STM vs ACA Plans

General eligibility requirements:

• Age: Typically must be between 18 and 65 years old.
• Residency: Must be a U.S. citizen or legal resident.
• Health status: Must meet the health requirements of the specific plan, which usually involves completing a health questionnaire. You may be denied if you have certain pre-existing conditions.

Factors that may affect eligibility:

• Pre-existing conditions: Many plans will not cover pre-existing conditions like cancer, diabetes, or heart disease, and you may be denied enrollment if you have them.
• Pregnancy: Short-term plans typically do not cover pregnancy.
• Other insurance: Having other coverage, such as Medicaid or government programs, can affect eligibility.
• Recent hospitalizations: Having a recent history of hospitalization can impact your eligibility.

Important considerations:

• Limited coverage: Short-term plans are not comprehensive and do not meet the Affordable Care Act’s (ACA) requirements. They often exclude coverage for preventive care, maternity care, and pre-existing conditions.
• Enrollment periods: Unlike ACA plans, there are no open or special enrollment periods for short-term plans, so you can apply anytime.
• Duration: Short-term plans have a limited duration. Federal rules currently allow initial terms up to 364 days, with possible renewals up to a maximum total duration of three years, but state regulations may impose stricter limitations.

STM State Availability Rules:

• STM plans can last up to 364 days and be renewed for a total of 36 months in states that allow it.
• Allowed with renewals (up to 36 months): Most states including AL, AZ, FL, GA, IN, KY, LA, MS, MO, NC, OK, SD.
• Allowed but limited (3–6 months): States like MI, MN, NV, IL, DE, DC impose shorter durations or renewal restrictions.
• Banned or effectively unavailable: CA, CO, CT, HI, MA, NJ, NM, NY, RI.
• Special rules:
  • Idaho: Offers “enhanced” STM plans with guaranteed renewability for up to 3 years.
  • Illinois & Michigan: Limit total coverage periods and prohibit consecutive policies beyond certain days.