What does Short-Term Health Plan’s rule change mean to your clients?

Short-Term Health Plan Rule Change

The Centers for Medicare and Medicaid Services (CMS) on Aug. 1 extended the length of time you can keep a short-term policy from just 90 days to one year. In addition, you’ll be able to renew the same short-term policy annually for up to three years.

The New Short-Term Health Plan Rule Change Should Boost Coverage Options for Hard-Pressed Middle-ClassGood news for families and individuals wrestling with soaring health insurance premiums: The federal government just made it easier to buy and maintain lower-priced, short-term health insurance.

The Centers for Medicare and Medicaid Services (CMS) on Aug. 1 extended the length of time you can keep a short-term policy from just 90 days to one year. In addition, you’ll be able to renew the same short-term policy annually for up to three years.

The changes are the latest tweaks to the Affordable Care Act (ACA or Obamacare) made by the Trump administration aimed at giving middle-class consumers access to more affordable health insurance. The announcement reversed a 2017 Obama-era rule that had reduced the coverage window of short-term insurance from one year to 90 days.

An Affordability Crisis

Short-term health insurance is 80 percent cheaper than non-subsidized, Obamacare coverage, according to a study eHealth published in July. The same study found that the average monthly cost of ACA insurance for a family of four that didn’t qualify for an Obamacare subsidy was $1,376 — up 15 percent from 2017 and more than 60 percent higher than the same policy in 2014, when Obamacare was launched.

“We continue to see a crisis of affordability in the individual insurance market, especially for those who don’t qualify for large subsidies,” said CMS Administrator Seema Verma in a statement announcing the rule change. “The final rule opens the door to new, more affordable coverage options for millions of middle-class Americans who have been priced out of ACA plans.”

Short-term health plans are cheaper, in part, because they aren’t required to include all of the benefits mandated by the ACA and, as the name implies, they’re only guaranteed for a limited amount of time. The plans originally were designed for people facing temporary gaps in medical coverage, and this remains the primary reason people buy short-term policies.

But a growing number of consumers are turning to the policies as a longer-term solution as premiums for non-subsidized ACA plans continue to rise.



Insurance Companies Rethink Short-Term

In February, only 42 percent of insurers said they intended to offer short-term plans in 2019. By July, that number had increased to 73 percent. The change of sentiment reflects the government’s widely anticipated extension of short-term coverage, as well as an increased awareness that consumers who can’t afford ACA coverage must have access to viable alternatives.

In an eHealth survey of insurers conducted last February, just 33 percent viewed short-term plans as a “necessary option for those who can’t afford ACA coverage.” By July, that percentage had increased to 80 percent.

What People Still Don’t Know

Most consumers remain largely in the dark about the modifications to the ACA currently underway. In an eHealth survey conducted in March, only 13 percent of customers were aware that short-term health coverage was likely to be extended.

A Limited Solution

Short-term health insurance may be a financially attractive alternative to ACA plans. But it is critical consumers clearly understand what the policies can and cannot do. The chart below highlights some of the key distinctions:

Even with these limitations, short-term insurance can make sense for some consumers, particularly if the alternative is no insurance at all. To learn more about the full range of coverage options available in the individual, non-employer-based market, check out our new eBook, the 2019 eHealth Insurance Guide.


What has the ACA changed for Short Term Medical plans?

Demand for Short-Term Health Insurance
Has Steadily Grown Since Implementation of the ACA

eHealth report: Short-term health insurance is gaining in popularity among older consumers; half of policyholders say they would be uninsured without it

MOUNTAIN VIEW, Calif.–(BUSINESS WIRE)–Today eHealth, Inc. (Nasdaq: EHTH) (eHealth.com), a leading private online health insurance exchange, released a report shedding light on trends in the short-term health insurance market and how consumers utilize plan benefits for medical care.

“Short-term plans serve an important function for consumers transitioning between jobs or with other temporary coverage needs, which is how most people continue to use them,” said eHealth CEO Scott Flanders. “But we’ve also seen that, as premiums rise, many people turn to short-term health insurance because they simply can’t afford ACA-compliant coverage.”

eHealth’s report, Short-Term Health Insurance: Value, Benefits and Cost, includes an analysis of the costs and benefits covered under short-term plans, an examination of the impact of the 2017 rule limiting coverage to no more than 90 days, and results from a survey of nearly 1,000 short-term policyholders.


Key findings include:

  • Demand for short-term plans has steadily increased since the ACA’s implementation: Short-term applications accounted for 57 percent of all combined short-term and major medical plan applications received by eHealth in 2017, up from 47 percent in 2016.
  • Need for temporary coverage and affordability drive interest in short-term policies: Sixty-one percent of survey respondents said they chose short-term policies primarily because they needed coverage for a limited period, while 27 percent did so because it was more affordable than other options.
  • One quarter chose short-term policies because they missed open enrollment: Twenty-six percent of respondents said they bought short-term coverage, in part, because they had missed open enrollment under the Affordable Care Act.
  • Short-term plans are becoming more popular among older consumers: Since 2015, the share of people between the ages of 45 and 64 buying short-term plans has increased from 21 percent to 25 percent.
  • Most short-term policyholders consider ACA coverage first: More than half of respondents (52 percent) said they considered buying an ACA-compliant health plan before turning to short-term coverage. About half (49 percent) believed they would not have qualified for government subsidies under the ACA.
  • Half of policyholders say they would be uninsured without access to short-term coverage: Fifty-one percent of policyholders said they would not have health insurance without short-term coverage; only 12 percent said they would enroll in ACA-compliant major medical plans if short-term policies were not available.
  • Nearly three-in-ten short-term policyholders use their coverage: Twenty-eight percent of eHealth survey respondents said they received medical care while covered under a short-term policy, most commonly for a sick visit to the doctor’s office.

