Short term health insurance cost
Generally speaking, buying Short Term Limited Duration health insurance costs less per month than buying an Affordable Care Act (ACA) plan, making Short Term seem like a more affordable health insurance option. However, saying Short Term insurance is cheap health insurance and ACA plans are expensive health insurance based only on monthly premium cost is too simple.
Short-Term health insurance and longer term ACA plans are different products for different situations. To determine if a temporary health insurance plan is a good option for you and your family, you need to consider a number of cost issues.
Short term health insurance vs. ACA insurance
Penalties, exemptions and subsidies, oh my!
When understanding the difference between short term health insurance and ACA insurance, the first and last thing to remember is this: Short-Term insurance plans don’t meet the minimum essential coverage (MEC) standards of the ACA, also known as Obamacare. They are designed solely to provide temporary health insurance during unexpected coverage gaps.
That said, having Short-Term insurance used to mean you were subject to a federal penalty for not having MEC. However, as of 2019, there is no longer a federal tax penalty for not having MEC.
That extra federal cost for having Short-Term health insurance is now gone, which may slightly lower the cost of choosing short term health insurance. Penalties may vary by state. Consult your tax advisor for more information.
No credits or subsidies with short term health insurance
You may be giving up on help by choosing a Short Term health insurance plan. If you get an ACA health plan, you may be eligible for help paying for your insurance in the form of:
- Tax credits on your premium
- Cost sharing reduction subsidies that can lower what you pay out-of-pocket for copayments, deductibles and coinsuranceF26
In contrast, Short Term insurance plans do not qualify for any credits or subsidies which affect your health insurance cost and short term health insurance rates.
Tips for saving money on the cost of short-term health insurance
The government may not help you cut your costs on Temporary medical insurance, but by using these tips, you can take action to find the best Short-Term health insurance rates for your situation and cut your costs:
- Choose a higher deductible. The deductible is what you have to pay of the expenses covered by your insurance plan before the insurance will pay anything. If you choose a higher deductible, meaning you pay more before the insurance starts paying, you can reduce your premium.
- Stay in-network for care. In-network health care providers agree to provide care at lower fees. If you stay with in-network doctors and providers, you can save money.
- Choose a plan with fewer benefits. You can get different levels of Short-Term health insurance coverage with different benefits for different prices. For example, you can control if the plan you choose includes copays for a doctor's office visit or if you want to include prescription coverage.
Exemptions to the ACA tax penalty
Although the federal tax penalty for not having minimum essential coverage no longer applies, some state penalties may still apply to your situation.
Seek out a qualified tax advisor if you have questions about potential state penalties or you think you might qualify for an exemption.
What you pay for short term health insurance costs after your premium
Once you have your Short Term health insurance plan in place, you need to understand four key concepts to keep an eye on your health insurance cost:
- Deductible
- Out-of-pocket maximum
- Copay
- Coinsurance
Deductibles and out-of-pocket maximums: Taking it to the limit
- Your deductible is the amount you have to pay for expenses covered by your insurance plan before the insurance will pay anything.
- Your coinsurance out-of-pocket maximum is the most you will pay during a term toward coinsurance expenses covered by your plan.
So, generally speaking, when you hit your deductible, your insurance plan starts paying toward your covered expenses. Then when you hit your coinsurance out-of-pocket maximum, you stop paying coninsurance on your covered expenses. Insurance pays 100% of them after that point up to the policy maximum.
Copays and coinsurance: Clearing up the "co-fusion"
- A copay is fixed-dollar amount you have to pay to receive certain services. For example, you may have a $50 copay for a doctor visit or a $20 copay for prescription drug you take. Note: Usually, copays do not count toward your deductible. Check your plan for specific information.
- Coinsurance is the percentage you pay of your covered medical expenses after you've met your deductible. So if your coinsurance is 30%, then after you meet your deductible, you would pay $30 of every $100 of any covered expenses. You pay that percentage until you hit your coinsurance out-of-pocket maximum.
Note: Some Short Term insurance plans do not pay any out-of-network benefits, meaning in those cases, you would be responsible for any medical expenses from care provided by a doctor or facility not in the plan's network. Also, some plans do not have an out-of-pocket maximum. With those plans, you would keep paying your coinsurance rate for any covered medical expenses. Check your plan brochure for details and understand your payment responsibilities before you buy.
What you pay for covered expenses (In-network example for 70/30 coinsurance)
| You pay 30% of covered costs (for example) | Insurance pays 70% of covered costs (for example) |
Shopping for short-term insurance? This is important
As you are shopping, remember that Short-Term insurance plans and ACA plans are not comparable products.
ACA health plans are guaranteed issue, meaning you cannot be denied coverage based on preexisting conditions. Also, ACA plans are required to cover certain minimum essential health benefits. Also, generally speaking, as long as you pay the premium, you can keep your ACA health plan.
Short-Term health insurance is not required to cover the same benefits.F9 Plans can vary in what they cover. Also, they typically do not cover preexisting medical conditions. A series of medical questions determines your eligibility for these plans. Also, short term insurance is only available for up to 4 months total coverage (3 months + a 1-month extension) in a 12-month period.
So, while you may save money choosing Short Term, be sure you are paying for the right coverage for you before you buy.
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