As ACA Enrollment Begins, What's Included in Some Short-Term Insurance Plans?

Open enrollment for the sixth season under the Affordable Care Act (ACA) begins today and lasts until December 15, and organizations like The Commonwealth Fund are highlighting resources to alert consumers to the differences between the various health insurance plans now available on the individual marketplaces.

While plans that are ACA—compliant with full, nondiscriminatory coverage are still available, it has become more difficult for consumers to sort out their options, due to the lack of critical information contained in marketing materials from short-term, limited duration health plans (STLDHP), said a trio of authors from Georgetown University’s Health Policy Institute at the McCourt School of Public Policy.

The STLDHP insurance available now—and marketed aggressively under the ACA— is similar to what was sold pre-ACA, when plans could deny someone coverage for having a pre-existing condition, or exclude certain services. But the Trump administration has said that the new plans are necessary to provide alternatives to consumers who find they cannot afford the ACA’s premiums.

The authors reviewed 5 plan brochures. None of the plans provided complete information about benefits, costs, and limits without first enrolling in the plan. But from the brochures, the authors gleaned the following:

Even if the plans say they cover pre-existing conditions, they don’t cover everything, and there are caps on coverage.

One plan says it provides coverage for pre-existing conditions up to $25,000 to consumers who qualify, subject to a deductible and coinsurance. The plan highlights that it will accept asthma claims before the effective date of the plan. But the plan does not cover people with other pre-existing conditions, such as anemia, a cyst or hernia, are not eligible.

The plans use applicant health histories to determine who gets coverage, even if illness hasn't struck yet.

One insurer the authors looked at uses a health questionnaire to “screen out applicants with symptoms of an illness or condition — even if not yet diagnosed or treated.”

The plans don’t cover the ACA’s 10 essential benefits.

• 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 substance use disorder services and 2 exclude tobacco cessation treatment.
• Future exclusions, undefined: Although the policy is not provided until after enrollment, the authors wrote that 1 of the insurers excludes “treatment, services or supplies not defined or specifically covered under the policy.”

The plans have dollar limits for specific services and overall total caps on coverage.

Before the ACA, health insurers could set a lifetime limit on covered benefits during any time spent in the plan. The short-term plans, which were originally intended to last 3 months under the ACA but can last for just short of 1 year and renewed for up to 3 years under the new rules put in place by the Trump administration, herald a return to dollar limits and overall caps. One brochure caps intensive care unit care at $1250 a day and $50 a day for doctor visits while in the hospital.

There’s no guarantee the coverage will be renewed.

Developing a new health condition while on the STLDHP could result in becoming ineligible to renew or purchase a second plan.