Short-term health insurance plans often seem cheaper than traditional health insurance, but buyers must take warning. They may offer a lower monthly premium, but these plans provide coverage only for limited medical expenses.
Insurance is intended to protect you from large financial risks. While the monthly price of a short-term health plan can seem attractive, it can leave you with expensive medical bills.
Before purchasing a short-term health plan, be sure to understand the risk of buying one by carefully reading the policy and asking these 11 questions.
1. Can I qualify for a special enrollment period or find financial help?
If you are looking for health insurance outside of open enrollment, Nov. 1 – Dec. 15, check to see if you qualify for a special enrollment period and apply for financial assistance.
There are many life events, such as getting married, having a baby, getting divorced, losing coverage through work, and moving that may qualify you for a special enrollment period. Visit Healthcare.gov to see if you qualify and apply for financial assistance.
All Oregonians who purchase their own insurance are encouraged to apply for assistance, even if they did not qualify previously. Oregonians who receive help with the costs of their health insurance pay on average $138 a month.
2. What is the definition of pre-existing conditions and does the plan cover them?
A pre-existing condition is any injury, illness, sickness, disease, or ailment that existed before health insurance coverage began. Pre-existing conditions can be physical or mental. It is important to know if the short-term plan will cover symptoms, treatments, and prescriptions related to any of your specific pre-existing conditions.
3. Does the plan have a network of doctors and specialists?
Many health insurance plans have a network of doctors, specialists, and providers they contract with to help control costs. The price difference between using a doctor that is in your health plan’s network versus one that is not can be astronomical.
Many short-term plans do not have a network of providers and offer only a dollar limit of coverage. This could leave you paying high out-of-network fees for everything from emergency services to routine preventive care.
5. How does the plan cover surgery or physical therapy?
Confirm the amount of coverage a short-term plan will provide for a scheduled or emergency surgery, as well as the necessary physical therapy to fully recover.
Short-term plans may not even cover these in an emergency. If it does cover surgery and physical therapy, you need to understand exactly how much it will cover to truly understand what it could cost you. Even when these services are covered, the plan’s dollar limits and exclusions can leave you with several expensive medical bills.
6. Does the plan cover emergency room visits or hospital stays?
Accidents happen. Before chopping your finger instead of an onion or falling awkwardly on your arm, make sure the short-term health plan covers potential emergency room visits and hospital stays. Again, confirm exactly how much it will cover. For example, a plan may cover hospital stays, but limit it to $1,000 per day.
7. What is the prescription drug coverage?
Prescription drug costs are rising. Find out how much coverage, if any, the short-term plan provides for prescription drugs. If you already have regular prescriptions, find out the dollar amount the health plan will cover on the medications you currently take.
10. Will the plan cover my whole family?
Many short-term plans have separate requirements for each member of your family, so it is essential to make sure that each one of them will be covered. If you have dependent children who are younger than age 19, contact the Oregon Health Plan at 800-359-9817 (toll-free) for an application packet.
Under Oregon law, short-term health plans can only be issued for three months at a time, including renewals. A new policy cannot be issued by an insurer to a customer within 60 days of expiration of a policy previously issued by the insurer to the policyholder.
Before buying a short-term plan, review the exclusions, ask questions, and make sure you understand how limited it can be. It is necessary to understand all the risks before buying a short-term health insurance plan.
If you have questions, concerns, or problems with your short-term health plan, insurance company, or agent call one of the Division of Financial Regulation’s consumer advocates at 888-877-4894 (toll-free).