Starting today, Americans can buy lower-cost health insurance policies that can stay in effect for as long as three years — up from the previous three-month limit.
But while the savings in premiums will be attractive to some, critics warn the old adage applies: “You get what you pay for.”
“As the bills from hospitals and other providers start to pile up, many of these folks… would come to realize they’re not really insured at all,” the Georgetown University’s Center for Children and Families says. “For the individuals enrolled in these plans, the devastating financial consequences could be real and long term.”
Limitations of Short-Term Health Insurance Policies
The plans are cheaper — as much as one-third cheaper in some cases, according to the Department of Health and Human Services — than those that comply with the Affordable Care Act, which has required coverages. The average monthly premium for one person in late 2016 was about $124 compared with $393 for an unsubsidized plan that complied with the Affordable Care Act, according to the department.
But many lower-cost plans don’t cover services such as mental-health or substance-abuse treatment or prescription drug coverage, according to a Kaiser Family Foundation analysis.
And none covers maternity care, the same study found. A regular birth costs about $32,000 and a cesarean section about $51,000, according to a 2013 Truven Health Analytics study of women with health insurance.
Also generally excluded are people with pre-existing medical conditions, who are required to be covered under policies that comply with the Affordable Care Act. An estimated 133 million Americans have a pre-existing condition, according to the Department of Health and Human Services.
Why Are Short-Term Health Insurance Policies Being Expanded?
Premiums for Affordable Care Act coverage went up about 21% in 2017, putting them out of financial reach for some people — especially those whose earnings are not low enough to qualify for a subsidy under the act, according to the Centers for Medicare & Medicaid Services.
The Department of Health and Human Services this summer announced that it would allow the lower-cost plans to be purchased for up to a year of coverage and renewed for two years.
The policies originally were limited to less than three months and intended as a stopgap for people who didn’t have health insurance through their employers.
Which Consumers Might Benefit From Short-Term Policies?
They work best for those who are generally healthy, because insurers can drop anyone who becomes sick, according to the Georgetown University Center on Health Insurance Reforms.
The reason the short-term policies are less expensive — the cost varies from state to state — is that they don’t have to meet the requirements of the Affordable Care Act, also known as Obamacare.
That means they can exclude benefits such as emergency services, hospitalization, rehabilitative services and devices, laboratory services, preventive care, chronic disease management, contraceptives, breastfeeding supplies, counseling and pediatric services.
There’s no easy way to determine what services are covered because plans vary widely, as do deductibles, copayments, and caps.
Other possible pitfalls:
- The Department of Health and Human Services warns consumers that they won’t automatically be eligible to buy insurance through the Affordable Care Act if their short-term policy ends before the open enrollment period begins and they decide not to renew or are dropped by their insurer.
- Short-term policies don’t meet the requirements to maintain health insurance under the Affordable Care Act, making consumers who buy them potentially liable in 2018 for a penalty of $695 per adult and $347.50 per child — or 2.5% of household income, whichever is greater. The penalty goes away starting in 2019.
- Short-term policies generally have limits on the amount paid for services and caps on lifetime payouts. Patients may have to pick up the sometimes-substantial difference between what the insurer pays and what the provider charges.
- Policyholders can be charged more based on age, sex and health.
The bottom line: These policies may be beneficial to some. But it’s critical to read all disclosures before signing up to avoid finding out later that you don’t have coverage for something you need. What’s cheap up front could end up costing you dearly later.
In short: caveat emptor.
Susan Jacobson is an editor at Codetic.