The full report may be found here or at eHealth’s media center.

Five Myths about Short Term Healthcare Consumers Believe

AgileHealthInsurance Report | 2018-02-20

Fact Checking Five Myths About Short-Term Health Insurance

Over the past two years, discussions of short-term health insurance have become highly politicized and, as a consequence, the product has been unfairly criticized. Short-term plans have been an important part of the American health insurance market for well over three decades, providing temporary coverage for millions of Americans who lose their existing coverage due to transitions such as job loss, college student graduation/summer vacation, retirement before Medicare eligibility, or a change in Medicaid eligibility. Until 2017, the maximum period of a short-term policy had been capped at 364 days.

Some supporters of the Affordable Care Act (also known as the ACA or Obamacare) have criticized short-term plans, arguing that many healthy Americans (particularly young adults) were using short-term plans as an alternative to the ACA, which in turn forced ACA plans to charge higher premiums and made the ACA market less stable. Additional criticism focused on the fact that short-term plans, as transitional coverage, had different benefit designs than ACA plans and insurance companies could reject applicants based on pre-existing health conditions.

Although these critics did not offer empirical support for their argument that short-term plans was negatively affecting ACA enrollment, in October 2016 the Obama administration approved a new regulation that limited the maximum duration of short-term plans to less than three months (see the regulation here). This regulation became effective on April 1, 2017. However, this regulatory situation has now come full circle. On October 12, 2017, President Trump signed an executive order that directed regulatory agencies to consider allowing short-term insurance “to cover longer periods.”[1]Additionally on February 20, 2018, the Department of Health & Human Services (HHS) released a new proposed rule that will lift the Obama administration’s three-month restriction.

Given the pending change to the short-term health insurance market and the politicized commentary it will inevitably attract, the purpose of this report is to provide empirical data on the strengths and limitations of short-term health insurance and dispel five commonly argued myths about this form of coverage. AgileHealthInsurance.com is a leader in online short-term health insurance sales, and this report is based on analyses of actual purchasers of short-term health insurance.

What is Short-Term Health Insurance?

Before discussing some of the myths surrounding short-term health insurance, it is worthwhile to briefly explain the central characteristics of this type of insurance product. A short-term plan is designed to serve as temporary (and not permanent) major medical coverage. There is no standard enrollment period so this insurance may be applied for any time of year and plans can provide next day coverage. Short-term plans do consider health status during the application process and some conditions (e.g. morbid obesity or a heart attack in the past five years) will result in an application rejection. After application approval, an enrollee has access to a broad or even unrestricted doctor and hospital network. Short-term insurance networks can stretch across state lines, which reduce the risk of being out-of-network for important care and enables consumers to retain their preferred healthcare providers. While benefits can differ among short-term plans, all short-term plans include coverage for doctor visits, specialist visits, emergency care, x-rays, lab tests, and hospital services. Some benefits such as prescription drug coverage are not part of some short-term plans while some other benefits such as maternity care are almost never covered. Benefits apply to new medical events and do not cover health conditions that had begun prior to purchasing the insurance even if they continue during the short-term coverage period. Short-term plans have been around for decades and are offered by many insurance companies including well-known brands such as UnitedHealthCare.

Myth #1: Only The “Young and Healthy” Qualify For Short-Term Coverage

Short-term health insurance is purchased by individuals of all ages from 18 to 64. From AgileHealthInsurance.com’s random sample of 100,000 actual enrollees, the average age of an enrollee was 36.3 years old at the time of application. This means the average age of a short-term health insurance buyer was roughly the same as the average age of an American (37.9 years old).[2] With respect to older enrollees within the sample (people ages 55 through 64), they accounted for 13 percent of buyers. 13 percent is a slightly higher representation of this older age group than is found in the U.S. (12 percent) as a whole.[3]

Myth #2: Eligibility For Short-Term Insurance Is Narrow & Lacks Transparency

The typical short-term health insurance application includes five to seven eligibility questions depending on the insurance company. The purpose of the questions is to ensure applicants do not have expensive chronic health conditions that are ill suited for a temporary insurance product whose enrollees pay premiums for less than a single year. A 2016 study[4] by eHealth, Inc. found only 13 percent of applicants were rejected for short-term coverage. On AgileHealthInsurance.com, the questions are sufficiently brief that taken together they can be answered in a minute or two. Should any of the answers to these questions reveal ineligibility for coverage, AgileHealthInsurance.com alerts the user immediately and alternative products to short-term coverage are suggested. Among consumers who passed the short-term insurance eligibility questions and then submitted their applications through AgileHealthInsurance.com, over 99 percent were approved by the insurance company.

Myth #3: Short-Term Health Plans Are Not As Cheap As People Think

Short-term plans are designed to serve populations with an immediate need for low-cost coverage. The most common reason given by consumers for buying short-term coverage is job loss. According to the Bureau of Labor Statistics, the ensuing unemployment period averages 6 months.[5] Consequently, the cost of short-term coverage needs to be low given the income loss for many during this period. When comparing the average short-term insurance monthly premium to the average monthly premium[6] for an entry-level Obamacare plan (i.e. bronze plan), short-term plans clearly demonstrate that they are less expensive than long-term forms of major medical coverage.


For a 30 year-old in 2017, the average short-term premium was $79 a month. In comparison, the average premium nationwide for bronze plan coverage was $311 for a 30-year-old without subsidies. For a 50 year-old, the average short-term premium was $198 a month while the average unsubsidized premium for a bronze plan was $489.

