Short-term health insurance is an excellent option for people who do not have permanent coverage. Usually, lack of permanent coverage can be due to having switched jobs, being unemployed, missing open enrollment, or inability to afford insurance. Or, perhaps you forgot to pay a premium and now have a lapse in coverage and need insurance ASAP.
It is critical to note that only some states allow short-term health insurance or may have relatively rigid rules and regulations. Luckily, West Virginia is a state where you can purchase short-term or temporary health insurance. Short-term health insurance is a fast and affordable way to get coverage.
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How Does Short-Term Health Insurance in West Virginia Work?
West Virginia is a state that has only one regulation on short-term health insurance, and that is the coverage period must be 364 days or less. The rest of the rules and regulations they follow are federal and include the ability to renew your coverage for up to 3 years.
Do you still receive an insurance card?
Like permanent health insurance, short-term health insurance works very similarly. You will still get an insurance card, policy number, and benefits guide to know what coverages are included and excluded.
Do healthcare providers typically accept short-term insurers?
Most healthcare providers will be fine with your short-term policy. After all, it works the same way as permanent coverage, where you would be responsible for the balance of anything not covered.
Are there copays, deductibles, and premiums?
Similar to permanent coverage, short-term health insurance has the same components as permanent plans, including premiums, deductibles, coinsurance, and copays. You must read your plan thoroughly to know what yours are. The premium is the cost of your plan, usually paid monthly. Your deductible is the amount you pay before any coverage kicks in. After you pay your deductible, you may also have coinsurance, usually a percentage of the cost. Some services will have a flat fee, called a copay.
How do claims and reimbursements work? Is there a limit to what claims you may submit based on how much time is left on your coverage term?
Claims work the same way as permanent coverage, and you will be responsible for your portion via your deductible and any applicable coinsurance or copay. Most plans have a maximum coverage limit, and claims can be submitted throughout the policy period. Pre-existing conditions are excluded.
Is Short-Term Health Insurance ACA Compliant?
Short-Term Health Insurance
Traditional Marketplace Health Insurance
Meets ACA regulations for benefits
Covers pre-existing conditions
None; enrollment is open year-round
Open Enrollment Period or Special Enrollment Period
Up to 364 days
Can renew for up to 36 months
Can renew indefinitely
Not available in some states
Available in every state
It is important to note that the ACA does not govern short-term health plans. The ACA requires 10 essential health benefits on all plans, which are not required on a short-term health insurance policy. That means your short-term policy may not cover several things, like preventative care, mental health or substance abuse care, rehabilitative services, prescription drugs, or maternity coverage.
A short-term health insurance policy is usually for specific health care services. It likely has a limited number of visits, a maximum amount of coverage it will pay, and possibly a higher than typical out-of-pocket maximum, which could be financially devastating.
The best option will always be a permanent, traditional health insurance policy for all these reasons. You will likely have more coverage and fewer out-of-pocket costs, and you won’t have to worry about pre-existing conditions or developing a new condition that could cause you to be excluded from a short-term plan.
Are There Regulations For Temporary Health Insurance in West Virginia?
West Virginia follows mainly one regulation which comes from the federal level. That is, a short-term health insurance policy can only be a policy term of 364 days and can be renewed three times. That means you could end up having coverage for up to three years.
Short-term health insurance availability can reduce the number of people who purchase a plan from the Health Insurance Marketplace, driving up costs for all consumers. Also, short-term health insurance can be lacking in the coverage department for those with significant medical needs, which can cause financial devastation for some families. For these reasons, the following states have banned short-term health insurance altogether or have strict regulations:
- New Jersey
- New Mexico
- New York
- Rhode Island
- Washington DC
In the event of a coverage gap, West Virginia’s temporary health insurance can be a useful option.
How Much Do Short-Term Health Insurance Plans Cost in West Virginia?
Short-term health insurance is a medically underwritten policy. Your premium will be based on age, medical history, and gender. If you are relatively healthy, it will be easy to enroll and affordable. Premiums have been seen anywhere from $35 to almost $500 a month. On the contrary, for permanent health insurance, the bronze ACA plan for 2022 is about $928.
Remember that it is not just the monthly premium you will pay but also the deductible, coinsurance, and copay as applicable. Some plans may have an out-of-pocket maximum which is the total you will have to pay out of pocket, and then coverage is paid at 100%.
Should You Get Short-Term Coverage?
You may consider obtaining a short-term health insurance policy if you need temporary health insurance coverage. Some situations in which short-term insurance may make sense include if you missed open enrollment for a Health Insurance Marketplace plan and do not qualify for a special enrollment period.
You may have recently lost your job, are in between jobs, or are waiting for your current employer-sponsored health plan to begin. If you don’t qualify for any subsidies to be put toward the cost of an ACA plan or can’t afford a permanent option. Medicare or Medicaid coverage could start soon, and you only need a short-term option until then.
Short-term health insurance may not be the best option if you have any pre-existing conditions or significant medical issues. Pre-existing conditions are excluded from all short-term health insurance plans in West Virginia, and most plans don’t cover things like prescriptions and rehabilitative services.
Advantages of Short-Term Health Insurance
There are some advantages to short-term health insurance. It could be a good option if you are having trouble finding and paying for a permanent solution. Because short-term health insurance can be more affordable than permanent insurance, it can be a decent option for someone who cannot afford a traditional plan. Most short-term insurance plans will be less premium than an ACA-compliant plan. Remember, this is likely due to providing less coverage. There is no enrollment period so you can purchase a short-term plan anytime.
Short-term health insurance is better than nothing if you are or will soon be uninsured. If you have a major medical event, some coverage is better than none, and a short-term health insurance plan will help you avoid being financially devastated by healthcare bills.
Disadvantages of Short-Term Health Insurance
There are also some disadvantages to short-term health insurance, and you must understand them before making such an important decision. Generally, if you can obtain and pay for a permanent ACA-compliant plan, that will be the best option as far as coverage goes.
- Eligibility Restrictions – Pre-existing conditions disadvantage many people with short-term insurance.
- Coverage limitations – Short-term insurance usually has many exclusions, lower limits for many coverages, and higher deductibles, coinsurance, and copays than traditional plans.
- Lack of standardized regulations, including ACA compliance – All available short-term plans could be different. Because the ACA does not regulate these short-term health insurance policies, they are not uniform. You must be diligent about reading and understanding the inclusions and exclusions.
- Potential expenses – Again, since short-term plans are not regulated, your out-of-pocket costs could be astronomical. Some plans will have an out-of-pocket maximum, usually higher than a standard permanent plan.
- Limited availability due to state regulations – Short-term health insurance is highly regulated in most states; if you move out of West Virginia, you could be in a predicament with fewer options or uninsured.
How to Buy Temporary Health Insurance in West Virginia
When you have chosen to purchase a short-term health insurance plan in West Virginia, make sure you research the insurers available. Then, compare plans to ensure you get the best plan for your needs. Working with a licensed agent is always a great idea, so they can help you compare and find a plan that provides the coverage you need.
If you decide to work with an agent, please check to ensure they are licensed using the West Virginia insurance website.