Short-Term Medical Insurance: Frequently Asked Questions
Temporary coverage when you need it most. Find answers to your questions about Short-Term Medical Insurance plans, coverage options, costs, and eligibility requirements.
Understanding Short-Term Medical Insurance
1
What is Short-Term Medical Insurance?
Short-Term Medical (STM) insurance provides temporary coverage for unexpected medical expenses due to illness or injury. These plans typically last from 30 days to 12 months, depending on state regulations, serving as a bridge when you're between permanent health insurance options.
2
Who is Short-Term Medical Insurance for?
STM plans are ideal for individuals between jobs, waiting for employer benefits to begin, recent graduates, early retirees, or those needing coverage outside open enrollment periods who don't qualify for a Special Enrollment Period (SEP).
3
Is Short-Term Medical Insurance ACA-compliant?
No. STM plans do not meet the Affordable Care Act (ACA) requirements, meaning they may not cover pre-existing conditions, preventive care, or essential health benefits. They are designed as a temporary solution rather than a long-term alternative.
Coverage & Benefits
What STM Plans Typically Cover
Emergency room visits
Hospitalization
Doctor visits
Some prescription drugs
Urgent care
Coverage varies by plan, so always review your policy details carefully before making a decision.
What's NOT Covered
Pre-existing conditions
Maternity care
Mental health services
Preventive care (annual checkups, vaccines)
Prescription drugs (limited or excluded)
Provider Networks
STM plans often have a network of preferred providers, but out-of-network care may cost more. It's important to check your plan's provider directory before selecting coverage to ensure your preferred doctors are included.
Costs & Payments
Premium Costs
Premiums vary based on your age, location, and coverage level. While STM plans are often more affordable than ACA plans, they come with higher out-of-pocket costs for services not covered. Be sure to calculate potential total costs when comparing plans.
Out-of-Pocket Expenses
Your plan will have a deductible (the amount you pay before coverage starts), copayments (fixed costs for certain services), and coinsurance (your share of costs after meeting the deductible). These can significantly impact your total healthcare expenses.
Cancellation & Refunds
Most STM plans allow cancellation at any time, but refunds are not guaranteed. Some plans may offer a pro-rated refund, while others may not. Always check your specific policy terms regarding cancellation policies.
Enrollment & Eligibility
1
Application Process
You can apply at any time, as STM plans are not subject to ACA open enrollment periods. The application typically includes a health questionnaire, and coverage can begin as soon as the next day after approval.
2
Medical Underwriting
Yes. Insurers may deny coverage or charge higher premiums based on your medical history. This differs from ACA plans, which must accept all applicants regardless of health status or pre-existing conditions.
3
Renewal Options
Renewal depends on state regulations and the insurer. Some states allow back-to-back policies, while others limit coverage duration. Once your policy term ends, you may need to reapply and go through medical underwriting again.
Claims & Support
Filing Claims
Most providers allow claims to be submitted online through the insurer's portal, by phone, or by mail. Check your plan's specific claim submission process and deadlines to ensure proper handling of your medical claims.
Processing Times
Processing times vary by insurer, but most claims are processed within 30-45 days. You may receive a notification if additional information is required to complete the claim processing.
Customer Support
For questions about coverage, claims, or billing, contact your insurance provider's customer service, your insurance agent or broker, or the claims department listed on your policy documents.
Making the Right Choice
State Availability
Some states restrict or prohibit STM plans. Always verify availability in your state before applying, as regulations vary significantly across the country.
1
Compliance
STM plans comply with state-specific laws and regulations, which may include restrictions on policy duration, renewals, and exclusions.
2
Temporary Solution
STM plans are temporary solutions and not substitutes for long-term health insurance or ACA-compliant plans. They're best for bridging coverage gaps.
3
Comparison Factors
When choosing a plan, review coverage limits and exclusions, compare deductibles, copays, and coinsurance, check provider networks, and understand state regulations.