The Difference in ACA Metal Tiers & Short-Term Medical Plans

Written by Lexi Williams

October 22, 2020

Choosing the best major medical insurance plan can be difficult for consumers. There are so many things to consider when selecting a major medical plan to cover a family.  Although the price is important, your clients shouldn’t be making a decision on health insurance plans based on their budget alone. There are important differences to pay attention to when comparing ACA and Short-Term Medical Plans. Let’s look at the differences, pros and cons between these two types of health plans.  

All individual ACA plans are categorized into four tiers based on cost-sharing between the insurance company and the beneficiary. The level of care and covered services included in the plan are not accounted for when metal tiers are assigned. 

The four tiers under the ACA are: Bronze, Silver, Gold, and Platinum. Most plans in these tiers have the same Minimum Essential Benefits: 

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Lab services
  • Preventive and wellness services, chronic disease management
  • Pediatric services 

However, plans may vary because insurance companies have the option to provide additional benefits. The most significant difference between tier levels for beneficiaries is cost, including monthly premiums, deductibles, and out-of-pocket expenses. 

It’s important to note that neither ACA Metal Tier nor Short Term Medical Plans will cover everything. 

Short Term Medical 

Short-Term Medical Plans are temporary health plans designed to fill in the gaps and maintain some coverage level while in between major medical plans. For example, suppose a client is unemployed, falling off a parent’s plan, or in a waiting period before they are eligible for employee benefits. In that case, they may be a good candidate for a Short-Term Medical plan. 

These types of plans usually provide benefits for: 

  • Hospital room and board
  • Emergency Room
  • Anesthesiology and Surgical Care
  • Diagnostic Services
  • Ambulance Services
  • Doctor Office Visits  

Since the Federal individual mandate tax penalty has been repealed, now clients are looking at Short Term Medical as a replacement for ACA plans. Some benefits make Short-term medical attractive for clients, such as: 

  • Lower premiums
  • No open enrollment periods, clients can apply anytime
  • Customizable plans, clients don’t pay for coverage they don’t need
  • No network limitations  

However, you should take into consideration what’s best for the client’s current and long-term needs. Remember, these plans offer limited coverage and are not comparable to ACA plans and have cons. Short Term Medical Plans are not a guaranteed-issue and require approval from the insurance company. They offer less coverage than ACA plans, and they don’t cover pre-existing conditions. 

Ensure you understand your client’s needs, what’s included or excluded in any plan you offer. While Short Term health plans are available and affordable, they are not meant to provide long-term or permanent solutions to your healthcare needs. 

For more information on ACA and Short-Term Medical plans, contact the experts at Agent Pipeline.

You May Also Like…