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Short Term Questions

Buyer beware, know the risk before buying short-term health insurance

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.

Before purchasing a short-term health plan, be sure to understand the risk of buying one by carefully reading the policy and asking some important questions.

How can I find financial help and enroll in full-coverage health insurance?

You might be surprised at how much financial assistance you are eligible for when buying a full-coverage plan through HealthCare.gov

Last year, more than 70 percent of Oregonians who enrolled in plans through HealthCare.gov qualified to receive help paying for coverage. For 2019, individuals making $48,560 or less, and families of four making $100,400 or less, may qualify. Financial help can be significant. For 2018 coverage, Oregonians who qualified for financial help got plans with an average premium of $138.

Open enrollment is the health insurance sign-up period for people who buy health insurance for themselves and their families. It runs from Nov. 1 to Dec. 15. For people who do not get coverage through their job or another program, it is likely the only time to sign up for 2019 health insurance and get help paying for coverage at HealthCare.gov.

Know the risk before buying short-term health insurance  

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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.

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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.

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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.

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It is essential to understand how much you will have to pay in addition to the monthly premium. If the monthly premium seems too good to pass up, make sure you can afford the out-of-pocket costs, especially the amount you must pay before insurance coverage starts.

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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.

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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.

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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.

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Regular shots and screenings are important ways to maintain your health. Short-term health plans are not required to cover these services, but many health plans such as those found on Oregonhealthcare.gov will cover these services at no cost to you.

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Get a copy of the exact exclusions for any short-term health plan you are considering. Do not assume a treatment is covered until you know for certain.

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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.

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Always ask if there are plans available that include essential health benefits such as ambulance and emergency services, hospitalization, maternity care, lab services, and pediatric care. ​

Under Oregon law, short-term health plans can only be issued for three months at a time, and cannot be renewed for at least 60 days.

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).