Affordable Care Act plans typically have broader benefits than those found in Short Term Health Insurance plans and, without the premium subsidies available to some qualified purchasers, cost much more than Short Term Health Insurance plans.
All ACA individual health plans must have the "10 essential health benefits." Short Term Health Insurance plans, in comparison, do not have a standardized set of benefits. Short Term Health Insurance plans usually offer what would be described as streamlined "major medical coverage" that covers healthcare costs in the event of accidents and illnesses. Most Short Term Health Insurance plans also cover doctor visits for routine illnesses and injuries.
The chart below details some of the major benefit differences between Short Term Health Insurance and Affordable Care Act plans. It is important to note that Affordable Care Act plans do not deny care for pre-existing conditions nor do they reject applicants based on health problems.
| Short Term Health Insurance Plans | Affordable Care Act Plans | |
|---|---|---|
Coverage availability |
Apply any time and get coverage as early as the next day | Apply only during Open Enrollment (or Special Enrollment due to a qualifying event) and get coverage on January 1st. |
Coverage duration |
Up to 12 months (in most states beginning in 2019) | As long as the plan is available. You can change plans during Open Enrollment (or Special Enrollment with a qualifying event) |
Prescription drug coverage |
Many Short Term Health Insurance plans provide a drug discount card but do not provide drug coverage. Some newer plans have a prescription drug coverage option for generic drugs not associated with a pre-existing condition. Brand name drugs and specialty drugs are typically uncovered | Minimum of 1 drug per class must be covered but the minimum number of drugs per class is often more due to the benchmark chosen for each particular state. |
Maternity and newborn care |
Complications of maternity are covered but not standard childbirth services. | Full coverage. Applicants cannot be denied based on pregnancy as a precondition. |
Mental health services |
Coverage is included only when mandated at state level. | Coverage included, but states vary on their definition of mental health services, so while some do include learning disabilities or conditions like Autism, other states do not. |
Substance use disorder services |
Coverage is included only when mandated at state level. | All ACA plans have full coverage. |
Rehabilitative & habilitative services and devices |
Coverage is included only when mandated at state level. | All ACA plans have full coverage. |
Preventive care |
Some plans have selected preventive care benefits with cost-sharing. However, most plans do not cover preventive care services. | Preventative services must be provided without cost-sharing |
Pediatric services - oral and dental care |
Coverage is included only when mandated at state level. | All ACA plans have full coverage. |
Healthcare provider networks |
Short Term plans typically have broad acceptance among healthcare providers. Some have a preferred network with negotiated pricing for healthcare services and a larger non-preferred network where the plans pay 'usual and customary' fees for covered healthcare. | These plans have been noted for a significant use of "narrow networks" to increase the ratio of enrollees to healthcare providers. |
Uninsured tax penalties |
None beginning in 2019 | None beginning in 2019 |
Coverage of pre-existing conditions |
These plans evaluate health status and pre-existing conditions when processing an insurance application and determine whether the applicant is approved or rejected for coverage. | These plans do not consider health status or pre-existing conditions when processing an insurance application. |
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