Myth #4: Short-Term Plans Are “Junk Insurance” That Provide Inadequate Coverage

Some critics of short-term health insurance argue the product is “junk insurance.” For example, one criticism is the claim that short-term coverage requires excessive out-of-pocket contributions before cost sharing begins. However, when comparing the deductibles of 2017 health plans, the average for a short-term insurance plan was $3,434, $2,658 less than the average deductible for an entry-level bronze plan ($6,092)[7].



Looking at annual out-of-pocket limits, short-term medical coverage has a higher average out-of-pocket limit than ACA plans. The average cap on covered medical expenses for an individual enrolled in a short-term plan was $8,206 while the average cap on entry-level ACA bronze plans was $6,904[8] for individuals. In this comparison, the bronze plan had a $1,302 advantage over short-term plans. However, premiums paid by the insured do not count towards their out-of-pocket limits. As discussed earlier, premium differences between short-term plans and ACA plans can be quite substantial. For example, a 30-year-old’s average annual premium for a bronze plan without subsidies was $3,734 in 2017[9] compared to $958 in average annual premiums for a short-term plan.


While it is true that short-term plans cover fewer benefits than ACA plans and exclude health conditions that began prior to purchasing the insurance, these plans do include all major benefit categories including coverage of doctor and specialist visits, emergency care, x-rays, lab tests, and hospitalization. Drug coverage is included in some but not all plans.

Myth #5: Most Consumers Are Using Short-Term Plans As Long-Term Primary Coverage, Continuously Re-Applying For Years

This myth was the primary reason offered by the Obama administration for reducing the maximum coverage period of short-term plans from 364 days to “less than 3 months.” However, actual market data does not support this claim. When analyzing a random sample of consumers enrolled in short-term plans prior to the three-month restriction, the average effective term of a short-term policy was 201 days (6.7 months).[10] Moreover, only 9 percent maintained short-term coverage beyond the statutory maximum of one year for a single policy. These customers did so by reapplying for a new short-term plan with an effective date that started after the expiration of their existing plan, either from the same or a different insurance company.


Short-term health insurance fills a critical need for consumers who experience gaps in long-term health coverage. The most common gap is job loss and, given its average length of more than six months, was much better served by the historic 364-day term limit rather than the recent three-month restriction. Likewise, the 364-day term limit was also better suited to consumers who miss the ACA open enrollment period and are locked out of ACA insurance for a year. In light of these realities, the myths used to justify the three-month restriction on short-term plans neither protect consumer interests nor find support from the actual data on how these plans are used.


This report was authored by Bruce Telkamp, with market research provided by Shaun Greene and data research provided by Andrejs Ivanovs. Mr. Telkamp is the CEO of AgileHealthInsurance.com and had previously served as executive vice president at eHealth, Inc. Mr. Greene is the General Manager of AgileHealthInsurance.com and the former CEO of Arches Health Plan. Mr. Ivanovs oversees analytics at AgileHealthInsurance and has a masters in economics and finance from the University of California, Santa Cruz.

Breaking News in the Short Term Medical Industry

Big news for insurance agents in the insurance benefits market. The Trump administration has officially cleared the way for insurers to sell short-term health plans as a bargain alternative to pricey Obama-law policies for people struggling with high premiums. Here are 10 reasons you could save money using this type of healthcare plan.

Many have and will argue the fact that since the new policies don’t have to cover existing medical conditions and they offer limited benefits that may not translate to broad consumer appeal among people who need an individual policy. All the while policies are receiving a big thumbs up from healthy individuals that rarely need to see a doctor and suddenly find themselves without traditional healthcare plan coverage.

“For many who’ve got pre-existing conditions or who have other health worries, the Obamacare plans might be right for them,” Health and Human Services Secretary Alex Azar acknowledged. “We’re just providing more options.”

Officials say the plans can now last up to 12 months and be renewed for up to 36 months. But there’s no federal guarantee of renewability. Plans will carry a disclaimer that they don’t meet the Affordable Care Act’s requirements and safeguards.

Unable to repeal much of the Obama-era law, Trump’s administration has tried to challenge how it’s supposed to work and to create options for people who don’t qualify for ACA subsidies based on their income.

Officials are hoping short-term plans will fit the bill. Next year, there will be no tax penalty for someone who opts for short-term coverage versus a comprehensive plan. There is a three month no penalty period currently in affect allowing individuals to consider this option. That means plans for Short Term Medical can start as early as October 2, 2018.

But critics say the plans are “junk insurance” that could lead to unwelcome surprises if a policyholder gets sick and will entice healthy people away from the law’s markets, raising premiums for those left. Under the Obama administration, such plans were limited to three months’ duration. Some states do not permit them and the list of states that do are growing. Click here to see list where Short Term Medical is available with cbg | CONFIDENT.

It is no surprise a major insurer group quickly expressed disapproval.

“The broader availability and longer duration of slimmed-down policies that do not provide comprehensive coverage has the potential to harm consumers, both by making comprehensive coverage more expensive and by leaving some consumers unaware of the risks of these policies,” said Justine Handelman of the Blue Cross Blue Shield Association, whose members are a mainstay of ACA coverage.

President Donald Trump has been enthusiastic. “Much less expensive health care at a much lower price,” he said, previewing the plans at a White House event last week. “Will cost our country nothing. We’re finally taking care of our people.” There is a cost, but he is correct, it is much less expensive, and it will not cost the government anything. This may be appealing to early retirees or small business owners.

The administration estimates that premiums for a short-term plan could be about one-third the cost of comprehensive coverage. A standard silver plan under the Obama law now averages $481 a month for a 40-year-old nonsmoker. A short-term plan might cost $160 a month or even less.

But short-term insurance clearly has fewer benefits. A Kaiser Family Foundation survey of current plans found none that covered maternity, and many that did not cover prescription drugs or substance abuse treatment — required under the Obama law. They can include dollar limits on coverage and there’s no guarantee of renewal. Where some plans in some locations have higher dollar limits then ACA.

