Final Rule Makes Short-Term Medical Insurance Renewable for Up to 36 Months

The Trump administration has issued a final rule that will allow short-term, limited-duration insurance to be purchased in increments of up to 364 days (or 12 months).

The final rule will also allow this type of insurance to be renewable with a maximum duration of up to 36 months. However, “States remain free to adopt a definition with a shorter maximum initial contract term or shorter maximum duration (including renewals and extensions) for a policy to meet their specific market needs,” according to the final rule documentation.

These new term limits will go into effect in October according to CNBC. This comes just before the 2019 Open Enrollment Period which will run from November 1 to December 15, 2018.

This follows a proposed ruling by the Department of Health and Human Services, the Department of the Treasury and the Department of Labor published for public commentary back in February of 2018. Much in line with the Trump administration’s concerns over the rising costs of health coverage today, this final ruling is expected to increase consumer choice, competition, and affordability in the individual health insurance market.

The Centers for Medicare & Medicaid Services (CMS) projects that approximately 600,000 people will enroll in short-term limited-duration plans in 2019.

Click here to view the final rule in full courtesy of the CMS. Stay tuned for updates on how this change will affect Health Insurance Innovations (HIIQ), contracted agents, brokers and the American public at large.

Road to Expand Short-Term Medical Offerings is Wide Open in 2018

Short-term medical (STM) coverage, a type of health insurance designed to help bridge gaps in your clients’ health coverage, offers consumers flexibility in coverage length and cost. While it does not provide the minimum essential health benefits by the Affordable Care Act (ACA), it can serve as an affordable option for those facing life-altering transition periods.

2018 and STM coverage

Because STM plans don’t have to adhere to ACA regulations, consumers “would have a wider array of options with lower monthly rates1.” Current legislative reform attempts are expected to make room for more STM plans2.  While “these policies can exclude those with pre-existing conditions or base rates on consumers’ medical history” and “offer skimpier benefits1,” major insurance carriers, including UnitedHealth and Aetna, have expressed interest in expanding their portfolios with STM offerings3:

UnitedHealth president and COO Dan Schumacher: “…we are excited to see [the regulation on STM plans that limited length of coverage] extended to the full year, because the reality is it provides a bridge for people in between coverage3.”

Aetna CEO Mark Bertolini: “We are actually looking at reenergizing a program we had prior to the ACA, but in a more on a focus of short-term, one-year kind of plan, or transition plan, versus just the skinny benefit…4.”

Who benefits from STM coverage?

This level of coverage may fit the needs of your clients who are:

  • Transitioning between jobs
  • Waiting for employer insurance to begin
  • Graduating from college
  • Rolling off parents’ coverage
  • Waiting for Medicare coverage to become effective

What are some of the features that STM plans provide?

  • Your clients can choose this level of coverage at any time in the year.
  • Your clients can choose from a variety of plans, many of which include preventive care for individuals as well as for families.
  • Because benefits are more restricted or limited, your clients can take advantage of rates that are often lower than major medical coverage.
  • Your clients can often see providers of their choice. If a provider does not file a claim for your client in office, your clients can easily submit their own claims to the carrier for reimbursement.
Disclaimer: STM coverage is not intended to be a replacement or alternative to ACA or other major medical plans nor does it provide the minimum essential health benefits that are required and it won’t help to avoid the fee for not carrying health insurance. They can have exclusions and limitations, which may not make them a valid option for some clients.

Learn more about incorporating short-term medical coverage into your portfolio by:

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Health Insurance Innovations, Inc. is a leading developer and administrator of affordable, web-based individual health insurance plans and ancillary products. We help consumers address their health insurance needs by offering access to a number of products offered by various insurance carriers.

