In Oregon you can purchase Short-Term Medical (STM) insurance for up to 90 days per contract. Short Term medical plans are a type of limited-benefit health insurance and are not subject to the Affordable Care Act/Obamacare regulations, and is not guaranteed-issue. You cannot reapply for another contract with the same company without a 60 day break. Therefore, if you decide to have on Short Term Medical plans to save money, I recommend the Pivot Health Plan for 3 months, then the Allstate plan for 3 months, then back to the Pivot Health plan for 3 months, and so on.

Generally, STM plans were designed for someone needing medical insurance for a limited amount of time while waiting for other coverage to begin. Most plans do not cover you for a pre-existing condition, prescription drugs, or preventative services. Some healthy people purchase Short Term medical plans if they are less expensive than coverage on the Federal Marketplace. The main appeal of a Short Term Medical plan is for a health person who wants catastrophic coverage and earns too much money to qualify for a plan on the Federal Marketplace place (and receive a tax credit).

Take the time to read the brochure plan limitations and exclusions prior to enrolling in coverage to see if the coverage is right for you. It is important to make and informed decision.

Coverage can begin as early as next-day, or you can select a future day for the plan to start. To qualify you have to answer NO to the 6 or 7 qualifying questions. I always recommend if possible to have the coverage end the last day of a month. For example, if your plan starts effective September 15, have your end November 30 or December 31. This will benefit you should you transition to a new plan on the Marketplace or buy another STM plan with a 1st of the month start-date.

1. Pivot Health: The Pivot Health Plan is my least expensive plan offering a variety of plan options and deductibles. You can pay monthly or select the single-pay option that saves you about 20% at check-out. The Deluxe & Choice plans include 3 Primary Care, Specialist, or Urgent Care visits with a copay before the deductible needs to be met. The plan has no provider network, so you can see any doctor willing to bill your plan. In the case where the provider will not bill your plan, you can file your own claim.

2. Allstate Health Solutions: Allstate Health Solutions, (underwritten by National General) is the most expensive option of the 3, and offers a monthly plan or single-pay with a discount. Urgent care visits are available before the deductible is met (read for details)

Pivot Health Plan is underwritten by Companion Life. The brochure outlines side-by-side the different plans and benefit options. Pivot Health has no contracted provider network: so you can see an doctor that agrees to bill the plan. The Deluxe plan offers the lowest out of pocket maximum.

Please review the plan coverage plan limitations and exclusions section of the brochure prior to enrolling. The qualifying enrollment questions are also included in the brochure below. All the plans include free Telehealth services.

The Choice and Deluxe plans both offer a combined 3 visits to an Urgent Care, Primary Care, or Specialist visit before your deductible needs to be met. The Deluxe plan has a lower out of pocket maximum.

When you get to the payment section of the application you will see a 'pre-pay' option. If you single-pay for the 3 months of coverage, you save about 20% in premiums. However, by pre-paying you are not allowed to cancel early with a refund if you only need a month of coverage.

To cancel your plan prematurely you can call customer service or email clientservices@insurancebenefitadministrators.com

Allstate Health, (underwritten by National Health Insurance Company) offers a solid plan with a good benefit and large, national network called the Aetna Open PPO Network. The contract can be taken out for 3 months. Urgent Care visits charge a $50 copay prior to your deductible PLUS coinsurance (20% or 50%), prior to your deductible. Doctor visits are subject to your deductible. You save about 20% if you select the single-pay option, but they only offer this for a 3 month contract.

Before making application please review the plan brochure, especially the plan limitations and exclusion section.

Select the 'Monthly' option when quoting. You can keep coverage from 1-3 months and cancel any month by calling Customer Service in advance. You can save about 20% of you choose the single-pay option. The contract maximum is 90 days.

Allstate Health Solutions: 888-781-0585 You can call and cancel your plan early if you want. Email memberservices@nhicadmin.com with general requests like another ID card or billing question.

