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 insurance or hospital indemnity plans pay cash benefits. See which supplemental plans pair best with a short-term plan. 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 888-730-6031 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).
Related guides
Find Local Health Insurance Help
Plans, prices and help programs change by state and even by county. These local guides show what is available near you.
More local help: the Georgia health insurance guide, plus guides for Florida, Texas, North Carolina and every state we serve.
Prefer to talk it through? Call 888-730-6031 Monday through Friday, 9 a.m. to 6 p.m. Eastern, for free help from a licensed agent.
