Texas Short Term Health Insurance
A Short Term Medical Plan is temporary medical insurance that provides comprehensive protection against unexpected health care health care expenses. In Texas, short term plans last up to 4 months in total (3 months plus a 1 month extension). The application process is simple with only a few qualifying questions to answer and coverage can begin as early as the next day.
Short Term Medical Insurance is perfect for individuals who are:
- Recent college graduates
- Between jobs or laid off
- Waiting for employer-sponsored coverage
- Losing dependent status
- Looking for a lower-cost alternative to COBRA
- Recently retired and not eligible for Medicare
- On strike
UHC Short Term Insurance
More About UHC
Company Information
Short term limited duration health insurance is designed to provide a fast, flexible, and budget-friendly option to help bridge a gap in coverage. UnitedHealthcare short term plans in Texas are underwritten by Golden Rule Insurance Company.
Plan length in Texas: UnitedHealthcare short term plans last up to 4 months in total (3 months plus a 1 month extension) within a 12-month period. The office visit copay on the Copay plan covers 1 visit on a 1 to 3 month plan and 2 visits on a 4 month plan.
Short Term Medical Plans Available in Texas
| Plan Design | Short Term Medical Value | Short Term Medical Plus Elite | Short Term Medical Copay |
|---|---|---|---|
| Deductible options (per person, per term) | $2,500 / $5,000 / $7,500 / $15,000 | $2,500 / $5,000 / $7,500 / $10,000 / $15,000 | $2,500 / $5,000 / $7,500 / $10,000 / $15,000 |
| You pay after deductible | 30% | 0% | 20% |
| Coinsurance out-of-pocket max (after deductible) | $10,000 | None, you pay $0 after the deductible | $5,000 |
| Lifetime maximum per person, per term | $1,000,000 | $2,000,000 | $2,000,000 |
| Doctor office visit | 30% after deductible | No charge after deductible | $50 copay, no deductible (1 visit on a 1 to 3 month plan, 2 visits on a 4 month plan) |
| Urgent care | $50 copay, no deductible | $50 copay, no deductible | $50 copay, no deductible |
| Emergency room | 30% after deductible. If not admitted, an additional $500 deductible applies | No charge after deductible. If not admitted, an additional $500 deductible applies | 20% after deductible. If not admitted, an additional $500 deductible applies |
| Hospital stay and surgery | 30% after deductible | No charge after deductible | 20% after deductible |
| Preventive screenings (mammogram, Pap smear, PSA) | 30% after deductible | No charge after deductible | 20% after deductible |
| Prescriptions | Tier 1: $25 copay. Tiers 2 to 4: 30% after deductible | Tier 1: $25 copay. Tiers 2 to 4: no charge after deductible | Tier 1: $25 copay. Tiers 2 to 4: 20% after deductible |
Premiums depend on your age, ZIP code and the deductible you choose, and are shown when you get a quote. Short term medical is medically underwritten, does not cover pre-existing conditions, and is not ACA coverage.
UHC Provider Network
UnitedHealthcare short term plans in Texas use the UnitedHealthcare Choice Network (EPO). There are no non-network benefits: you must use a network doctor or hospital, and the plans pay no benefits for out-of-network care except for emergencies. Emergency treatment from a non-network provider is treated as network eligible service.
Allstate Health Solutions Short Term Medical
More About Allstate Health Solutions
Company Information
Allstate Health Solutions (formerly National General) sells short term medical and a full shelf of supplemental plans to Texas individuals and families. Short term certificates are issued on association forms, so an association fee and a one-time enrollment fee apply alongside the premium.
