ACA marketplace plans work well for people who qualify for a subsidy — and can be brutally expensive for people who don't. If you're healthy and priced out of the marketplace, a short-term medical plan can offer real coverage at a fraction of the cost. Terms vary by state — some allow coverage stretching to 24 or 36 months, others just a few — but whatever your state allows, there's a plan built around those exact terms.
Neither is universally better — the right one depends on subsidy eligibility and health history.
General comparison for education. Duration limits and availability are set by each state and can change — confirm current rules for your specific state during a consultation.
The marketplace subsidy cliff leaves a real gap — income high enough to lose subsidy eligibility, but nowhere near high enough to treat an unsubsidized premium as background noise. This is built specifically for that gap.
Income that disqualifies from a subsidy but doesn't come with employer-sponsored coverage — one of the most common groups priced out of the marketplace.
A gap of several years between leaving employer coverage and turning 65 — a short-term plan can bridge that window at a lower cost than full marketplace pricing.
Without a subsidy, marketplace pricing reflects the full, unsubsidized cost — often dramatically higher than a medically underwritten short-term option for a healthy applicant.
That's a structural reality of guaranteed-issue pricing — a short-term plan prices more closely to your own actual health risk instead.
Short-term medical works differently than a marketplace plan — understanding the tradeoffs up front is the whole point of a real consultation.
Unlike ACA plans, applicants answer health questions, and coverage is priced — or declined — based on actual health history.
Each state sets its own rules — coverage is available across every state Lee is licensed in, but how long a plan can run depends entirely on where you live. Some states currently allow terms and renewals extending well beyond a year; others, like Texas, currently limit initial terms to around 4 months. Whatever your state allows, coverage can be structured around it.
Conditions that existed before the policy started are typically not covered — a real tradeoff for the lower premium, and one to go in with clear eyes about.
For a healthy applicant without a subsidy, the monthly premium difference compared to full marketplace pricing can be substantial.
Short-term medical isn't right for everyone — anyone with significant pre-existing conditions is usually better served by an ACA marketplace plan, subsidy or not, since those conditions won't be covered under medical underwriting. This is specifically for healthy individuals being priced out of the marketplace by the subsidy cliff.
State duration limits and rules referenced here are current as of this writing and are set by each state's insurance regulations, which can change. Not sure which path fits you? Find your coverage path →
A medically underwritten health insurance policy providing temporary coverage — duration ranges from a few months up to 36 months depending on the state.
Without a subsidy, marketplace premiums reflect the full cost. A medically underwritten short-term plan can offer meaningful coverage at a substantially lower monthly cost for a healthy applicant.
Varies by state, and can change as regulations are updated. Some states currently allow terms and renewals extending coverage to 24 or even 36 months; others, like Texas currently, limit initial terms to around 4 months. Coverage is available in every state Lee is licensed in — the specific terms just depend on where you live.
Generally no — pre-existing conditions are typically excluded or can result in a declined application, unlike guaranteed-issue ACA marketplace plans.
Generally healthy individuals without an ACA subsidy, people between jobs, early retirees not yet Medicare-eligible, and self-employed individuals seeking lower-cost coverage.
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