If you live in Virginia and become uninsured, there are several coverage options available to you. Short-term health insurance is one of them and tends to be a quick, economical solution while you are between major medical plans.
What You Need to Know
- Short-term health insurance benefits help with unexpected healthcare expenses when you’re between major medical plans.
- Virginia law allows short-term policies for as few as 30 days and up to 12 months.
- You can enroll in short-term health insurance year-round and start coverage as soon as the day after you apply, if your application is approved.
What Is Short-Term Health Insurance?
Designed to provide temporary insurance benefits, short-term health insurance helps cover medical expenses related to injuries and unexpected illnesses. Typical short-term plan benefits include visits to your primary care doctor and urgent care, in-hospital care and more. Some plans also include non-insurance benefits such as telemedicine.
Short-term health insurance is not subject to the Affordable Care Act and differs from the individual major medical insurance available through state and federal health insurance exchanges. Unlike ACA plans (i.e., individual major medical insurance), short-term policies are not guaranteed issue, meaning a health plan does not have to cover you regardless of your circumstances. They also do not include all of the essential health benefits and may exclude preexisting conditions.
Virginia Short-Term Health Insurance Laws
The minimum policy length for short-term health plans is 30 days. In Virginia, short-term health insurance means coverage that expires in less than 12 months,1 which is the same as the federal definition.2
While Virginians may currently purchase short-term policies that last up to 12 months, state legislation signed into law on April 10, 2020, will limit short-term policies to three months.3 A policy can be renewed or extended for up to a total of six months in a 12-month period. This law will become effective on July 1, 2021.
Policy renewability depends on underwriting and whether the plan comes from an out-of-state association or a Virginia-based insurer as follows:4
- Short-term health insurance policies that are issued in-state with an initial term that exceeds 6 months or that are underwritten may be renewed up to 36 months.
- Policies issued in-state with a term of up to 6 months and that are underwritten may be nonrenewable or renewable up to 36 months.
- If an out-of-state association issues short-term coverage, the policy may be renewable up to 36 months.
At present, out-of-state associations sell all of the short-term plans available in Virginia.5 Most, if not all, short-term health insurance policies are underwritten.
Is Short-Term Health Insurance Right for Me?
Short-term plans can be a good fit for those who need affordable health insurance for a brief period, don’t qualify for an ACA subsidy and are in relatively good health. A short-term plan may be the right for you based on the following:
Short-term health insurance premiums tend to be lower than those of unsubsidized ACA plans. That’s because short-term policies include more limited benefits, instead of all the essential health benefits that major medical plans must include.
You can buy short-term health insurance whenever you need it. There isn’t an open enrollment period. The application process takes only a few minutes and, if your application is approved, you can begin coverage as soon as the next day.
Short-term plans tend to work well if you are in relatively good health. For instance, if you don’t have ongoing medical conditions and tend to rely on healthcare only for injuries and unexpected illnesses.
Many life situations can leave you without insurance – getting a divorce, moving, aging off a parent’s plan. Short-term health plans offer a solution and can be especially useful when you’re between jobs with benefits or in a new employer waiting period.
Why Wouldn’t Short-Term Health Insurance Be Right for Me?
Short-term health insurance differs from major medical insurance in some important ways. Those differences can determine whether or not a short-term plan meets your needs.
Unlike major medical insurance, short-term health insurance is not guaranteed issue. That means your application can be denied based on your health history, including having a chronic condition such as diabetes. Short-term policies are not required to cover preexisting conditions, whereas ACA policies must. If your short-term application is approved, it may exclude care related to these conditions and you would be expected to pay for it out of pocket.
If you need all of the essential health benefits offered by the ACA (e.g., pregnancy, preventive care), then a short-term plan probably won’t be right for you.
How Much Do Short-Term Health Plans Typically Cost in Virginia?
Your short-term health insurance premium will depend on factors such as your age, ZIP code, tobacco use, and the plan you select.
In addition to how much coverage costs, you need to consider plan deductibles, coinsurance and copayments as you shop. Those amounts determine what you pay out of pocket when you use your insurance.
To give you a sense of short-term health insurance premiums in Virginia, here are some sample rates for a hypothetical 35-year-old woman who lives in Henrico County (23220).
|Plan C||$216.01||$2,500||$30 | $60**||20%|
* Cost subject to deductible and coinsurance.
** Office visit to primary care doctor | urgent care center visit
Source: Pivot Health Cost Calculator
As you gather quotes and compare plans, you should also pay attention to maximum out-of-pocket amounts and total policy coverage limits. These are the limits on what you pay out of pocket for covered expenses and what your policy will pay for covered expenses, respectively.
How to Buy Short-Term Health Insurance
You can buy short-term health insurance through a private marketplace such as Pivot Health, through a licensed health insurance agent, or directly from an insurance company. The federal health insurance exchange does not sell short-term plans.
Not all companies offer plans statewide.
What if You Need Extra Coverage?
Once you settle on medical insurance you can afford, you may still be concerned about paying out-of-pocket expenses when you need healthcare. Supplemental health insurance can help.
Supplemental plans provide fixed, lump-sum benefits when you have a covered accident or illness. You can use these benefits to pay for your deductible and coinsurance, medical bills not covered by your short-term or ACA plan, or even daily living expenses such as rent or childcare. Some plans also include non-insurance benefits like telemedicine, prescription drug discounts and vision care discounts.
Supplemental plans are additional coverage; they don’t coordinate with your medical insurance. If you have a short-term plan and later move to an ACA or job-based plan, you can continue to use your supplemental insurance.
Pivot Health does not sell supplemental health insurance in Virginia. You can find Virginia plans online through a private marketplace or insurer website, or contact a licensed health insurance agent.
What’s the Best Health Insurance for You?
Only you can decide what type of health insurance makes sense for you. As you get quotes and look at different plans, think about your budget and healthcare needs.
What can you afford to pay for coverage each month? How much are you prepared to pay out of pocket if you need to see the doctor or have a medical emergency? What kind of medical care do you expect to need in the months ahead? Would you like access to your existing healthcare providers, or are you okay with network restrictions?
When in doubt, ask questions about plan costs and benefits. Contact the insurers that offer plans you’re considering, or work with a licensed health insurance agent.