Landing a job with great health benefits is like winning the lottery. The feeling of security and stability that comes with high-quality coverage makes every ailment less threatening, every medical bill less scary, and every doctor’s visit less stressful.
But what happens when you lose that coverage? What if you can’t afford a new plan right away, or have to wait until you land a new job to find coverage? Do people in this situation have no choice but to cover any and all medical expenses out-of-pocket?
This is where short-term health insurance can help. Here’s what you need to know – how it works, who it works best for, and what rules Wisconsin residents need to follow.
What You Need to Know
Wisconsin residents can buy a short-term health insurance plan for up to 364 days and renew them for another six months.
You can sign up for short-term plans anytime during the year.
Short-term health insurance plans are an alternative to traditional health insurance. They cost less but offer different coverage from an Obamacare plan.
What to Know About Short-Term Health Insurance in Wisconsin
Short-term health insurance is an inexpensive alternative to traditional health insurance. It’s intended to bridge the gap between traditional insurance policies. If you can’t afford a plan from the Healthcare Marketplace or don’t have access to employer coverage, you could buy a short-term plan.
A consumer may also buy short-term health insurance if they’re no longer eligible for their parents’ health insurance plan, or if they missed the open enrollment period at work. It also may make sense if you are not eligible for premium tax credits (also known as Obamacare subsidies).
The initial period of a short-term health insurance plan in Wisconsin can last up to 364 days. Customers are allowed to renew the plan, but only for an extra six months. Short-term health plans in Wisconsin cannot exceed a total of 18 months.
The premium for a short-term health insurance plan is usually lower than a Marketplace plan as they do not offer the same kind of coverage as major medical insurance. Employer and Marketplace plans must cover 10 essential health benefits:
- Outpatient hospital care
- Emergency services
- Hospitalization, including surgery and overnight stays
- Pregnancy, maternity and newborn care
- Mental health, behavioral health and substance abuse
- Prescription drugs
- Rehabilitative and habilitative services
- Lab expenses
- Preventative and wellness care
- Pediatric medical, dental and vision services
Short-term health plans do not cover dental, vision or prescription benefits. You’ll have to buy supplemental coverage or pay out-of-pocket if, for example, you need to buy glasses or pay for a root canal.
Another major difference between regular health insurance and short-term health insurance is that you can buy the latter at any time. Employer and marketplace plans are only available during open enrollment windows or after a special qualifying event.
How Much Are Short-Term Plans in Wisconsin?
Like other insurance plans, the cost of a short-term health plan depends on your age, gender, and history of tobacco use. You should compare the available short-term health plans carefully before signing up.
Here are some basic terms to understand:
The premium refers to the amount you pay each month to the insurance company. In Milwaukee, Wis., the monthly premium cost for a 30-year-old woman with an 180-day plan ranges from $66.64 to $295.33, according to a search of plans on Pivot Health. The cost for a 364-day plan ranges from $82.98 to $392.53.
The deductible is the amount you have to pay before the insurance copayment or coinsurance kicks in. According to Pivot Health, in Milwaukee, Wis., the deductible for a 35-year-old woman with a 180-day or 364-day plan ranges from $1,000 to $20,000.
Short-term health insurance plans may require a copay, which is the amount you owe when seeing a doctor. The copay is usually a low sum, between $30 and $50, and typically only applies after you’ve reached the deductible.
Coinsurance is when the consumer and insurance company divide the amount owed by a predetermined percentage. This only applies once you’ve met the deductible.
According to Pivot Health, in Milwaukee, Wis., the coinsurance for a 35-year-old woman with an 180-day plan ranges from 20% to 30%. The coinsurance for a 364-day plan ranges from 0% to 30%.
Where to Buy Short-Term Insurance Plans in Wisconsin
As of July 2020, the following companies sell short-term health plans in Wisconsin:
- Companion Life
- Everest and Everest Prime
- National General
- North River Insurance Company
- Golden Rule from UnitedHealthcare
Before picking a company, make sure to compare the premiums and deductibles. Sometimes it’s worth choosing a slightly higher premium with a lower deductible so you pay less out of pocket.
Who Will Benefit from a Short-Term Health Plan
Short-term health insurance is appropriate as stop-gap insurance. If you’re very healthy and only need coverage for a few months, then a short-term health plan may be a smart choice. People who are in between jobs, moving to a different state or those who can’t afford traditional coverage may benefit from short-term health insurance.
Others who may want to buy a policy include early retirees who aren’t yet eligible for Medicare or young people who don’t quality for their parents’ health insurance anymore.
Why Short-Term Health Insurance May Not Be Right for Me
Short-term health insurance does not cover any preexisting conditions, which refers to any diagnosis you had before signing up for that particular insurance plan. This can include common issues like high cholesterol or anxiety. Short-term health plans also won’t cover any maternity costs if you’re pregnant.
Before deciding on a specific short-term health plan, look at their network of providers to see if your current doctors are covered. If you take regular prescriptions or need to have imaging done regularly, make sure those are included. Don’t assume something will be included in a short-term health insurance plan just because it’s been covered by a previous insurance company.
Every short-term health insurance plan is designed differently, with their own premiums, deductibles and coinsurance amounts. Before signing up for a plan, look through all the available options within your budget and see which one provides the most coverage.
When you have the limited coverage that short-term health insurance provides, researching medical expenses becomes more important. Contact the billing department before every appointment to get an estimate and ask about any discounts.