Allstate Health Solutions Texas Short Term Plans
| Plan | Deductible Options | You Pay | Out-Of-Pocket Max | Coverage Max |
|---|---|---|---|---|
| Essentials | $5,000 / $10,000 / $25,000 | 40% | $7,500 | $250,000 |
| Enhanced 50/50 | $2,500 / $5,000 | 50% | $5,000 | Confirmed with carrier at quote |
| Enhanced 80/20 | $2,500 / $5,000 / $7,500 | 20% | $5,000 | $1,000,000 |
| Enhanced 100/0 | $2,500 / $5,000 / $10,000 / $25,000 | 0% | $0 | $1,000,000 |
| Copay Enhanced | $6,000 / $8,000 | 0% | $0 | $5,000,000 |
| Guaranteed Issue | $3,500 / $5,000 | 20% / 10% | $6,500 / $5,000 | $100,000 |
Prescriptions are not covered except on Copay Enhanced ($10 generic, $3,000 maximum). Family deductibles are capped at 3x the individual amount.
What Every Texas Plan Does
- Emergency room: $250 access fee, waived if you are admitted, then deductible and coinsurance
- Urgent care: $50 access fee, deductible waived, only coinsurance applies
- Sickness waiting period of 7 days, waived if you apply more than 7 days before the effective date
- Organ transplant: $100,000 per certificate, $10,000 donor maximum
- Not covered: pre-existing conditions, pregnancy, vision, mental health and substance use, hospice
Plan length: Texas limits renewals and extensions with the same issuer to 4 total months of coverage in any 12-month period, so plan on a 3 month term plus a 1 month renewal. Short term medical is medically underwritten and is not ACA coverage.
Allstate Health Solutions Provider Network
Choose Your Provider
Allstate Health Solutions short term plans in Texas use the Aetna Open Choice PPO network, with no referral required. Allstate files plans on Aetna and Cigna in other states, but Texas is Aetna only.
No out-of-network penalty in Texas. In most states going out of network doubles your deductible and coinsurance. Texas is one of the few states where no cost-sharing differential applies. You still get network discounts, but going out of network does not change what you owe.
Short Term Health Insurance FAQ
How Is Short Term Health Insurance Different Than Obamacare?
Affordable Care Act plans typically have broader benefits than found in Short Term health insurance and, without the premium subsidies available to some qualified purchasers, cost much more than Short Term plans.
All health plans that fit in the Affordable Care Act must have "10 Essential Health Benefits." Short Term health insurance plans, in comparison, do not have a standardized set of benefits. Short Term plans usually offer what would be described as "major medical coverage" that covers healthcare costs in the event of serious medical issues. Most Short Term plans also cover normal doctor visits for routine illnesses and injuries.
Considering the prevalence of ACA insurance plans with narrow networks, consumers should heavily research plans before enrolling to ensure that they are not putting themselves at risk for high out-of-network costs.
For those needing broad coverage, short term insurance may be a good option. 100 percent of short term insurance plans sold through Independent Health Agents have out-of-network coverage. Enrollees in these plans can be ensured that they will have access to high quality providers without incurring unknown and potentially sizable costs. The chart below details some of the major benefit differences between Short Term health insurance plans and Affordable Care Act plans. It is important to note that Affordable Care Act plans do not deny care for pre-existing conditions nor do they reject applicants based on health problems.