IMPORTANT CONSIDERATIONS

DEDUCTIBLE AND OUT OF POCKET MAXIMUM:

It's important to note with Short Term that the plan deductible does NOT go towards meeting the plans out of pocket maximum: This is an important distinction compared with most traditional health insurance plans.

For example, if you purchase a $5000 deductible plan with a $3750 out of pocket maximum, should you have a $30,000 covered medical expense, your out of pocket maximum for covered services would be $8750. Different plans will have different out of pocket maximum options.

SINCE THE PLANS DO NOT COVER PRESCRIPTION DRUGS,
WHAT SHOULD I DO IF I TAKE A MEDICATION?

I recommend going to http://www.goodrx.com and looking up your drugs. You will find the best cash pricing at local pharmacies. It's a great tool!

1. APPLY FOR ANOTHER STM PLAN WITH MY OTHER STM COMPANY:
Before your STM contract ends, you can apply for up to 90 days of coverage with my other STM insurance carrier. Oregon requires a 60 day gap before you can reapply with the same carrier. I recommend the Flex Term plan first, then either Pivot Health or the Allstate Health Plan. For example, you can do the Flex Term plan for 3 months, then the Pivot Health plan for 3 months, then back to the Flex Term. The risk you face is having to pay more than one deductible per year if your health is poor.

2. BUY COVERAGE THROUGH THE MARKETPLACE:
The Marketplace accepts a Short Term Medical contract ending as a 'qualified event' to purchase coverage. I can help you apply for a 'fully qualified' plan (such as Kaiser or Providence) through the Marketplace when your STM plan ends. You have 60 days from the end of your STM plan ending to qualify for a Marketplace plan as a 'Special Enrollment' situation. Example, if your Pivot health plan ended November 30, I could write you a Marketplace plan that began on December 1.

I believe the Pivot Health and National General plans offer at no cost telehealth video visits with a doctor. If not, Providence Express Care Virtual visits are available to anyone. You can do a video visit with a doctor or nurse for a flat $79.00 per visit.

Download the Express Care Virtual app for your phone, or from a laptop start at the link below:

MONEY IS TIGHT, BUT I STILL NEED TO DO AN ANNUAL EXAM AND WOULD LIKE THE TESTS COVERED.

Some of my clients sign up for a traditional plan like Kaiser or Providence and have their preventative exams, then switch to Short Term Medical for the rest of the year. The Flex Term plans will pay for a preventative exam with a $50 copay, but not the tests that go with it like a routine colonoscopy, mammogram or pap.

I want to be very clear that Short Term Medical insurance is not the same as a creditable health plan under the Affordable Care Act and has many more plan limitations.

"What is Short-term medical insurance? Short-term medical (STM) insurance policies are designed to provide temporary coverage during life’s transitions until you can secure an Affordable Care Act (ACA) insurance plan. STM insurance policies are not required to comply with the requirements of the ACA and may have exclusions and limitations not permitted in ACA plans. ACA plans are guaranteed issue, must cover certain “essential health benefits” (EHBs), and you cannot be denied coverage based on pre-existing medical conditions. In contrast, STM insurance requires that you answer a series of medical questions to determine your eligibility, may not cover all EHBs, and does not cover pre-existing conditions. The limitations on benefits and exclusions, including the pre-existing conditions exclusion, likely will result in STM policies having lower insurance premiums than ACA plans and make them a viable option for your health insurance needs. If you have had medical conditions in the past or have current or chronic conditions, you should seek an ACA or other comprehensive insurance plan as soon as you are eligible for enrollment.

Flex Term Brochure & PHCS 2023

Flex_Term_&_PHCS_Brochure_2023.pdf

Pivot Health Brochure 2023

Pivot_Health_STM_brochure_2023.pdf

Allstate 2024 Brochure

Allstate_STM_Plan__brochure_8.30.24.pdf