Short-Term Plans Exclude Coverage for Pre-Existing Conditions, Leaving Enrollees Without Adequate Protection

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When Peter LaFrance went to the hospital for congestive heart failure and type 2 diabetes, he was left with over $35,000 in medical bills that his insurer refused to cover. His health coverage, obtained through Golden Rule, which is a subsidiary of UnitedHealth Care, was a short-term, limited-duration health plan. These types of health plans can exclude coverage of health issues that arise as a result of pre-existing conditions because they are not required to comply with the Patient Protection and Affordable Care Act (ACA). Even after appealing the insurer’s decision, Peter LaFrance was unable to get the insurer to cover his health care costs. Because Mr. LaFrance had experienced shortness of breath in the 24 months prior to being treated for his conditions, his health plan determined that he had a pre-existing condition. His health plan determined that an ordinarily prudent person would have had those symptoms examined by a doctor instead of waiting for them to develop into a more serious condition.

Consumers who enroll in these types of health plans are often left without comprehensive coverage without being aware of the plan’s limitations. Additionally, consumers are often attracted to these types of plans because they are less expensive than ACA-compliant plans that are available through the insurance marketplaces. While state law often requires insurance brokers to disclose the limitations of short-term plans and warn prospective enrollees that the plans are not required to comply with the ACA, consumers often look past these details when they are enrolling in a plan. However, some enrollees knowingly purchase plans like this because they do not expect to utilize healthcare services much or do not think that they need comprehensive coverage.

Review the map on our website that includes details on laws that states have enacted to protect consumers from the inadequacies of short-term plans.

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