Cost Example A healthy 30-year old male living in Texas with the option of purchasing an individual Affordable Care Act (ACA) plan or a short-term health plan can pay:


DeductibleOut-of-Pocket-MaxMonthly Premium

ACA Plan



Short Term Medical$5,000$1o,000


Senate Democratic leader Chuck Schumer of New York said Democrats will “do everything in our power” to block the administration. It wasn’t immediately clear how that might happen and looking at recent political history, Democrats have not been organized enough to block much of anything.

Short-term plans have been a niche product for people in life transitions: those switching jobs, retiring before Medicare eligibility or aging out of parental coverage. See all the reasons for Short Term Medical with Pivot here.

Azar said the new plans are tailor-made for the “gig economy.” Some critics could also argue these plans come to address consumer needs and the gig economy is the new economy.

Industry analysists indicate these plans are simply developing “next generation” short-term plans that will be more responsive to consumer needs, with pros and cons clearly spelled out. Major insurers are even playing in the market, but none offer the 3 consecutive, 90 day plan option, that Pivot Healthcare does.

Delaware insurance broker Nick Moriello said consumers should carefully consider their choice. We couldn’t agree more. It is important to have strong partners that can provide you all the options. Email us for more information on all the benefits we offer.

“The insurance company will ask you a series of questions about your health,” Moriello said. “They are not going to cover anything related to a pre-existing condition. There is a relatively small risk to the insurance company on what they would pay out relative to those plans.”

Nonetheless, the CEO of a company that offers short-term plans said they’re a “rational decision” for some people.

“It’s a way better alternative to not being insured,” said Jeff Smedsrud of Pivot Health. “I don’t think it’s permanent coverage. You are constantly betting that for the rest of your life you won’t have any health issues.”

Smedsrud said most plans restrict coverage for those who have sought treatment for a pre-existing condition over the past five years.

Few should consider these are long term health care solutions. Many should consider this as a cost saving alternative to address life’s unknown.

Short-term plans join “association health plans” for small businesses as the administration promotes lower-cost insurance options that cover less. Federal regulations for association health plans have been approved. Such plans can be offered across state lines and are also designed for self-employed people.

The nonpartisan Congressional Budget Office estimates that roughly 6 million more people will eventually enroll in either an association plan or a short-term plan. The administration says it expects about 1.6 million people to pick a short-term when the plans are fully phased in. You should be ready when your clients ask about health care plan options. Click here to get appointment paperwork.

About 20 million are covered under the Obama law, combining its Medicaid expansion and subsidized private insurance for those who qualify.

Enrollment for the law’s subsidized private insurance is considered stable, and HealthCare.gov insurers are making money again.

But a recent Kaiser Foundation analysis found turmoil in the unsubsidized market.


pig herds

ON WEDNESDAY LAST week, the nonprofit Natural Resources Defense Council revealed that pig herds in the United States receive almost as many antibiotics as people in this country do. That’s bad news, especially since most of the pigs receiving antibiotics aren’t sick, but instead are getting the drugs to prevent infections in intensive farming. Those drugs don’t keep the US pig herd healthy—major diseases have increased year over year since 2000—and all those antibiotics are increasing the amount of drug-resistant bacteria that arise on pig farms and that are routinely found on meat.

None of that is good news. But there’s a second story hidden in the NRDC report that is worse: The advocacy organization had to jump over hurdles to get the data to explain the effects of that drug use. Even in the era of Big Data, the information we‘re allowed to have about how antibiotics are used in US animals is limited, incomplete, and hostage to commercial interests—all of which keeps Americans from fully understanding how bad raising practices put our health at risk.

It doesn’t have to be that way. Other nations track and report agricultural antibiotic use, livestock diseases and human health impacts—not only in granular detail, but in unified data sets that make it easy to see how what’s happening on farms affects the wider world.

In the Netherlands, for instance, paired sets of data—Nethmap for human antibiotic use and resistance, MARAN for livestock (it stands for Monitoring of Antimicrobial Resistance and Antibiotic Usage in Animals in the Netherlands) are released in a single document every year by the Ministries of Health, Welfare and Sport, and Economic Affairs, Agriculture and Innovation. (Those are the equivalent, allowing for differences in government structure, of the US Department of Health and Human Services and the USDA.)

The Dutch data sets are assembled with the participation of physicians, pharmacists, and veterinarians, and they are a marvel of completeness. They are remarkably real-time, fine-grained, and coherent across categories—so much that, in the wake of a 2005 European Union ban on one type of farm antibiotic use, the Dutch data could show that drug-resistant infections linked to food didn’t drop as expected. That gave the government the proof it needed to recruit farmers into voluntary cuts in farm drug use. Antibiotic use dropped 60 percent in three years—and that time, they saw a drop in human infections.

Contrast that to the United States, where human prescription statistics are compiled and sold by a private company, Quintiles IMS, formerly IMS Health. (NRDC couldn’t afford to buy this data for its report; the group had to beg help from a deeper-pocketed think tank.) Animal-drug sales, but not usage, are tendered by veterinary-drug manufacturers to the FDA. Documenting where resistance is occurring is even more complicated: That is a joint project of the USDA, FDA, and CDC—but the agencies don’t report all their results in a single document or at the same time.

In the current political moment, perhaps it’s no surprise that the companies that make and sell antibiotics play a much larger role in the US surveillance system than they do in the Netherlands or across the European Union. For a glimpse of how uninformative American antibiotic surveillance is, look at how animal-antibiotic data comes to be.

