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Short Term Health Insurance and the Affordable Care Act

It’s no secret that the world of health insurance can be complex and confusing. After all, its landscape is constantly shifting and reforming in response to changes in law and policy. Here at Pivot Health, we’re dedicated to empowering coverage seekers across the country by providing them with simple and honest answers to all of their insurance questions. Today, we’ll be discussing how short term health insurance works with the Affordable Care Act (also known as the ACA or Obamacare).

To begin, let’s go over what the Affordable Care Act is and why it exists.

The Affordable Care Act

The ACA is a comprehensive healthcare reform law in the U.S. that was first introduced in 2010. According to HealthCare.gov, these are the three primary goals of the law:

Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.

Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)

Support innovative medical care delivery methods designed to lower the cost of health care generally.

Simply put, Obamacare was created to make the process of acquiring medical coverage easier and more affordable for families while decreasing the overall price tags on healthcare expenses. This law also guarantees that all new major medical plans sold today will offer the following ten essential benefits:

  1. Outpatient care
  2. Preventative care
  3. Lab testing
  4. Emergency room visits
  5. Hospitalization
  6. Prenatal and maternity care
  7. Prescription drugs
  8. Mental health services
  9. Rehabilitative care, including equipment
  10. Pediatrics services, including dental and vision for children

Furthermore, Obamacare ensures that all major health insurance plans offered on the marketplace and through private brokers are ACA-compliant. Consequently, you can’t be denied for one of these plans due to a pre-existing medical condition. This procedure exists to make sure that individuals who are suffering from a chronic illness or affliction will always have access to high-quality coverage.

As you can see, Obamacare has made some incredible and beneficial changes to the U.S. health insurance market. However, the plans that it offers leave much to be desired. Obamacare plans can subject members to incredibly high monthly premiums. It’s also worth noting that the cost of health insurance plans for individuals and medical deductibles are continuously rising as time goes on. A majority of families in the U.S. simply can’t afford to pull hundreds upon hundreds of dollars out of their monthly earnings, which is why many are seeking out alternative coverage options.

Additionally, the ACA introduced special sign-up deadlines for most major health insurance plans (excluding certain private companies that follow their own insurance scheduling). For instance, if you want to purchase coverage for 2018, you will need to enroll between the dates of November 1st, 2017 and January 31st, 2018. As a result, if you lose access to coverage for whatever reason (loss of a family member, a decrease in working hours, being let go by your current employer, etc.) and don’t qualify for a special enrollment period, you may be forced to wait several months for an opportunity to obtain a different major medical plan.

Fortunately, whether you’re struggling to acquire insurance due to financial constraints or the inability to enroll, there is a superb coverage option that can protect you and your family from the burden of medical expenses: short term health insurance.

Short Term Health Insurance Benefits

Believe it or not, short term medical plans from Pivot Health can cost 50% less than an Obamacare plan while offering many of the same benefits. And, unlike Obamacare, our plans don’t subject you to specific times of the year when you can enroll. Pivot Health products can be purchased at any time for a minimum of 30 days or maximum of 90 days, making them a fantastic coverage option for individuals who are waiting for the next enrollment period. (We also allow members to sign up for four 90-day periods to provide nearly one year of coverage). You can apply within minutes, and receive instant approval. Best of all, your plan can begin in as little as 24 hours, granting you near-instant access to phenomenal coverage.

Here’s a quick run-through of the key features that our plans provide.

  • Up to $1,000,000 in benefits per coverage period
  • Deductible options of $1,000 to $10,000
  • 20 percent coinsurance on all plans
  • Freedom to choose any doctor or hospital – no networks
  • Coverage from 1 month to 364 days (Coverage periods available vary by state)
  • On select plans, separate $500 prescription drug deductible, plus generic and brand prescription copay options
  • On select plans, $30 primary physician copay, $60 Urgent Care and specialty physician copay benefits
  • Maximum out-of-pocket as low as $3,000 per person, per coverage period on select plans
  • Child-only coverage available
  • Ovarian cancer screen and one annual pap smear per year, per covered female age 18 and over

All Pivot Health short term plans also include non-insurance benefits to help you save your hard-earned money on everyday medical expenses, including:

1. Doctor Consultations by Telephone or Video, 24/7 for only $49

Connect with a highly qualified physician at a cost much lower than a standard office visit. These remote doctors are driven and passionate healthcare experts with an average of 15 years of experience in patient care. Use these inexpensive and convenient consultations to address and diagnose minor health issues from the comfort of home and have prescription medication sent to your pharmacy of choice.

2. Savings of up to 70% Off Prescription Drugs

As a Pivot Health member, you can text or email prescription drug discounts to your phone (or print off a prescription drug card) for immediate use at more than 66,000 pharmacies nationwide, allowing you to save big on these invaluable medical commodities.

3. Discounts of 15%-30% Off Eye Exams, Lenses, Frames and Contacts

To mitigate the financial strain of eye care and prescription eyewear, Pivot Health provides substantial discounts on eye examinations, lenses, frames and contacts.

See our product brochure for short term medical for more information on these benefits.

Now that you have a solid understanding of what high-quality short term medical plans can offer, it’s time to explain how they work with ACA compliance policies.

Short Term Medical and ACA Compliance

Short term health insurance plans do not meet the minimum essential coverage that satisfies the health coverage requirement of the Affordable Care Act. These plans aren’t ACA-compliant, which means they don’t offer the same protection and rights that major medical plans do. Furthermore, in most cases, short term medical plans will not cover as many medical services and treatments as long term plans. That’s because short term health insurance is designed to fill gaps in your coverage and offer you a temporary insurance solution while you seek out alternate employer benefits or a long term plan.

Here are a few situations where seeking short term coverage is the right decision.

  1. When you have missed the open enrollment period
  2. When you are unemployed temporarily
  3. When you are looking for an alternative to COBRA
  4. If you are an adult child who is about to lose coverage from a parent or guardian plan
  5. If you are a recent graduate who does not have coverage under a parent or guardian plan
  6. If you are an employee without group insurance coverage
  7. When you are waiting for employer benefits to start
  8. When you are uninsured due to life circumstances
  9. When you are not eligible to apply for coverage on the marketplace during Special Enrollment
  10. If you are retiring before the age of 65 and don’t qualify for Medicare

However, if you suffer from a chronic condition or require expensive medication, then this insurance option probably isn’t the best choice for you. That’s because most short term plans may not approve you due to your preexisting medical condition, and they don’t cover the cost of medical treatment or prescription drugs until you meet your deductible.

Note: Not sure whether short term medical will fit your needs and budget? Then be sure to call or message us. We would be more than happy to discuss your situation and help you determine the best insurance solution available.

Lastly, bear in mind that if you don’t have minimum essential coverage, you may owe an additional payment with your taxes. Under the ACA, individuals without qualifying healthcare coverage must submit a “shared responsibility payment” for every month that they go without qualifying coverage. However, in most cases, the substantial savings that short term health coverage provides will more than make up for this fee. For example, take a look at this comparison between the Obamacare Silver Plan and Pivot Health short term medical plan. After taking his tax penalty into account, this individual still saved more than 2,500 dollars by choosing short term medical over Obamacare.

Purchase Short Term Health Insurance from Pivot Health Today

Thank you for taking the time to learn more about Pivot Health and how short term medical interacts with the ACA. If you have any other questions or concerns on this subject, then don’t hesitate to contact us today. We take pride in our exceptional customer service and support.

Last but not least, if you’re interested in applying for one of our outstanding short term medical plans, then head to our quote page now!