What is the difference between Marketplace coverage and short-term plans?

Marketplace plans offer comprehensive coverage. All Marketplace plans are required to cover certain categories of service, called Essential Health Benefits. Marketplace plans cannot have an annual or lifetime limit on essential health benefits. Remember that preventive services and immunizations are provided at no cost in all Marketplace plans. Also, under the law, in 2019, Marketplace plans cannot have an out-of-pocket maximum greater than $7,900 (or $15,800 for a family plan). This means that you will not have to pay more than this amount in deductible, co-pays or co-insurance no matter how much covered care you get in a plan year.

Alternative coverage options are also available, but are not sold through the Marketplaces. You can be denied coverage or charged a higher premium if you have a pre-existing condition. Short term plans are not required to cover the same mandatory benefits as Marketplace plans and often do not cover prescription drugs, preventive services, maternity care, or other treatments required for Marketplace plans. If you need these services, they may not be covered and you may have to pay more out-of-pocket.

You should consider how much care you think you may need during the year when deciding what coverage to purchase. While no one can predict when they will get sick or injured, we generally have a pretty good idea of any conditions or health problems we have, how often we see a healthcare provider, and how many medications we take. You should also consider how much you can afford to spend out-of-pocket if something unexpected happens like an illness or injury.

If you require a lot of health services or medications, a more generous Marketplace plan (like platinum or gold) might be a better fit for you. If you don’t anticipate needing many services, a Marketplace bronze or silver plan might be best.

If you only need coverage for a short period of time, for example to fill a gap between other coverage, alternative coverage like a short term plan might fit your needs. Just remember that the same services that are required for Marketplace plans might not be covered and there may be limits on the amount the plan will pay toward treatments. You should think about what kinds of services or prescriptions you use now and what you would be able to pay out-of-pocket if something unexpected happens before picking alternative coverage.