As open enrollment for ACA health insurance plans is running through January 15, 2023, you may wonder whether or not signing up for an ACA health plan is the best option. Short-term health insurance is a temporary solution for when one does not have comprehensive health insurance due to changing circumstances or the inability to afford it. This article will walk you through short-term health insurance and how much it varies in cost.
How Much Does Short-Term Health Insurance Cost?
The average monthly cost (premium) for short-term health insurance ranges from $52.30 to $1,621.55. The monthly premium varies considerably based on household income, size, location, and individual age. So, we put together three profiles with varying ages and household sizes to give you the best idea of short-term health insurance costs.
We used healthinsurance.org to browse through plans from multiple insurance companies. We also found that some short-term health insurance plans had a one-time enrollment fee of $19.95, which is not included in the costs listed in the tables below.
Our first persona is a 28-year-old female making $70,000 annually. The circumstance leading her to get short-term health insurance may be that she just started a new job and is waiting three months to receive employer benefits. The table below lists five U.S. cities and the range of premium costs based on this persona.
Average Premium Costs (28-Year-Old Female, $70,000 Annual Income)
|Chicago, IL||$86.10 - $223.28|
|Houston, TX||$98.96 - $235.51|
|Orlando, FL||$71.57 - $265.92|
|Atlanta, GA||$85.88 - $368.07|
|Salt Lake City, UT||$52.30 - $197.17|
The following persona we have put together is a 45-year-old male married with 2 dependent children and making $160,000 annually. He may choose to get short-term health insurance because he may be between jobs and does not have comprehensive health insurance from his employer. The table below lists five U.S. cities and the range of premium costs based on this persona.
Average Premium Costs (45-Year-Old Male, Married, 2 Dependents, $160,000 Annual Income)
|Chicago, IL||$298.83 - $982.52|
|Houston, TX||$353.05 - $928.72|
|Orlando, FL||$298.83 - $1,190.44|
|Atlanta, GA||$297.90 - $1,621.55|
|Salt Lake City, UT||$230.16 - $868.66|
The last persona we put together is a 60-year-old female making $80,000. A circumstance in which she may want short-term health insurance is that she wants to retire but is not yet eligible for Medicaid. The table below lists five U.S. cities and the range of premium costs based on this persona.
Average Premium Costs (60-Year-Old Female, $80,000 Annual Income)
|Chicago, IL||$281.99 - $772.07|
|Houston, TX||$332.94 - $873.84|
|Orlando, FL||$242.69 - $920.74|
|Atlanta, GA||$281.11 - $1,274.42|
|Salt Lake City, UT||$178.62 - $682.71|
Factors that Influence the Cost of Short-Term Health Insurance
Below are some factors that may influence the cost of short-term health insurance, including your age, household size, and location.
Our research found that the cost of short-term health insurance plans also increases as age increases. This is because when age increases, the risk of chronic and acute disease and the need for medical procedures increase. Thus, insurance companies find that covering you is a higher risk for them to take, making them increase the costs of the plans they offer you.
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As with comprehensive health insurance, the cost of short-term health insurance plans increases as household size increases. If you are looking for individual short-term health insurance, you will find that the monthly premium costs can start at under $100. If you are looking for short-term health insurance for your family, you will find that the monthly premium costs can start at around $300.
According to our research on the five U.S. cities, we listed in the tables above, Houston, TX, has the highest monthly premiums for short-term health insurance. Salt Lake City, UT, has the lowest (of those five cities). The cost of health insurance varies among cities and states, based on the majority population. Suppose the majority of the population in a city is young, healthy, working-class individuals. In that case, the costs may be lower because covering this population is a low risk for health insurance companies. The opposite is true for cities with a majority of older populations.
What is Short-Term Health Insurance?
Short-term health insurance is a temporary solution for healthy individuals and families when you may not have comprehensive health insurance for multiple reasons. These plans last from 3 to just under 12 months and only take 1-14 days to get approval for coverage.
