What does short-term health insurance cover? Most plans cover new illnesses and injuries: doctor visits, emergency room care, hospital stays, surgery, lab work and, on many plans, prescriptions. However, what they usually don't cover is just as important: pre-existing conditions, maternity care, and often mental health care. Coverage also comes with deductibles, visit limits and dollar maximums. So read the benefit summary before you buy.
- Overall, short-term plans are built for unexpected medical needs, not ongoing care.
- Also, they don't have to cover all ten ACA essential health benefits.
- In a 2018 KFF review of 24 short-term plans, none covered maternity care and 71% didn't cover outpatient prescriptions.
- UnitedHealthcare plans include many prescriptions and a national network, but still exclude pre-existing conditions.
What Short-Term Health Insurance Covers
In general, UnitedHealthcare short-term medical plans cover care for new medical problems, including:
- Doctor visits, including in-network specialists with no referral
- Emergency room care for sudden illness or injury
- Hospital stays and surgery
- Lab work and imaging
- Prescriptions on many plans, with limits on some drug tiers
You also get UnitedHealthcare's national network. Then, before your first visit, check if your doctor is in network.
What Short-Term Health Insurance Usually Doesn't Cover
| Usually not covered | Why it matters |
|---|---|
| Pre-existing conditions | Care for conditions you had before coverage is excluded |
| Maternity and newborn care | None of the 24 plans in a 2018 KFF review covered it |
| Mental health and substance use care | Often excluded or limited |
| Preventive care | Limited to a few screenings on many plans |
| Dental and vision | Sold separately |
| Out-of-network care | Some states cover it only in emergencies |
For more on the first item, read our guide to short-term health insurance and pre-existing conditions.
Deductibles, Limits and Maximums
However, short-term plans share costs differently than ACA plans. For example, UnitedHealthcare short-term deductibles often range from $2,500 to $15,000 per person. Plans may also include:
- Coinsurance out-of-pocket maximum per person, per term
- Visit or dollar limits for some services
- A cap on covered costs for some prescription drug tiers
- Lifetime or per-term benefit maximums
In addition, a deductible restarts with each new term or new plan. New to these terms? Read how deductibles work and what an out-of-pocket maximum is.
First, ask for the plan's benefit summary. Then look up three things: your deductible, your out-of-pocket maximum, and the lifetime or term maximum. In short, those three numbers tell you most of what you need to know.
How It Compares With ACA Coverage
| Benefit | ACA plan | Short-term plan |
|---|---|---|
| Pre-existing conditions | Covered | Excluded |
| Maternity care | Covered | Usually excluded |
| Preventive care | Covered at no cost in network | Limited |
| Yearly out-of-pocket cap | Required by law | Set by the plan |
| Subsidies | Available based on income | Not available |
| When you can buy | Open Enrollment or a life event | Any time, in approved states |
See the full comparison in our short-term vs. ACA guide.
A licensed Vivna agent will walk you through the benefit summary line by line before you buy.
How to Fill the Gaps
As a result, many people pair a short-term plan with add-on coverage to fill specific gaps.
- Dental and vision. Add a separate dental and vision plan for cleanings, exams and glasses.
- Supplemental insurance. For example, accident or hospital plans pay cash benefits. Learn about supplemental insurance plans.
- Longer coverage. TriTerm Medical adds preventive care after 6 months and may cover some pre-existing conditions after 12 months. Compare tri-term vs. short-term.
Covered or Not? Common Examples
To illustrate, these general examples show how a typical short-term plan handles common situations. Still, your plan's benefit summary has the final word.
| Situation | Typical result |
|---|---|
| ER visit for appendicitis that started after coverage | Covered, after deductible and coinsurance |
| Broken wrist from a fall | Covered, after deductible and coinsurance |
| Asthma you were treated for before coverage | Excluded as pre-existing |
| Routine physical | Usually not covered, except on TriTerm after 6 months |
| Prenatal care and delivery | Usually not covered |
| Therapy for anxiety | Often excluded or limited |
How to Read a Short-Term Benefit Summary
- Find the exclusions section first. It lists what the plan won't pay for.
- Check the per-term limits. Look for caps on prescriptions, visits and total benefits.
- Look at network rules. For instance, some states pay out-of-network care only in emergencies.
- Note the waiting periods. TriTerm, for example, has a 6-month wait for preventive care.
Want a second set of eyes on a benefit summary? Call 888-730-6001 and a licensed agent will go through it with you.
What Does Short-Term Health Insurance Cover: FAQs
Does short-term health insurance cover emergencies?
Yes. Emergency room care for a new illness or injury is a core benefit, subject to your deductible and coinsurance.
What about prescriptions?
Many UnitedHealthcare plans do, with limits on some drug tiers. However, some short-term plans from other insurers don't.
Is pregnancy covered by short-term health insurance?
Usually not. In fact, most plans exclude maternity care, and a pregnancy that began before coverage is pre-existing.
Can I get mental health care on a short-term plan?
Often it's excluded or limited. So check your plan's benefit summary.
Are routine physicals covered?
Standard plans cover only a few preventive screenings. However, TriTerm adds a $200 wellness benefit per term after a 6-month wait.
Compare short-term plans with a licensed agent. Call Monday through Friday, 9am to 6pm.
Sources
- UHOne: Short term medical insurance explained
- UnitedHealthcare: All about short term medical plans
- KFF: Analysis of short-term plan benefits
- UnitedHealthcare: TriTerm Medical FAQs
Short-term health insurance is not comprehensive coverage and is not required to meet ACA requirements. It is not minimum essential coverage and may exclude pre-existing conditions. Benefits vary by plan and state. Short-term plans are available only in approved states. Vivna Insurance is a licensed, independent agency (NPN 19168641).