Short Term Medical (STM) Insurance provides health insurance for individuals and families in times of transition. STM insurance covers the need for temporary medical coverage. It is an alternative to Qualified plans whenever those plans are either unavailable (i.e., outside of Annual Enrollment Period) or unaffordable.
When may you need STM Plans?
Use Short Term Medical (STM) Insurance if:
- You are the newly hired in the waiting period (before health insurance benefits begin)
- You’ve lost the job coverage, or you are between the jobs
- You are a student or graduate without coverage under your parent’s plan
- You are retired and waiting for Medicare eligibility
- You have just returned from active military duty
Short Term Medical Insurance Benefits
Short Term Medical Plans are not limited to medical or mini-med plans. They are truly Major Medical Plans covering the following expenses (but not limited to):
- Inpatient Covered Expenses (Room and Board, Intensive care or Specialized care unit, Operating and Recovery Rooms, Doctors’ Visits, Prescription Drugs)
- Emergency Room, Outpatient hospital or Ambulatory center
- Physician Services for treatment and diagnostics
- Outpatient Expenses (X-ray, Laboratory test, and analysis, Mammogram, Pap Smear, PSA Screening)
- Prescription Drugs
STM Plan Selections
Most STM plans are available for the coverage period up to 90 days. No extensions are allowed. Although STM plans are not renewable, if your need for temporary health insurance continues, most states allow you to apply for a new plan. The next coverage period is not a continuation of the previous period; it is a new plan with a new deductible, coinsurance, and pre-existing condition limitation.
P.S. The recent regulation now allows STM plans last up to 12 months, and consumers will be able to renew them for a maximum of 36 months.
The deductible choices (per person) are typically from $1,000 to $5,000. The deductible must be paid before the coinsurance benefits begin.
Office Visit Copay
Some plans allow office visit copay that is not subject of deductible – typically $50 per visit. The number of allowable copays depends on the lengths of coverage. Any office visits above the permissible number are subject to deductible and coinsurance.
Coinsurance percentage and Out-of-pocket
After the deductible has been met, the STM plan pays the selected coinsurance percentage of covered charges. The typical coinsurance percentages are 80%, 70%, and 50%. The insured person will be responsible for the remainder 20%, 30% or 50% until the selected Out-of-pocket amount has been reached. The range of Out-of-pocket is typically between $2,000 and $10,000; it does not include the deductible. One the Out-of-pocket has been reached, the insurance company pays 100% of covered charges up to the maximum benefit (typically $1-$2 million).
Short Term Health Plans do not cover preexisting conditions (defined as conditions within 3-5 years before coverage has begun). They also have a list of limitations and exclusions that you should become familiar with.
If you’ve filed a claim under existing policy, your policy may NOT be renewed, but another policy may be suggested.
STM Plan Cost
STM insurance plans are NOT Affordable Care Act compliant. In other words, their benefits are more limited and not being Guaranteed Issue Plans, they use preexisting conditions as a screening mechanism. Therefore, they are much more affordable in comparison with fully priced Obamacare plans (i.e., without subsidies).
Let Liberty Medicare help you choose a Short Term Health Insurance Plan
Liberty Medicare is here to help you during every stage of selecting and enrolling in the best and most suitable Short Term Health Plan for you.
As an independent insurance agency, we will provide you the benefits of objectivity in reviewing multiple plans. We’ll help you to understand the insurance industry jargon and ‘fine print’.
If you are considering buying a Short Term Health Insurance Plan, let us guide you. All our services are offered to you at no cost. To see real quotes from insurance providers, fill out our Individual Health Quote form or give us a call at 877-657-7477.