Due to a recent rule change by the Department of Health Services, Short Term Medical (STM) plans will now be able to be sold for up to 360 days of "coverage".
Short Term Medical (STM) plans are useful sometimes. They are good for healthy people who need to fill a gap in coverage. They are okay, but still risky, for healthy people who have higher incomes and need medical protection in case of illness or injury. But, they are just bad for anyone with a pre-existing condition big or small, for disabled people, and for heavier folks. That's right, fat is a pre-existing condition with most STM plans. The problem is that these plans look legitimate. Even the most savvy consumer could get fooled easily. They are designed and marketed to look like a lovely and inexpensive replacement for "expensive Obamacare". But watch out--these policies cover very little and have lifetime caps. Typically, short term medical plans do NOT cover the following: -Any pre-existing condition -Any condition that developed within the last 2 years for which you haven't been treated -Routine care -Treatment of any congenital condition or related conditions -Contraception of any kind -Fertility treatments -Pregnancy -Prenatal care -Maternity care -Alcohol or drug abuse treatments -Any sexually transmitted disease, regardless of how you contracted it -Allergies -Any mental health treatment -Outpatient prescription drugs of any kind -Chiropractic care -Kidney disease or ESRD -Skilled nursing care or rehab -Any weight related treatments ranging from simply talking about nutrition with a doctor to bypass surgery -Any medical condition of the eye (e.g. cataracts, or something as simple as an eye infection) -TMJ or any treatment related to the jaw bone -Injury resulting from a sporting activity (boating, soccer, skydiving, or anything fun you might do on a weekend) -Any condition of the foot -Any skin condition (moles, cancerous or not) -Treatment of sleep disorders -Organ or tissue transplant (yes, even if you develop a condition under the plan and need an organ transplant, expect a house-sized bill) and perhaps worst of all: Any condition that results from treatment or non-treatment of a different condition covered by the plan (this means if you have cancer, and develop a blood disorder from the treatment, that blood disorder is not covered) This is a partial list. And these policies typically only pay the Usual and Customary Charges for a given covered condition, which leaves people holding a balance bill for whatever they had treated. So, who is buying this junk insurance?! Too many people. Many have been bamboozled by fancy marketing and promises of full insurance coverage. Many have been unwilling to pay the price of full insurance. And, by the time they've figured out they have a junk plan, Open Enrollment is over and they can't get a full insurance policy until the next year. This is the kind of insurance many legislators have suggested we go back to as our only "option". There's definitely a place for STM plans--but it's a very limited place, almost exclusively for healthy people who need a "just in case" policy, ideally for a few months. Due to the rule change, I get four or five emails a day from STM companies because they are over the moon that STM is back, so watch out. You're going to be seeing a lot of advertisement for policies that sound too good to be true. These companies make huge money on these junk plans, because they have little regulatory oversight on how premium money is used and as you can see from above, the policies cover very little. How can you tell if a policy you're being sold is full insurance or STM? I've spoken to dozens of people who specifically asked the telephone agent what they were buying and were outright lied to (and of course, they have no way to contact this person back). First, do your best to speak with a local broker who has your back. Second, especially if you are buying from a call center rep, ask if the policy you're buying is compliant with the Affordable Care Act mandates. Third, if you are asked any medical questions other than whether you use tobacco this is a dead giveaway the policy is STM. Fourth, if the plan has any lifetime limits on coverage, it is STM. Open Enrollment for fully insured policies runs from November 1st to December 15th. We help people with their applications for Marketplace and non-Marketplace coverage at no cost in Wisconsin and parts of IL (and if you're in another state, we can help provide some information and connect you to help). If you would like to get on our call list for an appointment, please complete this form.
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Guest Blog by Maureen T.
On a cold February morning of 1982 my life changed forever. I was 8 years old and my father was about to go on a business trip. He told my mom that he didn’t feel like I was looking well. My mom took me to the doctor and didn’t see anything obviously wrong with me and we left the office. We put on our coats and hats and started to walk out the door. That’s when the nurse came running after us – my blood sugar results came back and they were off the charts. Though I was displaying so many of the symptoms of Juvenile Diabetes such as thirst, weight loss and blurry vision - they were subtle at that point because the disease was caught within weeks of onset. The next week was filled with visits to specialists, education classes, and an overhaul on what the rest of my life will look like. I remember my mom sitting on the hallway floor with the phone receiver outstretched from the kitchen crying and telling my dad I now had an autoimmune disease whose origins were a mystery. I was now a juvenile diabetic (referred now as Type 1 Diabetes). My pancreas had stopped producing any insulin and that I would have a lifetime of insulin injections to stay alive. A lifetime. I did my best to live as normal life as possible. As with many autoimmune diseases I did develop others as well. I struggled a lot but I did all the things kids do – I did well in school, I participated in school plays, I went to prom, I attended college. It was after college that life with chronic illnesses became difficult. Prior to the Affordable Care Act (ACA) (passed in 2010 and implemented in 2014), adult kids on their parents plan would be kicked off as soon as they left school. I truly believe the entire trajectory of my life would have been different if I could have stayed on my parents insurance until I was 26 years old. I could have found the right career; I could have had the time to find the right business to work in. Instead it was a desperate scramble to find any job that provided full benefit insurance to someone with a pre-existing condition. Every decision I had to make as an adult revolved around health insurance. This was a constant stressor of getting to a job that provided any insurance, staying at jobs that were terrible to keep insurance, going without insurance when I had to move states. A Type 1 diabetic was UNINSURABLE before the ACA. If I was offered any kind of insurance my pre-existing conditions wouldn’t be covered or I would be denied coverage or only be offered a subpar plan at an exorbitant premium rate, with an unattainable deductible and no prescription coverage for the very medications that keep me alive. Since the ACA, I’ve been able to keep my wonderful job in small business because I can buy an ACA plan on the Marketplace that cannot discriminate against me. A job where I can really help people, a job I’m good at, and a job with my many, many health challenges I can still be a productive contributing worker in society. Since the ACA I’ve had access to comprehensive medical care and with a disease like Type 1 diabetes - better access and diligent care on an ongoing basis are the keys to being healthy. The complications from decades and decades of diabetic wear and tear are overwhelming, expensive, and can be deadly. The more I’m able to take care of myself now, after almost 40 years of this disease, the better I’m prepared to avoid terrible outcomes like kidney failure or blindness. When you have a disease that will be with you for the rest of your life - health insurance isn’t about having something in case something bad happens. Health insurance is assurance in keeping bad things at bay. The ACA is not without deep flaws and personal sacrifices. I see it only as a first in a long needed step in being a country that resembles other first world countries. Premiums have risen year to year with huge jumps, nothing has been done to stop the runaway train of prescription drug prices, and in order to see any real, affordable premiums, deductibles or co-insurance the yearly salary has a very low cap. Also, Wisconsin chose not to expand its Medicaid coverage as other states have, so there’s a larger chasm between Medicaid coverage and where tax subsidies begin to take effect. Combining incomes with a marriage can put someone with a chronic illness into a position where taking care of oneself is not affordable, because they may no longer qualify for subsidies or with the higher income bracket you see higher premiums and huge deductibles. Despite all this I'm so grateful for the ACA. I’m grateful I had a choice. An unpreventable, childhood illness shouldn't have had the roadblocks that it has. I can only hope now we can take this as our springboard to true healthcare reform so that all citizens in the county can be their best most productive selves. |
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