Compiling and releasing those stats is governed by a law called the Animal Drug User Fee Act (ADUFA). The law’s origin was a slightly shady deal done between the FDA and pharma companies back in 2003: The companies were so impatient with the slow pace of new-drug approvals that they volunteered to pay a “user fee” that would allow the agency to hire more staff and process paperwork faster.

In ADUFA’s first years, drug companies paid the FDA $43 million, practically guaranteeing the act’s re-approval when it came up for a 5-year re-authorization. Sensing some leverage, members of Congress who wanted more transparency around farm antibiotic use shoehorned into the law a requirement that any antibiotics manufacturer that wanted new drugs approved would have to give up some agricultural sales data in exchange. That led to the first “ADUFA Report” (technically the “Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals”) in 2009. It has been published every year, more or less, ever since.

But the statistics included in the report have been incomplete at best. The first ADUFA report, which recorded 28.8 million pounds of antibiotics sold for farm use, was only four pages long and contained just a single table. (It’s up to 67 pages and 28 tables and figures now.) The ways that drugs are dispensed on farms only began to be described a few years ago, and the descriptions don’t exactly match scientific understanding of how resistance emerges from farms. David Wallinga, a physician and senior health officer at NRDC, points out, the breakdown of how the drugs are used in different livestock species was only divulged in last year’s report, which covered 2016.

The biggest problem, though, is that ADUFA isn’t considered an obligation owed to public health, as antibiotic data is in Europe. Instead, it’s a political football. The law is up for reauthorization again this year, and since March, versions have been bouncing between the House of Representatives and the Senate. Some have been what legislative wonks call a “clean bill,” a strict reproduction of the text from the last round. But others have been lavishly tinkered with: one provision allowed the use of animal drugs, for up to five years, under “conditional approvals”—that is, without companies having to reveal any data showing their drugs are effective.

The newest version of ADUFA isn’t final yet; versions that separately passed the House and Senate will have to be reconciled and then voted on again. Advocacy organizations who have been monitoring the maneuvers contained in the various amendments are already exhausted—not just by the argumentation, but by the persistent sense that farm antibiotic misuse isn’t anyone’s priority other than theirs.

“The lack of data is a problem because we know that antibiotics are vastly misused in agriculture, but we need more information on exactly how they are used to put in place the best stewardship practices possible,” says Matthew Wellington, antibiotics program director for the organization US PIRG.“The less clear that data is, the harder time public health advocates and elected officials will have in creating best practices.”

If American farm and human antibiotic data were complete, up to date, and open-access, we’d be able to easily draw the kinds of comparisons that the NRDC authors needed and that Europe takes for granted. Robust public health ought to be the entitlement of every American. It’s incongruous that the data that could help achieve it isn’t free to all.

pig herds" title="Five ways to affordable dental care">

Five ways to affordable dental care

Good personal hygiene and educating yourself on the dental industry will save you money over and over again when it comes to dental care.

See our FIVE tips on how to save money on your teeth!

The expense of health care does not end with your physician and can be overwhelming at the dentist. A twice-annual cleaning and exam is along with regular flossing and brushing are some ways to keep your dental bill low. Even the most devoted brushers and flossers can rack up dental bills for minor and major services.

How do you stay on top of it good dental hygiene without going broke?

Five ways to save on dental care:

1. Discounts and Deals

Dentists often advertise some super deals through social buying sites. On occasion a mail out, local “shopper”  or newspapers, and even the ubiquitous blue envelope from Valpak will have dental deals. Let me bear witness to deals that do exist: While living in Seattle, I redeemed a Valpak coupon that helped me pay just $29 for cleaning, X-rays and a free teeth-whitening kit custom-made for me in the office.

Things to remember:

  • Read all the fine print. Be sure to review the expiration date. If you look to redeem some deals post expiration date you will still be able to redeem the coupon value but the total bill will be much higher.
  • Consider if it is for a new customer. The second visit may not be worth the savings from the first.
  • Always get your initial exam with the special deal and any other visits or services compare to other providers. Don’t forget to get the total cost of the recommended treatment with the care plan.
  • Ask friends and co-workers for referrals. In some cases savings can be had from the provider when you are a referral or refer a friend.

2.Extra procedures

List of procedures to think twice about:

  • Teeth Whitning
  • Amalgam filling replacement
  • X rays
  • Precautionary Removal
  • Wisdom Teeth
  • TMJ Disorder

3. Second Opinions

Seeking dental care is hard enough in itself but when the exam comes back requiring major dental work one must ask themselves if the investment and care are worth the total cost and what other options are out there?

In the case you have an long term relationship with your dentist and are completely comfortable with the care, a second opinion wouldn’t and shouldn’t matter to your provider. The care plan will be the same. In the case you may have a questionable provider and cannot fully grasp the list of “required” work you have been diagnosed with, get a second opinion. It could save you a considerable amount of money.

4. Seek out free or low-cost options

Don’t have dental insurance? Look for discount dental plans and discount plans in one place with  Dental for Everyone. You can review the providers in your area by clicking here.  An annual membership fee qualifies you for discounts of up to 60 percent from a group of dentists who have agreed to lower rates. For more information on receiving a personalized analysis on dental insurance for your area contact us.

Other possibilities that could be options. Many options are based on income or will have an open door appointment schedule making it hard to get work done that requires a block of time.

