre-existing conditions can make short-term policies appear more affordable than ACA-compliant (Obamacare) policies. However, that upfront affordability disappears if you end up paying out of pocket for healthcare services related to an uncovered condition. That said, there may be situations when enrolling in a short-term plan might be an attractive option, 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 is typically a more affordable (but less comprehensive) stopgap than COBRA or an ACA-compliant plan, and it doesn’t have limited enrollment periods.
• If you will soon be eligible for Medicare and just need a few months of coverage to bridge the gap (note that you may then be subject to a pre-existing condition waiting period if you enroll in a Medigap plan, as your prior short-term plan might not be considered creditable coverage by the Medigap insurer).
• If you’re not eligible for Medicaid or a premium subsidy in the exchange, and aren’t able to afford the full price of an ACA-compliant plan.

An insurance agent or broker can provide information on the availability of various coverage options and help you evaluate the affordability of those options. Some things to keep in mind are the allowable plan durations, whether the insurer offers guaranteed renewability, and the specific benefits the plan covers.

Pay attention to things such as whether the plan covers outpatient prescription drugs (most short-term health insurance plans do not, but some do), whether it imposes dollar limitations on any specific type of service (such as inpatient care, surgery, etc.), and the overall policy benefit maximum.

HB695 introduced in Pennsylvania’s House of Representatives in February 2021, would have imposed strict limits on short-term health plans in the state if it had passed.

The measure was unsuccessful, but here’s what it would have done if it had been enacted:

• Limit short-term plans to 90-day terms, and prevent them from extending past the end of the year in which they’re issued (so a plan issued at the start of November, for example, could only have a tw0-month term).
• Prohibit short-term plans from taking effect in the next calendar year. This would prohibit short-term plans from being purchased during the ACA’s open enrollment period for use in the coming year, and would help to avoid confusion between ACA-compliant plans and short-term plans (all ACA-compliant plans sold during open enrollment take effect in the coming year).
• Allow short-term plans to be renewable, but only in the year that they’re purchased; the renewal could not extend the plan into the coming year.
• Prevent a health insurer from issuing more than one short-term plan to a given enrollee each year, and prevent a health insurance agent/broker from selling more than one short-term plan to a given enrollee each year.
• Require short-term plans to include disclosure language clarifying that the plan should not be considered a substitute for comprehensive major medical coverage.
• Require short-term plans to clearly state their medical loss ratios, and contrast them with the minimum 80 percent medical loss ratio that’s required for ACA-compliant plans.
• Require short-term plan marketing materials to clearly describe how the benefits would work for at least six common medical condition scenarios.
• Require anyone selling a short-term policy to provide verbal disclosure of the benefits and limitations of the plan, and get written confirmation that the disclosure was made.
• Prohibit short-term insurers from using post-claims underwriting; benefits determinations when claims are filed would be based on the enrollee’s application answers (unless the insurer can prove that the enrollee’s application was intentionally fraudulent), and could not involve an additional review of medical records after the claim is filed.