1. SHORT TERM (STM) COVERAGE
STMs are considered major medical insurance and typically cover 100% of medical costs after a deductible and out of pocket maximum to a lifetime limit of up to $2 million depending upon the plan and carrier.
- Depending on the State, they now can be written for up to one year and can be renewed up to three years
- Note: California and several other States do not allow STM plans
- Short-term medical plans do ask medical questions, so you are not guaranteed to be approved for coverage and they generally do not cover pre-existing medical conditions and prescriptions
Benefits of STM Plans
- Most STM plans have broad network coverage
- Premiums are often low, in the range of half of ACA plans
- Apply all year round, not limited to Open Enrollment periods
Problems with STM Plans
- Pre-existing conditions coverage not available
- Applications may be rejected due to health status
- Poor prescription drug coverage
2. SPECIFIED BENEFIT LIMITED MEDICAL/INDEMNITY PLANS
These plans pay a specified dollar benefit for medical services such as hospitalization, surgery, and physician office visits.
Benefits of Limited Medical/Indemnity Plans
- Premiums can be very affordable
- Member receives a cash payment upon a qualifying event such as an accident, or specific critical illnesses, or hospital admissions as specified in the plan
- Applications can be made any time of the year, no waiting for Open Enrollment
- Usually are “guaranteed issue” which means there is no medical underwriting, so applications are not rejected due to health status of applicants
- Generally, these plans have pre-negotiated rates with a healthcare provider network
Problems with Limited Medical/Indemnity Plans
- Benefits are tied to specific incidences, such as an accident, critical illness, doctors visit, or hospital admission, depending on the policy
- No benefits for general conditions such as diabetes, arthritis, etc.
- Medical expenses often capped at a rate much lower than major medical plans
- Certain pre-existing conditions may be not covered for up to twelve months
3. MEMBER HEALTHSHARING ORGANIZATIONS
Benefits of Modern Member HealthSharing Plans
- Plans tend to mimic ACA mandates
- Monthly rates may be 40% to 60% less than the cost of ACA (Obamacare) plans
- The nation’s largest nationwide PPO network
- Enroll year round, no qualifying event needed
Problems with Member HealthSharing Plan
- Depending on Plan, maximum benefits may be limited to $1,000,000
- Limited drug coverage
- Any pre-existing conditions at time of enrollment will be excluded for up to 24 months
- Pregnancy benefits will be excluded for the first 10 months after enrollment
WHAT ARE MY OPTIONS FOR 2019?
- ACA plans with all the mandates and the waiver of pre-existing conditions.
- Non-ACA plans like Catastrophic Plans, Healthcare Sharing Ministries (religious and secular), Hospital Indemnity Plans, and certain types of Association Plans.
- Non-ACA Plan Article: 7 Reasons Modern HealthSharing is Better Than Insurance - Download Now
- Non-ACA Plan Article: Affordable Healthcare Options Guide - Download Now