  • Children’s Health Insurance Program (CHIP): Designed for families who don’t qualify for Medicaid assistance but can’t afford private insurance, CHIP dental coverage is good for children up to age 19. Coverage varies from state to state. To find out more, visit the CHIP website.
  • Clinical trials: According to the National Institute of Dental and Craniofacial Research, you may qualify for studies that include your specific dental situation. This means free or low-cost care. To learn more, visit the NIDCR website and click on “Clinical Trials.”
  • Dental schools: The American Dental Association has a list of such schools; maybe you’re lucky enough to live near one. Don’t worry, dental students’ work is supervised.
  • Dental hygiene schools: You may be able to get low-cost cleanings at some dental hygiene schools. Check the American Dental Hygienists’ Association website to find the nearest school.
  • Federally funded health centers: These operate on a sliding-scale basis. The U.S. Department of Health and Human Services website has a health care finder tool.
  • Medicaid: Another state-run program that may cover dental benefits for low-income residents. Visit the website to learn about benefits in your state.

5. Research your dental charges

Unlike a medical clinic many dentist’s are sole proprietors or in a partnership making it more of an option to talk to them about pricing. Question your care. Look for ways to save money. Perhaps you can save some money by combining visits, for example a filling and a cleaning or some combination. It extends the appointment time but may save a clinic charge for each visit.

Understand Short Term Health Care by Julia Stanek

Short Term Medical


Choosing the right health plan is an important decision. While traditional health plans may be a good fit for some, one may find the traditional health plan is either more comprehensive than needed, not tailored enough to specific healthcare needs, or much too expensive. A short-term health plan is an important option to consider for those who need coverage but cannot justify purchasing a traditional plan or for those who find themselves uninsured due to life circumstances. As you reflect on your own healthcare needs, decide what coverage options might benefit you the most and which plan features will improve your healthcare experience.

Choosing a Short-Term Health Plan

Who can benefit from a short-term health plan? Why might one consider looking into investing in a short-term health plan? We all have different healthcare needs and there are many reasons short-term medical coverage may be right for you. Anyone who is not currently covered under a traditional health plan can benefit from a nontraditional short-term plan. Recent graduates and adult children who are no longer covered under a parent’s plan can use a short-term plan as a bridge to coverage under a future employer or while considering long-term healthcare options. Families and individuals who missed the open enrollment period have the option of enrolling in back-to-back coverage terms offered by Pivot Health. Those who are unemployed or uninsured but need medical coverage can benefit from the wide range of options short-term health plans offer, allowing you to tailor your health plan to your healthcare needs as well as your financial needs.


Considering Your Options

Short-term medical plans can last up to 90 days under one certificate of insurance- however, Pivot Health offers the opportunity to apply for up to four back-to-back certificates. This option may be advantageous to those anticipating specific healthcare needs, and while out-of-pocket responsibilities and your deductible start over with each ensuing coverage term, any medical conditions that arise and were initially covered will continue to be covered under your new certificates. Coverage may be available within 24 hours of applying or you may choose a start date within 60 days of the first application. You may choose a monthly payment option or to save money by pre-paying for the entire length of coverage. Pivot Health also offers a range of deductibles and coinsurance options, allowing you to customize your health plan.


Customize Your Health Plan

Important plan features include doctor visit copays and prescription coverage. Deductible options range from $1,000 to $10,000 and coinsurance may be selected at 20% or 30%- this means once you have met your deductible, insurance pays 80% of covered medical expenses while you are responsible for 20% up to the out-of-pocket limit. Separate prescription drug deductible options are available for those who require consistent prescriptions and maximum out-of-pocket costs are as low as $3,000 per person per coverage period. Conveniently, you have the freedom to choose from any doctor or hospital, as there are no network restrictions. Pivot Health also provides access to 24/7 telemedicine, making healthcare easy and accessible. In addition to these features, coverage includes several non-insurance benefits such as $49 doctor consultations available 24/7, discounted eye exams, lenses, frames and contacts, and up to 70% savings on prescription drugs.


Short-term health plans can be extremely useful for those uninsured and in need of coverage. With a wide range of coverage options and benefits and short-term financial commitment, these plans allow for personalized healthcare. Ultimately, making an informed decision is critical and can ease the uncertainty and stress of choosing the plan that’s right for you.

Is Short-term health care right for you? Review your options by clicking here. Looking to add Short Term Medical health care into your portfolio of products you sell? Contact us now. info@capital-benefits.com.

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Unlikely lawsuit to deem ACA Unconstitutional

The Department of Justice (DOJ) argued in court Thursday that key parts of ObamaCare are now unconstitutional, siding in large part with a conservative challenge to the law.

The move is a break from the normal practice of the DOJ to defend federal laws when they are challenged in court. Under President Trump, the department has opted not to defend a law that it strongly opposes.

Attorney General Jeff Sessions acknowledged in a letter to Speaker Paul Ryan (R-Wis.) that the DOJ has a “longstanding tradition” of defending federal laws, but argued that this is “a rare case where the proper course is to forgo defense” of the law.

The lawsuit in question was filed in February by Texas and 19 other GOP-led states, arguing that ObamaCare is unconstitutional and should be overturned.

Legal experts are deeply skeptical the challenge can succeed, and 17 Democratic-led states have already intervened to defend the law in the absence of DOJ action.

The DOJ argues that ObamaCare’s protections against people with pre-existing conditions being denied coverage or charged more should be invalidated, maintaining that the individual mandate that people have insurance or face a tax penalty is now unconstitutional.

The conservative states and DOJ point to the Supreme Court’s 2012 ruling that upheld ObamaCare’s individual mandate under Congress’s taxing power. Now that Congress has repealed the mandate penalty as part of last year’s tax bill – while technically keeping the mandate itself in place – they argue the mandate is no longer a tax and is now invalid.

They also argue that the key pre-existing condition protections cannot be separated from the mandate and should be invalidated. The DOJ argues the remainder of the law can stay.

The chances for that argument succeeding are viewed with deep skepticism by legal experts, in part because Congress itself indicated that the rest of ObamaCare could still stand without the mandate when it moved to repeal the tax penalty last year.