For agent use only – not for use with the public

Sources:

1: “What happened to Trump’s big plans for insurance?” WCPO.com.  https://www.wcpo.com/news/national/what-happened-to-trump-s-big-plans-for-health-insurance-?page=2

2: “From premiums to politics: 5 predictions for the health insurance industry in 2018.” Leslie Small.  https://www.fiercehealthcare.com/payer/year-preview-predictions-politics-aca-mergers

3: “UnitedHealth’s (UNH) CEO David Wichmann on Q3 2017 Results – Earnings Call Transcript.” SeekingAlpha.com.  https://seekingalpha.com/article/4114057-unitedhealths-unh-ceo-david-wichmann-q3-2017-results-earnings-call-transcript?part=single

4: “Aetna (AET) Q3 2017 Results –  Earnings Call Transcript.” SeekingAlpha.comhttps://seekingalpha.com/article/4118741-aetna-aet-q3-2017-results-earnings-call-transcript?part=single

 

health insurance open enrollment

It’s Beginning to Look A Lot Like Open Enrollment

The holiday season and Open Enrollment have arrived (whether we’re ready for it or not), and so have opportunities for your clients to spend time with their loved ones. Food, laughs, and gifts are likely on their agenda, but something else – something more important – may be as well: health.

Whether your clients are catching up with Uncle Mark who complains about aches and pains he didn’t have 5 years ago or they’re hanging out with Michelle from college who has a pre-existing condition and can’t afford major medical coverage, the topics of health and healthcare are likely to pop up. Have you helped your clients understand available coverage options? Let’s take a look at some of the features your clients could take advantage of:

Limited Medical Coverage

  • Helpful for those anticipating rising medical expenses, unable to afford major medical, not eligible for short-term medical, and/or looking for supplemental coverage to their major medical plans
  • Guaranteed issue coverage if eligibility is met and available in state
  • Premiums often lower than major medical, but also lower and more restricted benefits
  • Benefits such as $50-$100 paid toward doctor and specialist visits available
  • Not required to use a network of doctors – freedom to choose any doctor or facility (*Note: clients can still exceed eligible benefits)
  • Preventive care available for as low as $50
  • Next day coverage available or little to no waiting periods for accidental injuries or sickness
  • 12 month waiting period for pre-existing conditions
  • Does not count as minimum essential coverage required by the Affordable Care Act and is not suitable to serve as sole medical coverage

Short-Term Medical Coverage

  • Helpful for those facing life-altering transition periods such as pre-Medicare retirement, change in employment status, rolling off parental or student insurance, bridging a gap in major medical coverage or those who missed Open Enrollment (*Note: these policies are designed solely to provide healthcare coverage during unexpected coverage gaps)
  • Flexibility in coverage length and cost; coverage duration varies by state and is non-renewable
  • Variety of deductible and coinsurance options
  • Low copay options for in-network benefits
  • Limited preventive care available
  • Ability to cancel at any time without penalty
  • Benefits may be limited and subject to exclusions and restrictions
  • Does not cover pre-existing conditions
  • Coverage is not guaranteed
  • Not intended to be a replacement or alternative to ACA or other major medical plans and does not provide the minimum essential health benefits that are required; may result in a tax penalty

ACA Coverage

  • Helpful for those seeking major medical but who may not be able to afford it, those with pre-existing conditions, and those who need a broad array of health benefits
  • Option to change plan every year and to stay on policy as long as needed
  • Renews annually
  • Provides coverage for pre-existing conditions; applicants can’t be rejected based on health
  • Provides preventive care for individuals and families
  • Those enrolled may qualify for subsidies to lower costs
  • Provides minimum essential health benefits
  • Those who want to enroll must do so during the Open Enrollment period, the Special Enrollment period, or when a qualifying life event occurs

Critical Illness Coverage 

  • Helpful for those seeking an added layer of financial protection in the face of critical health concerns
  • Pays benefits directly to those enrolled or their designees
  • Benefits can be used to pay living expenses such as mortgage, rent, and car payments as well as prescriptions, copays, medical bills, and a myriad of other costs
  • Those enrolled can choose benefits up to $50,000
  • Limitations and exclusions may apply
  • Little to no waiting period

 

Help ease the minds of your clients this holiday season by educating them about available coverage options. While they add extra layers of clothes to stay warm, you can add extra layers of health and financial coverage to help protect them from potentially costly health concerns.

Learn more today by:

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This blog is for informational purposes only and is not intended to make any product recommendations. Encourage your clients to review any product details, such as costs, limitations, exclusions, restrictions, and benefits prior to any purchasing decisions.

Health Insurance Innovations, Inc. is a leading developer and administrator of affordable, web-based individual health insurance plans and ancillary products. We help consumers address their health insurance needs by offering access to a number of products offered by various insurance carriers.

