How is STM Different from ACA Plans?

Benefits Comparison

Benefit

ACA-Compliant Health Plan

Short Term Medical Plan

Maximum coverage

No lifetime or annual dollar limits on essential health benefits)

Choice of coverage maximum  up to  $2M lifetime

Pre-existing conditions

Yes

No

Preventative and wellness services and chronic disease management

Yes

No (unless a state-mandated requirement)

Ambulatory patient services

Yes

No (unless a state-mandated requirement)

Emergency services

Yes

Yes

Hospitalization

Yes

Yes

Pregnancy, maternity, and newborn care

Yes

No (unless a state-mandated requirement)

Mental health and substance use disorder services

Yes

No (unless a state-mandated requirement)

Prescription drugs

Yes

Only hospital inpatient prescription drug coverage (unless a state-mandated requirement)

Rehabilitative services and devices

Yes

No (unless a state-mandated requirement)

Laboratory services

Yes

Yes

Pediatric services, including oral and vision care

Yes

No (unless a state-mandated requirement)

Birth control coverage

Yes (except for grandfathered plans and some private, religious employers which are not required to provide coverage)

No (unless a state-mandated requirement)

Breastfeeding coverage

Yes

No (unless a state-mandated requirement)

Dental coverage

Plan specific (pediatric dental care is covered; adult dental care is plan specific)

No (unless a state-mandated requirement)

Vision coverage

Plan specific (pediatric vision care is covered; adult vision care is plan specific)

No (unless a state-mandated requirement)

Medical management programs

Plan specific

No (unless a state-mandated requirement)

 

Get Short Term Insurance

 

Plan Attributes Comparison

Logistics

ACA-Compliant Health Plan

Short Term Medical Plan

Counts as minimum essential coverage under ACA

Yes

No

Subject to ACA tax penalty

No

Yes

Qualifies for premium tax credit

Only Marketplace plans purchased at healthcare.gov (eligibility dependent on income and household size)

No

Available for purchase year round

No (only during the Open Enrollment Period or a Special Enrollment Period)

Yes

Guaranteed issue

Yes

No

Guaranteed renewability

Yes

No (non-renewable)

Application fee

No

No

Out-of-network coverage

Plan specific

Yes

Copay

Plan specific

Some states offer copay benefit; otherwise, the deductible is waived and substituted with a $50 co-pay option if treatment is received at an urgent care center

Money-back guarantee

No

 

Yes (written request required within 10 days of purchase; full premium refund if no claims filed)

 

Get Short Term Insurance

 

Short Term Medical (STM) plans provide temporary, short-term coverage of less than 3 months.  STM plans do NOT provide “minimum essential coverage” as defined in the Affordable Care Act ("ACA" also known as "Obamacare").  STM plans also do not cover pre-existing conditions, cannot be renewed, and are not guaranteed issue.
Please review the policy for additional exclusions and limitations. By purchasing an STM, you may still be subject to the ACA tax penalty for not maintaining minimum essential coverage. You should consult your tax advisor to determine if the ACA tax penalty applies to your specific situation. 

 

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