The case is currently before a federal district court judge in Texas, Reed O’Connor, who was appointed by former President George W. Bush.

Some supporters of ObamaCare view the DOJ’s move more as a damaging break from precedent rather than an actual serious legal threat to ObamaCare, since the lawsuit is unlikely to succeed.

Previous administrations have made their own break from precedent. In 2011, for example, President Obama’s Justice Department broke precedent by declining to defend the Defense of Marriage Act, which defined marriage as being between a man and a woman.

10 Life Situations When Short Term Health Insurance is an Excellent Option for Consumers

Capital Benefits Group is now offering a popular alternative to ACA plans!


Short Term Medical with Capital Benefits Group

These alternative plans could help over 8 million consumers keep insurance during times of transition.

SCOTTSDALE, Ariz.April 5, 2018 /PRNewswire/ — Pivot Health, a leading provider and manager of specialty health insurance products, defined 10 ways short term health plans can benefit consumers who would otherwise be uninsured or lack sufficient coverage due to changes in their life situation. 

“An Affordable Care Act (ACA) plan is a fine solution for individuals and families who qualify for financial subsidies to lower their health insurance costs. But for the 8 million Americans who don’t qualify for an ACA plan subsidy and for those in a variety of life events, they should know there are other affordable options,” said Jeff Smedsrud, Chief Executive Officer of Pivot Health. “When life throws a curve ball, short term health plans can be a low-cost insurance solution while covering doctor office visits, hospitalization and more. It is a niche, temporary solution, but a large overall market.”

Smedsrud compiled a list of 10 life situations when short term health insurance could make the most sense for a health care consumer:

  1. Joining the “gig” economy – At the end of 2016, the percentage of new entrepreneurs starting their own companies was 7.4 percent – the highest it has been in four years. A recent study credited a rebounding economy, easy-to-obtain credit and hopes for an Obamacare repeal and tax reform under the Trump administration as reasons for the surge. For new business owners or solo-preneurs, being able to obtain immediate and affordable health insurance coverage is a key component to their personal success. Short term medical insurance can start in just 24-hours and costs about 50% less than traditional health insurance. 
  2. Stuck in employer waiting period – The unemployment rate across the nation is at an all-time low due to recent economic upturn. With a robust economy, workers can jump from job to job to ultimately land their ideal career. Yet many times employers have a 90-day waiting period before health insurance benefits begin. A temporary short term health plan helps bridge the gap for workers who are between jobs or stuck in a new employee waiting period.
  3. Moving to new state – In 2016, about 7.5 million Americans moved to a new state. When an individual with an ACA plan moves, their insurance certificate is no longer valid in their new state of residence. They can certainly enroll in another ACA plan once they have settled in their new home, but time and paperwork can delay coverage. In addition, the deductible starts over which is a big disadvantage to those who move late in the year. Short term medical with a lower deductible can serve as a temporary solution to provide immediate coverage for an unexpected illness or accident that occurs.
  4. College Students.   Students are allowed to stay on their parent’s health insurance plan until the age of 26.  But not all insurance companies will cover students attending college out-of-state. It could also be less expensive to remove a student from a parent’s policy and enroll in a short term health plan, a quick and easy solution for the months a student is away at school.
  5. Aging off parents insurance plan – The ACA allowed parents to keep their adult children on their family plan until the age of 26. Children who do not have access to employer coverage or need a more affordable option can benefit from low-cost short term health insurance. This is especially important for those who age off of their parent’s plan later in the year. A short term plan can be an excellent bridge of coverage to January 1.
  6. Early retirees –  When examining a larger demographic of 50-64-year old women, Pivot Health sales data shows this group completed the most applications on its website in 2017 when looking at gender-specific data. Early retirees who do not yet qualify for Medicare but have too much household income to qualify for an Obamacare subsidy, can find a new option through short term medical that is friendly to budget-conscious, not-quite-yet-senior-citizens who are retiring early. Pivot Health estimates that nearly one million pre-retirees may be best served by – but should at least consider – a short term medical plan. 
  7. Freedom from doctor network – In 2017 1.9 million individuals who enrolled in an ACA plan only had one insurance carrier to choose from, often with restricted provider networks. This limits health care choice, especially in rural communities where provider resources are thin. Short term health plans marketed by Pivot Health have no doctor network. All providers are accepted, giving policyholders the ability to see any physician or facility without the worry of staying in-network.
  8. Divorce – More than 825,000 individuals divorced in 2017. In almost every case, one of the two partners needs to adjust their health insurance coverage, even temporarily. Women are at a greater risk of losing their insurance. A government study indicates that approximately 115,000 women lose their health insurance in the months following divorce. A short term health insurance plan can be purchased for a minimum of 30 days or for multiple months, depending on how long someone going through a divorce needs to get back on their feet.
  9. Too rich for Medicaid, too poor for subsidies – Across the U.S., 2.4 million people don’t make enough to qualify for a tax credit to purchase health insurance on the ACA exchange, yet make too much money to qualify for Medicaid benefits. This group of “coverage gap” individuals could benefit from low-cost short term insurance.
  10. COBRA – The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides individuals who lose their job the ability to keep their health insurance for up to 18 months. The Bureau of Labor Statistics reports approximately 36 million Americans changed jobs in 2017. They might have the option to enroll in a COBRA plan, but the cost is far from economical. When an individual enrolls in COBRA, they must pay the entire insurance premium plus a 2 percent administrative fee. Many would be better off purchasing a short term health plan and saving their extra dollars while they job hunt. Additionally, those who had been employed by firms with less than 20 employees are not eligible for COBRA. 