For agent use only – not for use with the general public

2017 Open Enrollment is Approaching Are You Ready

Open Enrollment is Approaching: Are You Ready?

Open Enrollment is just around the corner, and it’s important that you provide your clients with up-to-date details about coverage options that fit their health concerns, budget, and lifestyle needs.

If you’re enrolling clients in ACA coverage, here are some important dates to remember:

November 1, 2017

Open Enrollment Period begins

December 15, 2017

Open Enrollment Period ends

January 1, 2018

Plans sold during Open Enrollment become effective

Your clients will undoubtedly have questions about which options address their needs as well as provide affordable and quality coverage. While it is not a substitute for ACA or other major medical plans, short-term medical coverage may be an appropriate option for those who are:

  • Graduating from college and/or in need of replacing their student insurance
  • Transitioning between jobs
  • Waiting for employer insurance to begin
  • Rolling off parents’ coverage
  • Retiring soon and waiting for Medicare coverage to become effective

You may also have clients who miss the Open Enrollment period and reach out to you at that time to help them address their coverage needs. Short-term medical coverage may be an appropriate option for those clients as well.

Short-term medical plans can provide features to your clients such as:
  • Flexibility in timing of enrollment – there is not special enrollment period Preventive care for individuals as well as for families
  • Lower premiums than other types of plans
  • Access to providers of choice
  • Convenience of filing a claim in provider’s office with an additional option to submit their own claims for reimbursement

It’s important that your clients understand there are limitations associated with short-term medical plans such as restrictions for pre-existing conditions, maximum coverage periods, and restrictions on renewability. Ensure consumers fully understand the details, exclusions, limitations, and restrictions of any short-term medical plans prior to making a purchasing decision.

STM coverage is not intended to be a replacement or alternative to ACA or other major medical plans nor does it provide the minimum essential health benefits that are required and it won’t help to avoid the fee for not carrying health insurance.

Remember: There is no special enrollment period for short-term medical plans. This may provide you more flexibility in helping your clients manage their health coverage needs.

Learn more about Open Enrollment and short-term medical coverage by:

Health Insurance Innovations, Inc. is a leading developer and administrator of affordable, web-based individual health insurance plans and ancillary products. We help consumers address their health insurance needs by offering access to a number of products offered by various insurance carriers.

For agent use only – not for use with the general public.

HIIQ as the Modern Landscape

We’re Modernizing the Insurance Landscape

In the ever-changing health insurance market, consumers recognize that change is constant. Costs for care and coverage are on the rise, some major carriers have reduced their plan options or left the ACA exchange completely, and the battle for ACA reform still wages on.

But there’s one important factor that will remain unchanged: the need for affordable coverage options.

Short-term medical policies have provided those options and filled coverage gaps for millions of consumers. The market saw the number of short-term policies sold in 2014 increase by 20% in 2015 while the sale of long-term policies decreased by 20% in 2015.

It would seem that the future of this market is boundless. Recent data indicates short-term coverage sales will continue to increase in 2017, as many consumers will be unlikely to find ACA exchange coverage options that meet their budget needs.

At Health Insurance Innovations, we’re on a mission to modernize the insurance landscape and provide access to more affordable coverage options, including short-term medical policies. We know that every day is an opportunity to make new paths, and we’re proud of the path we continue to blaze with highly rated carrier partners that offer affordable, value-rich coverage solutions. Our simplified application process and cloud-based digital platform enables licensed agents to enroll consumers in coverage through our carrier partners that tackles evolving healthcare and budget realities. That coverage includes:

  • Short-term medical
  • Limited medical
  • Accident, cancer and critical illness
  • Prescription
  • Dental
  • Vision
  • Life
  • AD&D
  • Health and wellness programs
  • Lifestyle discounts

Our role is to serve as consumers’ billing and technology resource when they purchase a policy from a licensed agent. We provide customers with:

  • Access to their Member Portal to view and download important insurance documents and to update policy and payment information
  • Printed insurance cards on behalf of their carriers
  • Billing support and assistance
  • Periodic emails on behalf of their insurance carriers on how to take full advantage of their coverage

With a variety of products and leading edge tools and technologies, we’re leveling the playing field as our carrier partners provide competitive coverage that fits a variety of lifestyles and needs.

Learn more today by: