Pivot Health is the “Best Value” Short Term Medical Plan in 2020

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Pivot Health is the best value
short term medical plan in 2020.

Pros

  • No network (all doctors accessible)

  • Access to 24/7 telemedicine

  • Discount programs

  • Prescription coverage

Cons

  • Very low maximums on the cheapest plans

  • Requires emergency pre-certification within 48 hours

Pivot Health has been around since 2016, managing over $7 billion in insurance premiums, and is affiliated with Communicating for America, a consumer advocacy group in favor of affordable healthcare for Americans. Pivot Health underwrites its short-term health plans through Companion Life Insurance Company, which has an AM Best financial stability rating of A+ (Superior). Pivot Health is available in 27 states.

Pivot Health has easy-to-use online tools that help you prioritize your insurance needs before it gives you quotes, and it offers you a selection of available features, as well, such as 70% off prescription drugs. You will also receive discounts up to 30% off of eye exams, frames, lenses, and contacts, making this company our stand-out for excellent STM value.

We got 51 plan options ranging from $62 to $269 per month for a 27-year-old. Almost half of the options were under $100. For a 35-year-old, the pricing was the same at $62 to $269 per month, and for a 45-year-old it was $89.69 to $411 per month. At age 55 it was $121 to $618 per month.

You can choose deductibles between $1,000 and $10,000, the maximum out-of-pocket cost is between $3,000 and $10,000, and the maximum annual limits range from $100,000 to $1,000,000. All plans have co-pays of 20% or 30%.

Examples of some of their common exclusions include pre-existing conditions, immunizations, routine physical exams, and injuries resulting from extreme sports. The waiting periods are five days for illness, 30 days for cancer, and six months for certain specified items like a tonsillectomy.

Why We Chose It: Pivot provides a vast selection of affordable basic coverages and valuable options so that you can get the right policy for the right price, with the ability to add numerous discounts for things like prescription drugs and vision care.

 

 

Who Is Eligible for Short-Term Health Insurance?

Short-term health insurance provides limited coverage as a temporary bridge while you wait to qualify for an ACA compliant plan.3 It can be used in circumstances where you do not yet qualify for a group insurance plan or you are waiting for the next open enrollment. Some people choose short-term health insurance as a temporary coverage in case of an emergency if they are suddenly without coverage for a variety of reasons, here are some examples:

  • Leaving a job that had a health insurance plan and not qualifying for COBRA plans
  • Retiring early and looking for temporary insurance until qualifying for Medicare
  • No longer qualifying for a group plan due to divorce
  • Moving to a new state where an existing plan cannot follow, and waiting until a new plan starts
  • Students or young adults turning 26 who no longer qualify for their parent’s insurance
  • People who want to have a plan with no network, and find ACA plans too expensive

Anyone can apply for short-term health insurance. However, because short-term health is not ACA compliant, it uses medical underwriting and may refuse to insure you (or offer only limited coverage). Depending on which state you are in, coverage may only be available for a very limited time for a maximum of three years.4

 

How Can You Buy Short-Term Health Insurance?

Short-term health insurance is available through quotes you can obtain by phone or directly on the insurance company’s website. Online marketplaces and insurance agencies also have websites that provide quotes with various insurers (in some cases hundreds), so it makes it easy to find options. See link for coverageoptions by clicking here.

Short-term coverage has always been known as a lower-cost health insurance option, but with many changes to tax credits for lower-income individuals, it is important to consider all your options. 

 

How Much Does Short-Term Health Insurance Cost?

The average cost of short-term health insurance is $124 a month compared to $393 for an unsubsidized ACA-compliant plan.7 We found plans with very limited coverage, or coverage more suited to the concept of catastrophic plans (due to their high deductibles), for as low as $60 a month. It can be a confusing process due to the lack of consistency in plan coverages, but it is recommended to shop and compare the options line by line.8

 

What Does Short-Term Health Insurance Cover?

Short-term, limited-duration (STLD) health insurance, also known as short-term medical (STM), is meant to cover hospital room and board, emergency health situations, inpatient doctor visits, and other unexpected medical needs that are not part of pre-existing conditions. Unfortunately, confusion about how the coverage works and existing exclusions create a lot of claim denials. These are emergency plans with limitations for preventative care, high deductibles, which prevent you from being covered until the deductible has been met.

Short-term health providers will tailor different types of packages in varying price ranges. When purchasing short-term health, you can find some policies that offer more coverages than others. You do not need to settle for a bare minimum plan, just be sure and ask about preventive care add-ons or other coverage to get the best quotes. It is worth comparing a few options before you make a decision.

 

What Does Short-Term Health Insurance Exclude?

Short-term health plans have many exclusions, including no coverage for pre-existing conditions. Short-term health plans are not subject to the ACA provisions and are not ACA compliant. Short-term health plans leave you with significant risks of incurring medical debt due to high deductibles, extensive exclusions, and, because of this, potential denials of coverage.

Here are some examples of exclusions that demonstrate the limitations found in many short-term health plans:

  • 43% do not cover mental health services – Some of Pivot plans cover mental health. Contact gwhite@capital-benefits.com for more info.
  • 62% do not cover substance abuse
  • 71% do not cover outpatient prescription drugs
  • No short-term health plans cover maternity care

Short-term health plans do not cover wellness visits, although we found a few in our reviews that do offer it for a cost.3

 

Short-Term Health Insurance vs. COBRA

COBRA plans allow you to maintain the coverage you had through your employer or previous group benefits, which include all the ACA-compliant essential benefits and allow you to maintain coverage for things like pregnancy or mental health if your former plan covered it.9 In contrast, STM plans will provide you with much less coverage, and no essential benefits.

The average cost of a COBRA plan will depend greatly on what kind of plan your employer or group had in the first place. In some cases, the employer may continue to pay into the plan for you, which will give you a reduced cost. In others, you may end up having to pay into the plan yourself fully. Don’t forget to consider that all amounts you already paid toward your deductible will count toward the COBRA continuation of benefits, and this can save you a lot of money, especially if you only plan to be on it for a short while.9

Not having to pay the deductible again can sometimes justify the added monthly costs. These savings can be significant if you consider that the truly “cheap” healthcare options offered through short-term health plans exclude many coverages you may need, and often have very high deductibles before you can access the coverage.

 

How We Chose the Health Insurance Companies

We looked at short-term health insurance plans through insurance companies and independent health insurance marketplaces to discover what options exist. We investigated the waiting periods, qualifications, types of coverage available, common exclusions, maximum limits, deductibles, and copays across the different plans. Our goal was to highlight some of the best short-term health insurance options offered through reputable insurance companies to help you compare and decide if short-term health insurance is a good idea for you. 

 

Article Sources

Investopedia requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy .
Original Article Link: https://www.investopedia.com/best-short-term-health-insurance-4844942
  1. Communicating for America. “About Communicating for America.” Accessed June 1, 2020.

  2. FACT. “About FACT.” Accessed June 1, 2020.

  3. Kaiser Family Foundation. “ACA Open Enrollment: For Consumers Considering Short-Term Policies.” Accessed June 1, 2020.

  4. Healthinsurance.org. “Duration and renewals of 2020 short-term medical plans by state.” Accessed June 1, 2020.

  5. eHealth. “Customer Promise.” Accessed June 1, 2020.

  6. Kaiser Family Foundation. “How ACA Marketplace Premiums Are Changing by County in 2020.” Accessed June 1, 2020.

  7. CMS.gov. “Fact Sheet: Short-Term, Limited-Duration Insurance Proposed Rule.” Accessed June 1, 2020.

  8. ThinkAdvisor. “Average Short-Term Health Premium Creeps Lower.” Accessed June 1, 2020.

  9. U.S. Department of Labor. “An Employee’s Guide to Health Benefits Under Cobra,” Page 6. Accessed June 1, 2020.

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