SCOTTSDALE, Ariz.--(BUSINESS WIRE)--Pivot Health, a leading direct-to-consumer provider and manager of specialty health insurance products, today released a statement from Jeff Smedsrud, Chief Executive Officer of Pivot Health, with answers to the top questions consumers have about short term health insurance.
Smedsrud is widely known as an expert on individual health plans and has testified before Congress and written extensively about the pros and cons of various health insurance plans for those not covered by employer-paid plans.
“As we begin the health insurance open enrollment period, there are many misconceptions about short term medical insurance in the marketplace. It can be very good insurance, despite what some skeptics claim but it’s also not a solution for everyone,” said Smedsrud. “It serves a niche market. Consumers need to know what to look for when shopping during open enrollment and learn about their options to ensure they get a health plan that’s right for them.”
Smedsrud outlined the top questions consumers often ask about short term medical plans when shopping for health insurance coverage:
Why do short term medical plans cost less than individual health
insurance?
Short term health plans are a temporary coverage
option. The longer time period that coverage is provided, the more
expensive it becomes. Plans that cover individuals for 12 months are
costly than those for only 90-days. Short term plans are not available
in all states and are not required to offer essential benefits like an
Obamacare (ACA) plan.
Are short term health plans a replacement for individual health
insurance on the federal or state exchanges?
No. Short term
medical insurance is meant to cover someone temporarily (up to 364 days
in many states). Short term insurance carriers are also allowed to ask
medical questions to determine eligibility. These plans are not for
individuals who have a pre-existing condition or have been advised by a
doctor that they need medical treatment in the near future. Those
individuals should enroll in an ACA plan.
If I am eligible for a subsidy to pay part or all of the cost for
an Obamacare plan, should I consider a short term plan?
In
most instances, no. Obamacare plans offer more comprehensive benefits,
and don’t exclude pre-existing coverage.
Is there a different type of doctor network? How are claims paid?
Every
short term medical plan is different, so it’s smart to check the
network. Many plans do not have a doctor network, allowing you to see
whomever you would like. In this instance, medical claims are paid based
on the Medicare reimbursement scale, in which the amount paid is usually
25% more than providers are paid for treating those on Medicare. This
allows consumers the freedom to see any physician they would like, which
is especially helpful if they live in a rural area or don’t have network
options that are convenient.
Do short term health plans offer the same benefits as individual
health insurance?
No. Since short term plans are meant to
be temporary, some services like maternity and preventive care are not
covered. However, in some states, certain types of women’s wellness
screenings are covered. A policy’s plan detail will provide all of the
limitations the coverage would have.
I’ve read that short term medical plans don’t cover prescription
drugs or mental illness services. Is that true?
False.
Again, not all short term health plans are the same so it’s important to
compare apples-to-apples when shopping for a new plan. There are some
short term medical plans that offer drug coverage and will pay for
mental health services. Many offer doctor office copays and Urgent Care
coverage as well. Always read a plan’s details and fine print before
buying.
If I am not eligible for an Obamacare subsidy, should I think
about buying short term medical?
Perhaps. It will
certainly be less expensive. And, there is no longer a penalty for not
buying coverage. However, there are risks if a person has very large,
ongoing medical expenses. It could be a temporary fit, but not a
permanent fit.
“During open enrollment, it’s vital for individuals to size up their past health care experiences and current health needs when determining what type of plan to buy for the next year,” said Smedsrud.” And then they need to spend time shopping and comparing what their options are. The key is to shop. No two plans are exactly alike, and no two consumers have exactly the same needs.”
About Pivot
Health (a HealthCare.com company)
Launched in 2016, Pivot
Health is an insurance product development, management and marketing
company led by an experienced team of health insurance professionals
that have managed over $7 billion of insurance premium. The company has
proprietary products and dedicated relationships with several national
carriers. Pivot Health was acquired by HealthCare.com,
the nation’s largest privately-owned search-and-compare health insurance
shopping platform. For more information, visit www.pivothealth.com
and www.healthcare.com.
