Is this the same as an ACA (Obamacare) plan?
No. Short Term Medical is temporary coverage for times of change. It asks health questions before approving you, doesn't cover pre-existing conditions, and doesn't include everything an ACA plan must cover, like maternity care and most mental health care. It also doesn't qualify for premium tax credits. If you need those protections, an ACA plan may be the better choice, and I can quote both.
Will it cover a condition I already have?
Generally no. The plan doesn't cover conditions you were treated for, got medical advice about, or had symptoms of in the 24 months before your plan starts. It also doesn't cover a pregnancy that began before coverage. Some states look back less: 12 months in Indiana, North Carolina, Texas, Utah, and Virginia, and 6 months in Georgia, Mississippi, New Hampshire, and Wyoming.
How long can I keep it?
It depends on your state. In most states you choose 1 to 12 months (less one day). In Michigan, Missouri, Montana, Nevada, New Hampshire, and Wyoming it's up to 6 months. In North Carolina, Oklahoma, Pennsylvania, and Texas it's up to 3 months plus a 1-month extension, and in Virginia it's 3 months in total. Pick your state above to see yours.
The plan doesn't renew. You can apply for a new plan when it ends, but you'll answer health questions again, and conditions covered on your old plan won't be covered on the new one.
Can I see any doctor?
You'll use a nationwide UnitedHealthcare network, either Choice or Choice Plus, depending on your state. You don't need referrals or a primary care doctor. In Choice states, there are no out-of-network benefits, except for emergencies. In Choice Plus states, the plan pays less out of network: your deductible doubles, there's a 25% penalty, and there's no out-of-pocket limit.
How do the doctor visit copays work?
On the Copay plan, office visits for an illness or injury cost a $50 copay. How many copay visits you get depends on how long your plan lasts: 1 visit for 1 to 3 months, 2 for 4 to 6 months, 3 for 7 to 9 months, and 4 for 10 months or more. After that, visits go toward your deductible. On Plus Elite and Value, all visits go toward your deductible. Urgent care is a $50 copay on every plan.
How does prescription coverage work?
Show your ID card at the pharmacy. Tier 1 drugs, which are usually common generics, cost a $25 copay with no deductible. Tier 2 to 4 drugs go toward your deductible, then your coinsurance. The plan covers up to $5,000 in drug costs per person, per term on Copay and Plus Elite, and up to $2,500 on Value.
What preventive care is covered?
Only a few specific services: one mammogram, one Pap test, and one prostate exam and PSA test per term, plus preventive care for children. The prostate screening and children's vaccines are covered without the deductible. Other preventive care goes toward your deductible. Routine physicals and adult vaccines like the flu shot aren't covered, though some states require more.
What happens if I go to the emergency room?
Emergencies are covered on every plan, even at an out-of-network hospital. If you're not admitted, there's an extra $500 deductible for that visit, and then the visit goes toward your regular deductible and coinsurance. An out-of-network hospital can bill you for the difference between its charge and what the plan pays. For something that isn't an emergency, urgent care is usually much cheaper, at a $50 copay.
When does coverage start?
As soon as the day after UHC receives your application, once you're approved and your first payment is made. You can also choose a later start date. Illnesses and injuries are covered from your start date, and your first payment is charged right away.
What is FACT, and do I need to join?
In 16 states, these plans are offered through FACT, the Federation of American Consumers and Travelers, a consumer association. You join when you apply, and the dues are added to your premium. Membership includes extras like prescription, dental, and travel discounts. Pick your state above to see if it applies to you.
Can I cover my spouse and children?
Yes. You can add your spouse and children under 26 (through age 30 in Florida). Each person has their own deductible, but a family pays at most 2 deductibles per term. The person applying must be at least 19. In Utah, plans cover one person only. Coverage ends when the only person on the plan turns 65.
What if I change my mind?
You have 10 days after your plan is issued (longer in some states) to return it for a full refund of the premium you paid.
How do I manage my plan once I have it?
Register at the UHC Member Hub to see your ID card, pay your premium, submit claims, and find network doctors. Here's my step-by-step Member Hub guide.
What if I need coverage for longer than a year?
Ask me about TriTerm Medical. It's UHC's longer short-term plan, with coverage for nearly 3 years over 3 terms. It's available in Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, South Carolina, Tennessee, and West Virginia, and it can cover pre-existing conditions after your first 12 months. Here's my TriTerm Medical guide.