Today short term medical plans are restricted to 90-days of coverage. However, a proposal to overturn the 90-day limitation was recently issued by the Trump administration. The Department of Health and Human Services (HHS) is accepting comments about the proposal through the end of April 2018. It is expected HHS will reverse the rule at the end of 2018, allowing short term health insurance plans to have a coverage duration of up to 364 days. Short term plans generally do not cover pre-existing conditions, can deny coverage to individuals with chronic health conditions, have leaner benefits than ACA plans and are not considered qualified health benefits for purposes of premium subsidies based on income.

“Truth is, the short term medical insurance market is much bigger than experts estimate and helps millions get coverage and keep from being uninsured,” said Smedsrud. “It is not for everyone nor should it be considered a permanent plan. But there are millions who need temporary coverage because there are lots of curveballs in this turbulent time. Our plans provide easy enrollment, next day coverage, access to all medical providers, the ability to tailor plans to meet current needs, offer monthly pricing to meet many budgets, plus prescription drug benefits.”

About Capital Benefits Group
Capital Benefits Group is an insurance management, and benefits distributor company led by an experienced team of health insurance professionals.The company has proprietary products and dedicated relationships with several national carriers. Capital Benefits Group is excited to promote and distribute Pivot Health benefits. Pivot Health has led previous firms that were acquired by NYSE listed companies and recently announced it was acquired by HealthCare.com (www.healthcare.com), a privately-owned search-and-compare health insurance shopping platform. For more information, visit www.capital-benefits.com or email info@capital-benefits.com. 

Trump proposal boosts skimpy insurance plans, again undercutting Obamacare

The Trump administration is proposing to expand the availability of short-term health insurance plans that some deride as “junk insurance” — an effort that could give consumers cheaper coverage options but undermine Obamacare’s marketplaces and popular protections for pre-existing medical conditions.

Proposed rules issued this morning follow an executive order from President Donald Trump this fall seeking to expand access to more affordable health insurance alternatives to comprehensive, but pricey Obamacare plans. The HHS proposal, released weeks after the Trump administration issued a rule encouraging small businesses to find coverage outside the Affordable Care Act marketplaces, represents the administration’s latest effort to unwind the health care law with repeal efforts stalled in Congress.

“We need to be opening up more affordable alternatives,” Health and Human Services Secretary Alex Azar said on a call with reporters today. “Today’s action represents an important promise kept by the president.”

But many health care experts fear expanding the availability of the health plans, which are exempt from Obamacare’s robust consumer protections, could further destabilize the law’s wobbly insurance markets. Critics say the plans offer just the illusion of coverage, and enrollees often don’t realize how limited their benefits are until it’s too late.

Short-term plans maintain cheaper prices than traditional insurance by refusing coverage for pre-existing conditions, in some cases, and some medical services. Unlike Obamacare coverage, the short-term plans typically cap payouts, which could leave enrollees with catastrophic illnesses or injuries on the hook for huge medical bills.

“The way that you get to lower premiums is to reduce benefits,” said Kevin Lucia, a professor at Georgetown University’s Center on Health Insurance Reforms. “It’s a quick fix, but ultimately those products don’t help consumers who need them.”

The new rules are a reversal of the Obama administration’s efforts to limit short-term plans. It reduced the plans’ maximum length from one year to three months, hoping to steer more people into comprehensive Obamacare coverage.

The new proposal from Trump’s health, labor and treasury departments would restore the 12-month limit on short-term plans. The administration projects that between 100,000 and 200,000 individuals now in Obamacare plans would instead opt for short-term plans in 2019.

“You’ll get such low prices for such great care,” Trump said at the signing of his October executive order on health care. “It should have been done a long time ago.”

Supporters of short-term plans say they are an affordable insurance option for people who don’t want robust coverage and have been priced out of the individual market — especially middle-income customers who don’t qualify for Obamacare’s insurance subsidies. The Trump administration on Tuesday pointed out that the number of individuals purchasing plans without subsidies fell by 2 million, or nearly 25 percent, between 2016 and 2017, and one in four customers had access to just a single insurer selling coverage this year.

“Basically what they’re doing is giving people options who are already trying to jump off the ship,” said Edmund Haislmaier, a health policy analyst at the conservative Heritage Foundation.

UnitedHealthcare, which withdrew from the Obamacare marketplaces after mounting financial losses, was “excited” by Trump’s health care executive order, chief financial officer Dan Schumacher said on an investor call in October. He cited the company’s history of selling short-term plans and touted it as an attractive option for people “in between coverage.”

The Trump administration last month also proposed expanding the availability of association health plans, in which small businesses and self-employed individuals band together to purchase coverage. The association plans are exempt from some Obamacare rules, such as the requirement to cover a set of 10 health benefits the law deemed “essential,” including prescription drugs and emergency care.

Trump’s insurance proposals come shortly after the GOP tax overhaul scrapped Obamacare’s individual mandate starting in 2019. The administration is also taking steps to expand exemptions to coverage requirement while it’s still in effect this year.

 Taken together, the administration’s moves are expected to weaken the law’s insurance marketplaces since individuals with few medical needs are likely to gravitate to the cheaper coverage. That would leave a disproportionately sicker, more expensive population in the Obamacare plans, further driving up already-rising premiums. Most low-income Obamacare customers would be protected from the resulting premium increases thanks to the law’s hefty insurance subsidies, meaning the marketplaces likely can still survive.“There won’t be a death spiral, but the people who really lose in that scenario are basically middle class people who are sick,” said Michael Miller, policy director of consumer advocacy group Community Catalyst.

States supportive of Obamacare are likely to take steps to curb the proliferation of short-term and association plans. In California, for example, state lawmakers this year have already offered legislation that would prohibit the sale of short-term plans.

The proposed rule will be open for comments until April 23.

Rachana Pradhan contributed to this report.