Availability of short-term health insurance in Virginia

Virginia limits the initial term of a short-term health insurance policy to no more than three months. Coverage can be renewed (if the carrier allows renewal) but can last no more than six months including the renewal.²³

In addition, a short-term policy cannot be sold or renewed it if would result in the buyer having more than six months of short-term coverage in any 12-month period. In other words, a person cannot string together multiple back-to-back short-term policies.²

And short-term health insurance in Virginia cannot be sold during the open enrollment period for individual-market coverage that starts on November 1 each year.² Washington and Maine have similar rules.

Virginia’s rules regarding short-term health insurance policy durations and the ban on sales during ACA open enrollment are a result of legislation the state enacted in 2020.⁴

Virginia requires short-term health insurance policies to cover – at a minimum – emergency services, hospital and physician care, out-patient medical services, surgical benefits, radiology, and laboratory work.⁵

Short-term health insurance in Virginia can be purchased by applicants who meet the insurers’ underwriting guidelines.

In general, people can qualify for short-term health plans if they’re under 65 years old and do not have a specific medical condition that will result in a declined application.⁶ But the underwriting rules vary from one insurance company to another.

Short-term health insurance plans typically exclude coverage for any pre-existing conditions, and they often use post-claims underwriting. This means that if a claim is filed, the insurer can look at the person’s medical history to ensure that the claim is not related to a pre-existing medical condition.⁷

Short-term health plans also generally exclude coverage for some of the ACA’s essential health benefits. The most commonly excluded are maternity care, prescription drugs, and mental health care.⁶ And they typically impose dollar limits on the coverage they do provide.

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 need health insurance coverage in Virginia outside of the annual open enrollment period for ACA-compliant individual market plans, you’ll want to first check to see if you might be eligible for a special enrollment period that would allow you to enroll in an ACA-compliant plan.

A variety of qualifying life events will trigger a special enrollment period and allow you to buy a plan through the health insurance exchange in Virginia (a state-run platform called the Virginia Health Insurance Marketplace).

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.

Virginia has expanded Medicaid under the ACA, so you may find that you’re eligible for Medicaid, depending on your income.

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 deductibles and coinsurance) or medical costs for a condition that isn’t covered by the plan.

Whether on the shores of Virginia Beach or riding high in the Shenandoah, you might find a situation where a short-term health plan might be a viable 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 may provide a lower-premium (but less comprehensive) stopgap than COBRA or an ACA-compliant plana (if you’re eligible for a Marketplace subsidy and you have a special enrollment period for a Marketplace plan, you might find that the after-subsidy price is even lower than a short-term policy, but this will depend on your household income).
• If you will soon be eligible for Medicare and don’t have access to other health insurance in the meantime.
• If you’re not eligible for Medicaid or a premium subsidy in the exchange, an ACA-compliant plan might be unaffordable.