Short-term health plans in West Virginia
- West Virginia defers to federal rules for the maximum duration of short-term health plans.
- Short-term health plans can have initial terms of up to 364 days, and total duration, including renewals, of up to 36 months.
- Opioid Reduction Act’s insurance provisions do apply to short-term health insurance in West Virginia.
- At least five insurers offer short-term plans in West Virginia.
Short-term plans duration in West Virginia
West Virginia does not have regulations pertaining to the maximum duration for short-term health insurance plans, so the state defaults to the federal rules for short-term plan duration.
Until October 2, 2018, federal rules limited short-term plans to three months and renewals were not permitted. But the Trump Administration implemented new short-term insurance rules at that point, allowing the plans to have initial durations of up to 364 days. Renewals are permitted as long as the total duration of the coverage doesn’t exceed 36 months.
But renewability is optional for insurers, and insurers can choose to offer plans with shorter terms. Some of the insurers that offer short-term health insurance in West Virginia cap their terms at six months and don’t allow for any renewals.
West Virginia’s short-term health insurance regulations
Insurers that offer short-term health insurance in West Virginia are required to file rates and plans with the West Virginia Office of the Insurance Commissioner.
The state passed legislation (SB273) in 2018 designed to reduce opioid utilization, and the Office of the Insurance Commissioner confirmed that the insurance-related provisions of that bill do apply to short-term plans.
Which insurance companies offer short-term plans in West Virginia?
- Companion Life
- Everest Reinsurance
- Golden Rule (UnitedHealthcare)
- Independence American Insurance Company
- National General
Some of these insurance companies offer plans with one-year terms and renewability for a total duration of up to three years, while others limit their policies to shorter durations. The specific benefits and limitations of the plans vary too, so it’s important to carefully consider the details before purchasing any short-term medical plan, in order to understand whether it will actually meet your needs.
Who can get short-term health insurance in West Virginia
Short-term health insurance plans in West Virginia can be purchased by those who can meet the underwriting guidelines used by insurers. In general, this means being under 65 years of age (some insurers put the age limit at 64 years) and in fairly good health.
Since short-term health insurance plans typically include blanket exclusions for pre-existing conditions, they are not adequate for someone who is in need of medical care and seeking a policy that will cover those needs. And short-term plans are not required to cover the ACA’s essential health benefits. It’s common to see these plans exclude coverage for maternity care, prescription drugs, and mental health care, although the healthcare benefits and limitations will vary considerably from one policy to another.
If you’re in need of health insurance coverage in West Virginia, you’ll want to first determine whether you can enroll in an ACA-compliant major medical plan (ie, an Obamacare plan), either through the health insurance exchange (marketplace) in West Virginia or directly from an insurance company (note that while the plans will be fully compliant with the ACA either way, premium subsidies are only available if you enroll through the exchange).
Open enrollment for ACA-compliant plans runs from November 1 – 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. ACA plans are purchased on a month-to-month basis, so you can enroll in one even if you only keep it for a few months before another policy takes effect. So if you’ll soon be covered under Medicare, for example, or a new employer’s plan, you can still enroll in an ACA-compliant plan if you’re eligible to do so, and then cancel the coverage when the new plan takes effect.
And if you qualify for premium subsidies, the coverage may end up being much less costly than you had anticipated — perhaps even more affordable than a short-term health plan.
It’s also important to note that West Virginia has expanded Medicaid under the ACA. Adults under the age of 65 can enroll in Medicaid if their household income is up to 138 percent of the poverty level. And eligibility is based on monthly income, rather than yearly income. So if you’ve recently lost your job, for example, you may qualify for Medicaid to cover the gap until you’re employed again and receiving coverage under an employer’s healthcare plan.
But short-term plans can serve as a safety net if you’ve got no other alternatives.
When should I consider short-term health insurance in West Virginia?
- You missed open enrollment for ACA-compliant individual market coverage and do not have a qualifying event that would trigger a special enrollment period.
- You’ll soon be enrolled in Medicare and aren’t eligible for any other coverage in the meantime. Note that although you’ll receive your Medicare card about three months before you turn 65 (assuming you’re already receiving Social Security benefits), your Medicare benefits don’t start until the month you turn 65, so you do need other healthcare coverage up to that point.
- You’re newly employed and the business has a waiting period of up to three months before you can enroll in the group healthcare plan.
- You’ve already enrolled in an ACA-compliant plan, but have to wait up to several weeks until your new plan takes effect. For example, if you enroll during open enrollment, your new plan won’t take effect until January 1. And if you sign up during a special enrollment period, you’ll generally have to wait until the start of the following month or the second following month before your new plan is effective.
- You’re not eligible for Medicaid or a premium subsidy in the exchange, the monthly premiums for ACA-compliant plans might be too costly. People ineligible for premium subsidies include:
- Those earning more than 400% of the poverty level. (For 2021 coverage, that is $51,040 for a single person. If your ACA-specific modified adjusted gross income is somewhat above the subsidy-eligibility, there are steps you can take to reduce it).
- People trapped in the ACA’s family glitch.
- People who cannot enroll in a plan through the exchange because they are not lawfully present in the U.S.
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.