Opinions and Thoughts on Short-Term Health Insurance for Millennial Travelers

This my account of selecting short-term health insurance during my most recent month on the road. It is not meant to be political nor from an insurance professional perspective. It is simply my experience of getting insurance as a traveling millennial nurse practitioner, for whatever that's worth.
 
Earlier this year I had an excellent opportunity to hit the road for a month as I transitioned between two jobs. It was a millennial dream to go on a 26 state road trip and live out of my car and tent for the late summer. But, one of the things that must be taken into account for this length of trip is health insurance. I may seem like a "throw caution to the wind" type but I wouldn't go a single day without coverage.

So my situation was this- I was working at a hospital and had decent group coverage through their employee plan. I would be ending my term there approximately one month and a few days before officially starting at a new medical group in Chicago. The new job would be offering similar group coverage but, like most employers, the plan would be in effect after 30 days of employment. So that's two months without coverage.

Here were my options-

• COBRA insurance: This means that I would continue my plan through my past employer and pay the employer's portion of the premium. While employed, my plan was a tiny $65 per two week pay period (benefits of working at a hospital and taking their HMO plan!). But continuing with COBRA would mean I would pay the additional $200 that the employer normally pays. For two months of coverage in between jobs, this is not very helpful. Especially because I would be far away from any kind of in-network coverage in my home state, COBRA was an uneconomical option.
• Obtain a plan on the "Obamacare" Marketplace: This was also an unlikely option as I was reasonably sure that I would have coverage through a new plan in 2 months. Had my future employment or health insurance been questionable, this might have been a good option.
• Take out a short-term health insurance plan: this is what I ended up doing and I go into the reasons why.
• Go without health insurance: As they say up in Maine... nevah-evah!

I did not have the benefit of having a spouse with an insurance plan but this could be a good choice for some. Ending or beginning employment constitutes as a qualifying life event where you could change coverage through a spouse's plan. For those who have that luxury, I'd recommend doing that over anything.
 
SHORT TERM HEALTH INSURANCE HAS ITS RISKS: It should first be mentioned that short-term health insurance does NOT meet the standards set by the Patient Protection and Affordable Care Act, otherwise known as Obamacare or just Affordable Care Act. It took less than 30 minutes to complete the application for my plan and I had coverage in 24 hours after submitting the application. I went through ehealthinsurance which is like the priceline of short term health insurance plans. Reviewing and selecting a plan was not difficult but I was wise enough to know that while the plans were cheaper than long-term coverage, there were several risks I was taking.

COMPARING PLANS: I liked using ehealthinsurance because you could compare plans very easily and figure out what best best. Deductibles ranged from $500-$5,000 dollars. Nearly every plan had a 2 million dollar limit, meaning if some reason I had medical costs greater than that, I was on my own. Most the plans were indemnity type which meant that I didn't have to establish a primary care provider and could essentially go anywhere for care (as long as it was in-network). Obviously this was the greatest benefit of short-term insurance as my employee plan was managed care (meaning I wouldn't be covered for anything other than emergency visits if my plan was based in my home state and I was 1,000 miles away). Prescription drug coverage varied substantially between plans.

WHAT I CHOSE: Given that all I really wanted a plan that would cover any adventure-related injuries or hospital admissions, I went with a slightly more expensive plan ($75/month) for a $1,000 deductible and 20% co-insurance. So this was similar to having catastrophic health insurance, except with a low deductible. I didn't need prescription drug coverage nor any other services outside of urgent/emergency visits or admissions. It was through HCC life which seemed to offer better plans for what I was seeking. Obviously I didn't need any OB/GYN type coverage but if you're female, this is something to consider.

SERVICES NOT COVERED: Because short-term health insurance does not have to follow the rules of the Affordable Care Act, coverage does not have the cover the full extent of long-term or group plans. There was a list of 59 things that were not covered in my plan. Here are some noteworthy examples which are typical of short-term plans:

• Pre-existing conditions: anything that has happened within 2 years prior to obtaining the plan was not covered. TThis can include common problems such as diabetes, asthma, COPD, chronic pain, injuries that have resulted in continued therapy and any other conditions that pre-date the plan.
• Pregnancy, Pre-natal care and Abortions
• Substance Abuse, Alcoholism and Addiction
• Vision and Dental
• "Injuries resulting from participation in any form of skydiving, scuba diving, auto racing, bungee jumping, hang or ultra light gliding, parasailing, sail planing, flying in an aircraft (other than as a passenger on a commercial airline), rodeo contests or as a result of participating in any professional, semi-professional or other non-recreational sports including boating, motorcycling, skiing, riding all-terrain vehicles or dirt-bikes, snowmobiling or go-carting." 
• Any self-inflicted Injury or Sickness.
• STDs/STIs
• Immunizations and Routine Physical Exams.
• Charges for travel or accommodations other than local ambulances (no wilderness rescue services, obviously)
• Services received or supplies purchased outside the US
• Chronic fatigue or pain disorders.

As you can see, the list is pretty extensive and there are numerous things on here that could happen to even the safest of travelers. While I don't have the specific details on all plans, I'm under the impression that this is pretty common for most short-term medical plans.

MENTAL HEALTH SERVICES: Know that most short-term medical plans do not cover any kind of mental health or substance abuse treatment. Take this into consideration when deciding whether short term health insurance is best for you.

PREVENTATIVE HEALTH: Most normal preventative health services were not covered. Again, I needed short-term insurance and I'm young and healthy so this was not concerning.
 
PRESCRIPTION DRUG COVERAGE: As mentioned earlier, there was no prescription drug coverage under my plan other that inpatient medications. I had the benefit of being a healthy young person with zero medications. I don't believe oral contraceptives would have been covered under my plan.

PAYMENT AND DURATION: The plan was billed and went into effect 24 hours after I applied and I paid by the month. The maximum duration was 6 months. If I had kept this plan, I would have had to have paid the "Obamacare Penalty" if I continued to get coverage through the non-Affordable Care Act compliant plan. Fortunately, my employer's insurance kicked in before the end of the year. There was an option to pay the entire up-front cost of a plan for a certain period of time which would have been cheaper. For example, instead of paying $75 on a month to month basis, I could have paid for 2-6 months of it up-front and saved money. I didn't do this just in case I needed to cancel the plan early or continue it longer than anticipated.

In the end, I didn't use the insurance at all; my trips were all safe and I had no reason to see a healthcare provider nor hospital. However it was a great comfort to know that I had the insurance, just in case. I got a refund from the short-term plan for the time that I paid for after my employer's insurance kicked in.

Health insurance and outdoor adventure are largely about managing risk. You wouldn't mountain bike technical single track without a great helmet, regardless of your skill level. It would be a bad idea to go on month-long trips without health insurance, regardless of whether you're young and healthy.