Short-Term Health Plans
We are continuing our advocacy blog series meant to help youtake carewhen it comes to important arthritis health care and coverage issues. If you’re now just tuning into this series, check out previous advocacy blog postshere．Our lasttake careblog kicked off a focus on health insurance benefits andopen enrollment．今天我们将探讨短期健康计划，这是一种已经上市一段时间的保险，但由于政府采取的新措施而受到关注。继续往下读，了解这些计划，以及为什么它们对关节炎患者来说是不令人满意的选择。
What are short-term health plans?
Short-term health plans are not new. As the name suggests, these plans are meant to fill in temporary gaps in health coverage. For example, if an individual is in between jobs or needs coverage outside of the traditional open enrollment period, short-term plans are available to purchase for up to three months from insurers and brokers.
Why are short-term plans in the news?
Earlier this month, the federal Departments of Labor, Treasury, and Health and Human Services finalized a regulation that loosens and expands the availability of short-term plans. Despiteover 98 percentof health care stakeholders strongly opposing this action, the administration decided to move forward with its proposal.
What is changing with short-term health plans?
Beginning in October, the new regulation permits short-term plans to be sold for 12 months and renewed by an individual for up to 3 years. This is a change from current rules, which do not allow short-term plans to be a substitute for comprehensive coverage. Today, they are limited to a duration of 3 months and are not renewable health policies.
Are short-term health plans different than individual market health plans?
是的，短期医疗计划与医疗保险交易所提供的计划是分开的，因为它们不需要遵守《平价医疗法案》(Affordable Care Act)制定的对患者的重要保护措施。You will not find these plans onhealthcare.gov, for example. Since short-term plans are not considered comprehensive coverage, the new regulation means insurers and brokers can more widely sell short-term plans that:
- Deny enrollment based on age, gender, health status, or other factors that might suggest an individual’s future use of health care services
- Exclude coverage for pre-existing conditions
- Exclude any or all of the essential health benefits like prescription drug coverage, emergency care, or other provider services
- Apply annual or lifetime dollar limits on coverage
- Increase patient out-of-pocket maximums above limits imposed by current law
- Impose more stringent network adequacy requirements
如果关节炎患者参加短期健康计划，他们会面临什么样的问题?
Short-term plans are not ideal for people with arthritis since they can deny coverage for people with pre-existing conditions. The plans are also medically underwritten, meaning you would be asked to fill out a medical history; in turn, this is used to approve or deny your enrollment. The Affordable Care Act prohibited this behavior for plans offered on the individual market. However, because short-term plans are not considered comprehensive health coverage, they do not need to comply with this rule.
Do short-term policies need to disclose anything specific to consumers?
Yes, they must include clear language stating these plans may not work best for people with pre-existing conditions like arthritis. Be on the lookout for disclosure language that:
- Urges you to carefully check the policy for exclusions or limitations regarding coverage of pre-existing conditions, or specific health benefits like prescription drugs
- Warns a loss of short-term plan coverage means you may have to wait until the next open enrollment period before enrolling in health insurance again
For any health plan, it is always good practice to carefully review the terms and conditions to understand the scope of benefits and potential out-of-pocket costs you may incur.
Is there anything else I should be aware of about short-term health plans during open enrollment?
Short-term health plans often misrepresent health coverage and benefits; these plans also have a history of fraud. In addition, you should know that since these health plans are temporary and do not offer comprehensive coverage, premiums are significantly cheaper than insurance found onhealthcare.gov．虽然较低的保费可能听起来很有吸引力，但如果你意外地被诊断出患有关节炎等慢性疾病，你的保险计划可能不会为处方药或急诊室等服务提供保险，以帮助你管理自己的健康——而且不提前披露医疗状况也可能导致保险公司取消保险政策，让你失去任何医疗保险。
What resources are available from the Arthritis Foundation?
In the coming months the Arthritis Foundation will be raising awareness about the open enrollment period, but you can get started with ourYour Coverage, Your Care toolkit．这是一个很好的资源，可以帮助你了解你的保险选择，索赔过程，以及克服障碍的技巧。此外，如果您有任何关于您的医疗保健的问题，我们的工作人员有执业临床社会工作者，可以24小时与您交谈，方便您。你可以拨打关节炎基金会热线1-844-HELP(4357)。
If you’d like to stay informed of federal and state-based health care issues, considersigning up to be an Advocate．Becoming a part of our Advocacy grassroots network is an easy way to get involved and stay informed.
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