As ACA registrations begin, what do some short-term insurance plans include?

Registration for the sixth season under the Affordable Care Act (ACA) begins today and runs until December 15, and organizations like The Commonwealth Fund are highlighting resources to alert consumers to the differences between the various health insurance schemes currently available in the different markets.

Although ACA-compliant plans with full, non-discriminatory coverage are still available, it has become more difficult for consumers to choose their options, due to the lack of essential information contained in marketing materials. Short term and limited term health plans (STLDHP), said a trio of authors from the Institute of Health Policy at Georgetown University at the McCourt School of Public Policy.

The STLDHP insurance currently available – and aggressively marketed by the ACA – is similar to that sold before ACA, when plans could deny someone coverage for a pre-existing illness or exclude certain services. . However, the Trump administration has stated that new plans are needed to offer alternatives to consumers who realize that they can not afford the ACA premiums.

The authors reviewed 5 plan brochures. None of the plans provided complete information on the benefits, costs and limitations without first being included in the plan. But in the brochures, the authors gleaned the following:

Even though the plans indicate that they cover pre-existing conditions, they do not cover everything, and coverage is capped..

A plan says that it offers coverage for pre-existing conditions up to $ 25,000 to eligible consumers, subject to a deductible and co-insurance. The plan emphasizes that he will accept requests for asthma before the date of the plan's effect. But the plan does not cover people with other pre-existing conditions, such as anemia, cyst or hernia, are not eligible.

Plans use applicants' medical histories to determine who benefits from coverage, even if the illness has not yet occurred.

One of the insurers examined by the authors uses a medical questionnaire to "screen candidates with symptoms of a disease or condition, even if they have not yet been diagnosed or treated."

The plans do not cover the 10 essential benefits of ACA.

• Prescription drugs: not covered by 3 insurers; excluded in some plans by the other 2 insurers.
• Maternity: not covered by any of the 5.
• Mental Health: 3 insurers exclude coverage for mental health and addiction services and 2 exclude tobacco treatment.
• Future exclusions, not defined: although the policy is only provided after registration, one of the insurers excludes "treatments, services or supplies not defined or specifically covered by the policy".

Plans have financial limits for specific services and overall coverage ceilings.

Prior to the ACA, health insurers could set a lifetime limit on covered benefits for the entire period of the plan. The short-term plans, which initially were expected to last three months as part of the ACA but can last a little less than a year and be renewed up to three years under the new rules put in place. place by the Trump administration, announce a return to dollar limits and global caps. A booklet limits ICU care to $ 1250 per day and $ 50 per day for doctor visits to the hospital.

There is no guarantee that the cover will be renewed.

If you develop a new health condition while you are on STLDHP, you may no longer be eligible to renew or purchase a second plan.

Related Articles