Short-Term Plans Explained

The 2019 Open Enrollment period runs from November 1, 2018, to December 15, 2018. Open Enrollment is your chance to choose a health insurance plan that meets your and your family’s needs. This year you may be hearing more about short-term insurance plans. Here are some key facts you should know before making a decision.

Short-term plans and the ACA

Their premiums are much less than plans you’ll find that are compliant with the Affordable Care Act (ACA). But that’s because short-term plans provide much less coverage. For an insurance plan to qualify as ACA-compliant it must cover a set of Essential Health Benefits, including:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital).
• Emergency services.
• Hospitalization (surgery and overnight stays).
• Pregnancy, maternity, and newborn care.
• Mental health and substance use disorder services, including behavioral health treatment (for example, counseling and psychotherapy).
• Prescription drugs.
• Services and devices that help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills.
• Laboratory services.
• Preventive and wellness services and chronic disease management.
• Pediatric services, including dental and vision care.

Every plan offered by UPMC Health Plan is ACA compliant and provides these Essential Health Benefits .  

Less coverage than regular plans

 Many short-term plans may not cover:

• Routine office visits.
• Prescription drugs.
• Preventive care (like vaccinations and screenings).
• Prenatal and maternity care.
• Behavioral health and substance use.

Not only are fewer types of care covered, there may also be no limit on the out-of-pocket expenses you pay for care. ACA-compliant plans – such as those offered by UPMC Health Plan – must set out-of-pocket limits, which means the amount you’ll pay for treatment is limited. With a short-term plan, there is no required out-of-pocket limit, which means your bills for care could be extremely high, causing long-term debt.

Because short-term insurance plans are not ACA-compliant, they can also deny coverage or charge much higher premiums if you have a pre-existing condition. If you’re healthy when you buy a short-term plan and develop a medical condition, you could lose your coverage once your plan ends.

An important choice

Choosing the right insurance is important because if you sign up for a short-term plan and then decide it’s not right for you, you might not be able to sign up for an ACA-compliant plan until the next Open Enrollment. And when you purchase a short-term plan, you’re taking a risk: if you do need medical care, you could be left owing money for uncovered services.

You don’t have to worry about that when you enroll with UPMC Health Plan. We offer plans with some of the lowest premiums on the Marketplace and provide access to high-quality care. Depending on your income, you may qualify for subsidies that will make a plan more affordable.

Make sure you’re informed and shop wisely. If you have any questions, you can call us at 1-877-563-0292 , Monday through Friday, 8 a.m. to 5 p.m. During Open Enrollment, these hours extend to 8 p.m.—and from December 9 to December 15 (the final week of Open Enrollment), you can call for assistance 24 hours a day.

Or you can visit a UPMC Health Plan Connect Sales and Service Center at the following locations:

• Logan Valley Mall, Altoona
• Millcreek Mall, Erie
• Monroeville Mall, Monroeville
• Ross Park Mall, Pittsburgh
• South Hills Village, Pittsburgh
• The Mall at Robinson, Pittsburgh
• Loyal Plaza Shopping Center, Williamsport