We all desire protection under a health insurance plan to cover our medical needs. No one wants to face having to visit the doctor, or, worse, a hospital stay without health coverage. There are moments in life when we may experience small gaps in our health insurance coverage, whether you are between jobs or waiting for Open Enrollment for a Marketplace plan.
What matters is how much we will pay for treatment because of our uninsured status. Will you wait out the probationary period of your new employer, or is there a way to pick up a temporary form of health insurance to bridge the gap between losing coverage with one source and picking it up elsewhere, and if so, how long can you keep that short term insurance in Texas?
What is Short Term Health Insurance in Texas?
Short-term health insurance is a policy designed to help bridge the gap between insurance policies you carry. For example, when you leave an employer, you lose your insurance benefits. Meanwhile, your new employer will most likely have a waiting period before you begin receiving coverage under their benefits package. Rather than face having no coverage at all, you may want to consider a short-term health insurance policy.
First, when you talk about Short-term health insurance, it must be understood that it is not intended to be a permanent solution to a health coverage need. But it meets a need of those seeking coverage. So, let’s begin by reviewing what short-term health insurance is not:
- Short-term Health Insurance is NOT an Affordable Care Act insurance plan: STH insurance is not a replacement for ACA compliant health insurance. The plan does not meet the full list of mandated essential coverages and is not considered credible coverage. If you live in a state that still mandates health insurance, this would not meet ACA guidelines.
- Short-term health insurance is NOT guaranteed insurance: One must qualify for STH insurance through medical underwriting. When you apply you will be asked about your medical history of diagnosis or treatment for the last 2 to 5 years If you have a pre-existing health condition, you may either be denied coverage, or your insurance policy will carry a rider that will exclude coverage for that condition. Also, if you develop a health condition while on the insurance when you attempt to renew, you may not be able to renew your policy.
- Short-term health insurance IS available year-round: One does not have to wait for a special enrollment period to qualify for coverage. All you need to do is fill out the application and submit it to the insurance company that offers the plan.
- Short Term health insurance IS customizable: In some cases, you can customize your policy to lower your costs. Depending on the provider, you can adjust your deductible to lower your monthly premium or add or subtract benefits like prescription coverage. You can also pay the premium for your policy upfront, this can save you monthly costs and could warrant a discount. Another deductible option that can save an insured money is called per cause. This is a sliding scale deductible depending on the illness or injury.
STH insurance policies are never designed to be a permanent solution to your healthcare needs. But they can provide you with the ability to see a doctor when you need it most. But you may wonder, if they are not intended to be permanent, how long are short-term health insurance policies meant to last?
Are Short-Term Health Insurance Policies Limited on How Long I Can Have Them?
We just learned that STH insurance is available year-round, but is there a limit on how long you can have a short-term policy? The term ‘short term’ leads one to believe it would determine how long one can hold a policy. But just how ‘short-term’ is ‘short-term?’
There are a few different ways to go about using short-term health insurance
- You are close to the Marketplace’s Open Enrollment period but don’t want to wait to have medical insurance coverage. If you want health insurance and don’t want to wait for the end of the year’s Affordable Care Act open enrollment period, a short-term policy can provide temporary coverage.
- You are within an employer’s new hire period. Some employers require employees to work a certain length of time before benefits kick in. As discussed earlier, short-term health insurance can bridge the gap between new hire and employer benefits.
- If you will soon qualify for Medicare. You may think it pointless to purchase any type of health insurance right now, be it from a private insurer or an ACA policy, because you’ll soon be covered under Medicare. A short-term health insurance policy may be what you need to get you to Medicare. Just know that not all companies will offer this option if you are over 64 years old.
- Those financially in between Medicaid and ACA insurance. Sometimes short-term insurance may be your only option if you find yourself in the position of not qualifying for Texas Medicaid and the Marketplace insurance is too expensive. The danger you run into here is that once you are diagnosed with a condition and come up to your next renewal, chances are you will be denied coverage.
Now that we know how you can obtain it, let’s take a look at how long you can keep your policy once you are under it.
The good thing about short-term health insurance in Texas is that if you are healthy, once you have your policy, you are good to go for your basic health coverage. I say basic because STH insurance only meets four of the ten ACA health insurance-mandated essential coverage options.
Some of the six coverage benefits that are not covered are:
- Maternity care – If you plan to become pregnant, you will want to wait until you are covered under your Marketplace or employer’s insurance policy before you take that step.
- Dental and Vision care – Neither teeth nor eyes have any maintenance coverage. So, if you wear glasses or need a tooth pulled, you would not want to use this type of insurance as a long-term solution.
- Preventive Care – This can vary by insurance company. If the insurance does not have coverage, it would mean physicals and checkups by your Primary Care Physician would be an out-of-pocket expense. This includes immunizations. However, you can find insurance companies with policies that provide preventive care but at a copay. We talked a bit about customization earlier, this is where this benefit comes into play.
- Prescription Drugs – In the state of Texas, most STH insurance plans cover this benefit. I put prescription drugs here because of their cost; they can be rather high, even with the discount. You may be able to find a pharmacy drug program that could give you a better discount.
While your short-term health insurance in Texas is limited in coverage, you are able to hold your policy for up to 12 months. After that period ends, some companies allow renewals for an additional two years without going through the underwriting process.
Where Can I Buy Short-Term Health Insurance?
Short-term health insurance is not as easy as clicking on an insurance provider’s website and applying for it. This type of insurance is limited in its availability. In Texas, only nine providers offer these policies.
- Companion Life
- Everest Reinsurance
- Independence American Insurance Company
- Allstate Health Solutions
- Standard Security Life Insurance Company
- United Healthcare (Golden Rule)
- United Security Health and Casualty
A few other companies offer policies but do not have an online presence. These are Moda Health, Philadelphia America Life Insurance Company (New Era), and United States Fire Insurance Company. To obtain a policy, you would need to apply directly with a licensed agent contracted with the company. Location is also a consideration when searching for your STH Insurance provider. Some companies are only available in certain locations.
Maintaining health insurance coverage is important to keeping yourself healthy and financially secure. When you experience a lapse of coverage, you can have short-term health insurance to prevent the stress that would be caused by an unexpected accident or sudden illness onset. Your coverage will help until you are picked up by your employer’s coverage, or you reach Open Enrollment for Marketplace coverage, even up to three months in some cases.
As a reminder, short-term health coverage is not a replacement for permanent health insurance. It is limited in its coverage, and should you develop any condition, when you renew, you will most likely not be renewed. Cover Mile desires to assist you in finding the best health insurance policy to fit your situation. From Short Term Health Insurance to ACA Marketplace plans, we can guide you in providing your family with the protection you need. Contact us today.