This year, the law changed to allow for longer duration short term medical (STM) plans. Due to their low-cost, these plans will be a solution for many individuals in 2019. Before you run quotes, please consider carefully:
‘PROS’
- Lower Cost: About 1/3 of the cost of an ACA plan
- More Providers: STM plans use a PPO network
- Choice: More deductibles & out-of-pocket maximum choices than ACA-qualified plans.
- Supplemental benefits available to enhance coverage.
‘CONS’
- Medical underwriting applies: Not everyone will qualify.
- Limitations apply: Such as pre-existing conditions, check-ups, maternity, mental health, and even prescriptions are not covered (or very limited in some way).
- Your deductible, benefits, and premium will reset halfway through the year. In AZ, you must set up two consecutive 6-month policies at the time of application to remain covered through the year. You will know the rate of the second policy when you set up the first one.
- Post-Claim Underwriting: If a claim arises, you may have to prove it was not a condition that existed at the time of application.
- Policy Maximums Apply: These can be anywhere from $100k to $2M.
WHO FITS STM PLANS BEST?
- You must be healthy!
- Individuals with annual income over $36,420; a family of four making over $100,400. (300% of the 2018 US Federal Poverty Level)
- Individuals turning 65 next year
- Individuals waiting for group coverage to begin
- People turning 26 coming off parents’ plan
- You must be willing to accept all the exclusions & limitations, including the ‘Cons’ mentioned above. Review them carefully before you apply.
WHERE DO I APPLY?
Even if you already have a short term medical plan, you will need to buy a new one for 2019:
- If you need coverage for 6-12 months, use National General
- If you need coverage for 6 months or less, use United HealthOne
THIS DOESN’T WORK FOR ME…
If STM is not right for you or if you are not sure, you will want to review your ACA plan options here.
Need help? Schedule Time with your Broker
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