Expanded Short Term Health - Trump short term versus Obamacare
One of the main changes to short term by Trump is notification.
ACA stands for Affordable Care Act but it's commonly called Obamacare.
Or Exchange plans.
ACA plans have very defined requirements on what they cover.
Short term health plans do not have those requirements.
Part of the expansion of the new Trump short term plans is notification of these differences.
Let's touch base some differences between the two.
You can quickly quote the new Trump short term health plans here:
Feel free to jump to any section below:
Let's get started.
Keep in mind that these are the broad strokes.
It's really important to look at the exclusions and brochures for the new expanded Short term plans to understand all the differences.
The carriers will spell it out clearly as required by the executive action.
Here we go!
Obamacare or ACA is a law that did a few things starting back in 2014:
There lots of other changes but these were the big ones that really transformed the market.
Depending on where you were sitting, for much better or for worse.
If you get a tax credit or have more significant health issues, the ACA has been a huge benefit.
If you don't, the cost of coverage has roughly tripled.
The Medicaid/Medi-cal expansion has probably had the most effect.
We'll assume that the people who get tax credits or medicaid/medi-cal are not reading this article.
The reason for the Trump expansion of short term was to address the other people.
People who have either opted not to enroll due to cost or who can no longer afford to have ACA coverage.
Let's look at the response to them.
We've always had short term health plans.
Traditionally, they were designed to cover gaps in coverage.
3-6 months on average.
After 2014, they were expanded to almost 12 months as a response to the Open Enrollment requirement.
Some people would use short term to get there.
In 2015, Obama restricted the length of short term to 3 months.
The idea was to force these longer term short term health plan buyers onto the ACA market.
Most people who need longer term coverage don't take short term plans because they want to.
They can't afford the ACA plans or they just want catastrophic coverage.
Enter the Trump changes:
The Trump expansion had three main changes:
As we started with, we've always had short term, catastrophic plans on the market.
For decades now.
You can get short term plans to take you to Open Enrollment.
Up to 3 years potentially.
It's as if we had our pre-ACA health plans available for the most part.
There are big differences between these short term plans and ACA plans that we need to understand.
That goes to the 2nd requirement of the Trump expansion.
The law makes sure that carriers explain to enrollees that short term health plans are very different from ACA plans.
They are designed for catastrophic or major medical coverage.
The big bills!
It's more akin to what we had for health insurance when health insurance first started.
If you want to make medication costs come down, get rid of copays.
The explosive increase in medications is partially a disconnect between cost and the doctors/patients that use them.
The ACA law furthered this disconnect albeit with good intentions.
Either way, the Trump expansion requires that people understand the differences between the new short term plans and Obamacare.
Let's get into some of the big ones (beyond cost of course).
This is a big difference and drives most of the activity in short term.
For ACA plans you must enroll during two periods:
Most common SEP qualifying events:
Outside of these times or medicaid/medi-cal enrollment, we may be out of luck.
Short term may be the only option there.
Short term can be enrolled in year-round.
In fact, we can generally get coverage midnight following online enrollment.
You can quote/enroll in Short term here:
We do need to answer some medical questions so let's at our first big difference between ACA and short term health.
Make sure to check out the brochure but here's a good place to start:
Let's get into the details now.
If you enroll during the specified times mentioned above, ACA plans are what we call "Guaranteed Issue"� in the insurance world.
This means they can't decline you based on health.
That's why they have the enrollment periods to begin with.
Otherwise the costs will explode even after than they are.
Short term is medically underwritten.
This means that they can decline based on health.
It's also what we called "Simplified Issue".
That's fancy insurance speak for saying that the underwriting is much simpler.
You can access the online short term application here through the quote.
Once approved, what about existing conditions?
This is another big difference depending on your health.
ACA plans will not have waiting periods based on pre-existing conditions.
Short term plans will cover services related to pre-existing conditions.
Makes sure to check out the brochure for definition of pre-x conditions and period of time.
You can get access to the brochure through the online quote here or by email.
Just know that health care associated with a pre-x condition will not be covered under the old or new short term health plans.
ACA plans will cover maternity regardless of where you are in the pregnancy.
Short term health plans do not cover maternity.
Known pregnancy is a question on the application as well for qualifying.
Preventative benefits including annual routine physical and annual OBGyn visit are covered at 100% by all ACA plans.
Preventative benefits are not covered by the new Trump short term health plans.
Again, short term plans are designed to cover more catastrophic care.
At a reduced monthly premium if you're not getting a tax credit!
That's the trade off.
This distinction has been lessened with the Trump expansion.
Before, we could only get 3 month blocks and we had to re-apply for another block.
We were then usually out of luck.
That's 180 days.
Not enough to get us to Open Enrollment.
That was intentional!
Now, we can renew the short term up to 3 years.
3 x 364 days.
We do need to re-qualify based on health each period.
Ideally, you time this for Jan 1st each year so it ends at Open Enrollment in case we need to get on an ACA plan.
The big distinction here is outpatient versus inpatient.
The ACA health plans will cover outpatient medications (where you take a prescription to your local pharmacist)
The level of coverage depends on the plan of course.
For the Bronze plans, your RX is all subject to the main deductible (which is high) unless tied to preventative visits or birth control.
These are medications use while you're in the hospital.
What about the office visit...either general practice or specialist.
We covered preventative benefits above.
For office visits resulting from injury/illness, ACA plans will cover these according to the benefits of the plan.
For example, with the Bronze plan, you may have a limited number of higher copays and then subject to the deductible.
Short term health plans will apply the eligible costs for physician services towards the deductible.
With a PPO plan, you will get the negotiated PPO rates for ACA or short term which is probably the bigger savings.
That generally leads to a comparison against the Bronze plan!
Quoting the new short term coverage options is easy.
For new expanded Short term coverage:
We're happy to help with any questions at 800-320-6269 or by email.
There's no cost for our assistance and the rates shown are the best available.
This is one of the best parts about short term health plans.
The enrollment is online and easy.
It generally takes 5 minutes.
You can enroll right through the quote link here.
We're happy to help with this process!
We've covered a lot.
It can all be boiled down to this simple calculus.
The new expanded short term health plans are designed...
As long as we understand that, we're not going to be surprised.
Make sure to download the brochure for more detail on what's covered.
We're essentially insuring in 12 month blocks.
12 months is the new short term!
364 days to be exact.
There's ZERO cost for our assistance.
Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!
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