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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