Short-term health plans in Wisconsin
- Wisconsin statutes limit short-term health plan duration to no more than 12 months.
- Short-term health plans can be renewed but total duration can’t exceed 18 consecutive months.
- The rules for short-term health insurance in Wisconsin remain in place despite the Trump Administration’s relaxed regulations on short-term plans.
- At least eight insurers offer short-term health insurance in Wisconsin.
Wisconsin’s short-term health insurance regulations
Wisconsin health insurance regulations require short-term plans to conform to certain state mandates. But state law requiring uniform applications for major medical policies does not apply to short-term coverage as the state’s statute specifically excludes short-term plans from the definition of major medical coverage.
Short-term plans duration in Wisconsin
Short-term health insurance in Wisconsin is regulated by state statutes [Section 632.7495(4)] which limit short-term plan duration to no more than 12 months. The plan can be renewed — if the insurer offers that option — but the total short-term plan duration can’t exceed 18 consecutive months, including the initial term and subsequent renewals. After 18 months, the enrollee must have a break of at least 63 days before being allowed to sign up for another short-term plan from the same insurer.
Until October 2, 2018, federal regulations limited short-term health insurance plans to no more than three months in duration, and prohibited renewals. But the Trump Administration began allowing for much longer short-term plans as of October 2018, unless a state imposes its own restrictions. The rules for short-term health insurance in Wisconsin align with the new federal rules when it comes to the maximum initial term, but Wisconsin has different rules for renewals.
The Trump Administration’s 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 can impose stricter rules, and existing state rules will continue to apply. So in Wisconsin, the initial term of a short-term plan can be just under a year. But the total duration of a short-term plan, including renewals, is capped at 18 months.
Which insurers offer short-term plans in Wisconsin?
Several health insurance companies offer short-term medical plans in Wisconsin, including some that also offer ACA-compliant plans (in some states, the insurers that provide ACA-compliant coverage do not also offer short-term plans):
- Companion Life
- Everest Reinsurance Company
- National General
- UnitedHealthcare (Golden Rule)
- Wisconsin Physicians Service Insurance Corporation (WPS)
- Anthem/Compcare (Enhanced Choice plans; newly available in Wisconsin as of late 2020. Anthem’s marketing materials indicate that pre-existing conditions will be covered unless they’re specifically excluded, indicating that the medical underwriting will likely be more thorough than the process commonly used by short-term health insurers).
Who can get short-term health insurance in Wisconsin
Short-term health insurance in Wisconsin can be purchased by residents who can meet the underwriting guidelines of insurers. 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 medical insurance plans typically include blanket exclusions for pre-existing conditions, so these types of plans are not adequate for someone who needs medical care for ongoing or pre-existing conditions. (As noted above, Anthem has indicated that their new short-term health insurance plan will come with specific exclusions for pre-existing conditions — as opposed to a blanket exclusion — which is similar to how individual market health insurers treated pre-existing conditions prior to the ACA.)
If you’re in need of health insurance coverage in Wisconsin, your first step should be to see whether you’re eligible for a special enrollment period that you could use 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 Wisconsin.
If you buy an ACA-compliant plan in the individual major medical market, you can keep it for just a short while if that’s all you need. The plans are purchased on a month-to-month basis, so there’s no annual contract or requirement that you keep the policy for a certain amount of time. If you’re eligible for a special enrollment period, your best bet is to enroll in an ACA-compliant plan (with a premium subsidy if you’re eligible), even if you know you’ll only use it for a short period of time and plan to terminate the coverage when another plan takes effect.
When should I consider short-term health insurance in Wisconsin?
Short-term health insurance plans tend to have significant coverage limitations, and often do not cover various essential health benefits, including prescriptions, maternity care, and mental health care. They also tend to have limitations on the total amount of benefits that the insurance company will pay on your behalf. So it’s important to carefully read the plan information before purchasing a policy. But depending on the circumstances, a short-term medical plan might be your best or only option. This includes situations like these:
- You missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period for ACA-compliant healthcare coverage.
- You’ll be eligible for Medicare soon and need something to bridge the gap before your Medicare coverage takes effect (note that although Medicare coverage is guaranteed-issue for eligible enrollees and covers pre-existing conditions right away, insurers can impose a pre-existing condition waiting period for Medigap plans; if you have a pre-existing condition and it’s not covered by the short-term plan you have prior to Medicare enrollment, your Medigap insurer may make you wait up to six months before they’ll cover the pre-existing condition).
- You’re newly employed and have enrolled in your employer’s health plan but have a waiting period before it takes effect (if you also have a qualifying event that would allow you to sign up for an ACA-compliant individual market plan, you can use that instead).
- You’re employed by a small business that does not provide healthcare benefits for its workers, or you missed your employer’s open enrollment period for health benefits and do not qualify for a special enrollment period. During the next open enrollment period for individual market plans or your employer’s plan, you should enroll if at all possible. But until that point, a short-term health plan can provide coverage for unexpected medical events.
- You’re not eligible for Medicaid or a premium subsidy for an ACA-compliant plan through the marketplace. This includes people who
- Earn more than 400% of the poverty level. (For 2021, that amounts to $51,040 for a single person. If you find your ACA-specific modified adjusted gross income is a bit higher than the subsidy-eligible threshold, there are steps you can take to reduce it).
- Are ineligible for subsidies due to 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.