2018 short-term health plan medical outlays*Cambia Health Solutions: 9.3% Spectrum Health: 36.1% Genève Holdings: 36.2% UnitedHealth Group: 37.3% Medical Mutual of Ohio: 40.4% Blue Cross and Blue Shield of SC: 44.2% * As a percentage of premium charged The above chart means that for every dollar collected in premium, the average short-term plan spent 39 cents on medical care for policyholders – with the rest spent on administration or kept as profit. Short-term plans usually lack the consumer protections found in ACA-compliant plans and they have gaps in coverage that may not be readily apparent in marketing materials, which makes it difficult to compare plans and understand the full scope of coverage. Importantly, as stated above, they are not required to and usually don’t cover the 10 essential health benefits that the ACA requires compliant plans to cover at no cost to the enrollee. This scant coverage makes these plans much cheaper than ACA-compliant plans. Here are some of the features of short-term plans that ACA-compliant plans are not permitted to offer: Use health histories to determine who can get coverage – Applicants for short-term plans must often answer a health questionnaire used to screen out applicants with symptoms of an illness or condition – even if not yet diagnosed or treated. Some plans also exclude coverage for conditions for which medical advice, diagnosis, care or treatment was recommended or received in the prior 12 months. Exclude key service categories from covered benefits – Few if any short-term plans cover maternity. Prescription drugs are not always covered, or they are only partially covered. Some plans exclude coverage for mental health, substance use disorder services, and tobacco cessation treatment. No pre-existing conditions – Few short-term plans cover any pre-existing conditions. Typically, they cover only what’s listed in the Schedule of Benefits. If one of those is a pre-existing condition, it will likely have a cap of no more than $30,000. Also, insurers will often deny claims or cancel coverage for conditions they consider to be pre-existing. Covered services limited – Many short-term plans have covered benefit limits like:
- $1,000 per day for a hospital room and board
- $1,250 a day for intensive care
- $50 a day for doctor visits while in hospital
- Total benefits are often capped at little more than $100,000 per year.