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Published on December 02, 2019

couple talking to insurance agent

Short-Term Health Insurance vs. Regular Plans

Not all health insurance plans are created equal. Some plans may be cheaper on a monthly basis, but if you have a major medical event or pre-existing condition you may not be covered — at all.

That’s a major difference between plans that are Affordable Care Act (ACA) plans, which Avera Health Plans offers to individuals and families, and short-term medical plans.

Plans that meet the requirements of the Affordable Care Act are meant to cover major medical issues, pre-existing conditions and other things considered essential health benefits. In fact, some coverage such as mammograms and immunizations are free with your monthly premium.

In addition, you may be eligible for cost savings options, based on your income, that can help with the cost of your monthly premium.

“Our goal is to help members cover the cost of both the expected and unexpected,” said Jordan Anderson, Vice President of Sales and Account Management for Avera Health Plans. “Whether you’re getting treatment for arthritis, planning a pregnancy, or managing an unexpected broken leg, you shouldn’t have the added stress of wondering if your health insurance will help shoulder the cost.”

Here’s a side-by-side comparison of what a typical ACA plan will cover vs. a typical short-term plan.

ACA Plans

Short-Term Plans

Emergency Services

Covered

Covered

Hospitalization

Covered

Covered in emergency, not for pre-existing condition

Pregnancy, maternity, newborn care

Covered

Not covered

Lab services

Covered

Covered, or limited

Pre-existing conditions

Covered

Not covered

Prescription drugs

Covered

Not covered, or limited coverage

Ambulatory/outpatient services

Covered

Covered

Mental health care

Covered

Not covered, or limited coverage

Subsidies available

Yes

No

Coverage length

Renewable every year

30-180 days

Knowing all of your options will give you the most buying power. With an ACA plan, Premium Tax Credits and Cost-Share Reductions can increase your benefit potential and lower your monthly costs. Here are a few steps you can take to ensure you know and understand all of your options this open enrollment:

  1. Log in to healthcare.gov to see if you qualify for Tax Credits or Cost Share Reductions.
  2. Shop different plan designs and features that work best for your budget and your personal medical needs.
  3. Get support from a local agent about what plan is right for you.

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Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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