| Short Term Health Insurance Plans | Affordable Care Act Plans | |
| Coverage availability | Apply any time and get coverage as early as the next day | Apply only during Open Enrollment (or Special Enrollment due to a qualifying event) and get coverage in 2-6 weeks |
| Coverage duration | Coverage duration is less than three months. Many plans can be cancelled at any time. | As long as the plan is available. You can change plans during Open Enrollment (or Special Enrollment with a qualifying event) |
| Prescription drug coverage | Many Short Term health insurance plans provide a drug discount card but do not provide drug coverage. Some newer plans have a prescription drug coverage option for generic drugs not associated with a pre-existing condition. Brand name drugs and specialty drugs are typically uncovered. | Minimum of 1 drug per class must be covered but the minimum number of drugs per class is often more due to the benchmark chosen for each particular state. |
| Maternity and newborn care | Complications of maternity are covered but not standard childbirth services. | Full coverage. Applicants cannot be denied based on pregnancy as a precondition. |
| Mental health services | Coverage is included only when mandated at state level. | Coverage included, but states vary on their definition of “mental health” services, so while some do include learning disabilities or conditions like Autism, other states do not. |
| Substance use disorder services | Coverage is included only when mandated at state level. | All ACA plans have full coverage. |
| Rehabilitative and habilitative services | Coverage is included only when mandated at state level. | All ACA plans have full coverage. |
| Preventive care | Some plans have selected preventive care benefits with cost-sharing. However, most plans do not cover preventive care services. | Preventative services must be provided without cost-sharing (cf.https://www.healthcare.gov/preventive-care-benefits) |
| Pediatric services - oral and dental care | Coverage is included only when mandated at state level. | All ACA plans have full coverage. |
| Healthcare provider networks | Short Term plans typically have broad acceptance among healthcare providers. Some have a preferred network with negotiated pricing for healthcare services and a larger non-preferred network where the plans pay 'usual and customary' fees for covered healthcare. | These plans have been noted for a significant use of "narrow networks" to increase the ratio of enrollees to healthcare providers. |
| Uninsured tax penalties | The maximum penalty is the national average premium for a bronze plan. For 2016, the tax is 2.5% of modified adjusted gross household income or $695 per person, whichever is greater. | ACA plans meet the requirements for avoiding the tax penalty. |
| Coverage of pre-existing conditions | These plans evaluate health status and pre-existing conditions when processing an insurance application and determine whether the applicant is approved or rejected for coverage. | These plans do not consider health status or pre-existing conditions when processing an insurance application. |
What does short-term health insurance cover?
Short-term health insurance is major medical insurance for a set period of time. It covers doctor visits, hospitalizations, emergency care, lab tests, x-rays, and other common medical needs.
Is short-term health insurance Obamacare?
No. Short-term health insurance is a streamlined insurance plan. While it includes many benefits, it does not cover all 12 of the minimum essential benefits that the Affordable Care Act plans are required to cover. For example, in most cases, short-term health insurance will not include maternity care or mental health services.
In addition, short-term health insurance involves an application. Depending on your health status, your application may be declined or your pre-existing condition may be excluded. Obamacare guarantees that all applicants and their pre-existing conditions will be covered, no matter what your health status.
When can I apply for short-term health insurance?
You can apply at any time. There is no fixed open enrollment period. On Texashealthagents.com, you can submit your application and, if approved, your insurance can be effective within as little as 24 hours.
Can I cancel a short term plan at any time?
Within the first ten days of the effective date of your plan, you can cancel and will receive a full refund. For cancellation beyond the ten days, you simply email or call the insurance company with your reason for cancelling. If you cancel before your policy period is over, in most cases you will be given a prorated refund based on the unused benefit.
What conditions on the application will make me ineligible for a short term plan?
Within the last 5 years if you have been diagnosed, treated, or taken medication for any of the following conditions, term health insurance cannot be issued: Cancer or tumor, stroke, heart disease including heart attack, chest pain or had heart surgery, COPD (chronic obstructive pulmonary disease) or emphysema, Crohn's disease, liver disorder, degenerative disc disease, rheumatoid arthritis, kidney disorder, diabetes, degenerative joint disease of the knee, alcohol abuse or chemical dependency, or any neurological disorder; HIV or AIDS; or if you are now pregnant or in the process of adoption.
If you are looking for insurance to cover your pre-existing conditions, we can refer you to an agent who can help you find a health insurance plan that to cover these conditions:
- For ACA/Obamacare Plans: (972) 666-0578
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What To Know:
- Temporary coverage. Texas plans from UnitedHealthcare and Allstate Health Solutions last up to 4 months in total (3 months plus a 1 month extension), so it is a bridge, not a long-term plan
- Not ACA coverage. You answer health questions and can be declined
- Doesn't cover pre-existing conditions
- Optional add-ons such as accident, critical illness and hospital plans are available