You can enroll in a short-term health insurance plan at any time of the year. Short-term health insurance plans can include whatever services they choose- some that are usually provided include necessary inpatient and outpatient care, emergency services, lab work, surgeries, and imaging.
In What Circumstances Should I Get Short-Term Health Insurance?
The circumstances in which you should get a short-term health insurance plan are when you may have a gap in health coverage due to the following:
- Missing the open enrollment period for ACA health plans.
- You are between jobs and do not have employer-sponsored health insurance.
- You just started a new job and are waiting to receive employer benefits, including health insurance.
- Waiting for Medicaid eligibility after retiring.
- Waiting for insurance to take effect after enrolling in a plan.
These include instances where a short-term health insurance plan might be right for you. If you are experiencing a gap in coverage for other reasons, these plans are still a good option.
What States Offer Short-Term Health Insurance?
All states in the U.S. offer short-term health insurance, except for these 12 and Washington D.C.:
- New Jersey
- New Mexico
- New York
- Rhode Island
- Washington D.C.
How and Where Do I Sign Up?
The Affordable Care Act does not regulate short-term health insurance plans, so you cannot enroll in them on the federal health insurance marketplace. You can enroll in short-term plans directly through insurance companies, such as UnitedHealthcare or Pivot Health. You can also compare plans from multiple companies and enroll on healthinsurance.org.
To be eligible to enroll in a short-term health insurance plan, you will need to pass the medical underwriting on the application. You will be asked questions about your medical history for the company to assess the risk involved with covering you. As these plans usually do not cover pre-existing health conditions. They will check to ensure any claims to cover medical issues were not caused by pre-existing health conditions.
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Short-Term Health Insurance Frequently Asked Questions (FAQs)
Below are some frequently asked questions about short-term health insurance plans.
Do Short-Term Health Insurance Plans Cover the ACA Essential Health Benefits?
Short-term health insurance plans are not regulated by the Affordable Care Act, so they do not have to provide the essential health benefits that comprehensive plans have. In general, most short-term health insurance plans will cover these services:
- Necessary inpatient/outpatient care
- Emergency services
- Lab work and imaging
However, because the ACA essential health benefits are not covered, short-term health insurance plans typically do not cover these services:
- Maternity care
- Mental health care
- Preventive care
- Prescription drugs
It is important to note that what each short-term health insurance plan covers varies by the plan, as insurance companies may include coverage for any services they choose.
What are the Benefits of Short-Term Health Insurance?
The major benefit of short-term health insurance is that it provides an option for those with a gap in their comprehensive health coverage. Whether that is because they cannot afford it or are in between jobs, etc., additionally, it is cheaper than comprehensive ACA health insurance plans. But you get what you pay for, as there are some drawbacks.
What are the Drawbacks of Short-Term Health Insurance?
Short-term plans do not protect against pre-existing conditions. You will likely be turned away if you have one, such as cancer, substance use, hepatitis, HIV/AIDS, etc. There are limits during the coverage period, such as the number of doctor visits, dollars covered during hospital stays, prescription drug coverage, and other excluded benefits. Finally, health insurance companies can bill you for the difference between service costs and what the company pays, which is called balance billing.
Can I Renew a Short-Term Health Insurance Plan?
Renewability of short-term health insurance plans is optional, so only some plans will allow you to. If they do, you can renew your plan for up to three years, but only some states allow this. Check the details of your short-term health insurance plan options when browsing for one to ensure you can renew it if necessary.
Short-term health insurance is a temporary solution for when you may have a gap in comprehensive health coverage. Multiple circumstances may lead you to experience a gap in coverage where you may want to consider it. The average monthly premium costs range from $52.30 to $1,621.55 and vary based on age and household size. It is essential to consider the advantages and disadvantages of short-term health insurance and whether it is a good option for you.
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Michelle Fleming is a sophomore at the University of Texas at Austin majoring in Public Health, focusing on biostatistics and informatics and minoring in Health Communications. Michelle is passionate about bridging the gap in health inequalities through advocacy and policy, especially within minority groups.