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California's state-based health exchange since 2013

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Short-Term vs Marketplace Health Insurance

Short-term health plans can seem like an affordable option, but they come with significant limitations. This guide explains the differences and helps you make an informed choice.

Overview

Short-Term Plans

  • Temporary gap coverage
  • Lower premiums
  • NOT ACA-compliant
  • Can deny pre-existing conditions
  • Limited benefits

Covered California Plans

  • Year-round comprehensive coverage
  • Higher premiums (subsidies available)
  • ACA-compliant
  • Must cover pre-existing conditions
  • All essential health benefits

Key Differences

Feature Short-Term Covered California
Coverage Duration Up to 364 days (varies) Full year
Pre-existing Conditions Can be excluded Must be covered
Prescription Drugs Often not covered Always covered
Mental Health Often not covered Always covered
Maternity Usually not covered Always covered
Preventive Care May not be free Free (no cost-sharing)
Premium Subsidies Not available Available
Out-of-Pocket Limits May be very high or none $9,200 max (individual)
California Penalty Doesn't satisfy mandate Satisfies mandate

California-Specific Rules

California Individual Mandate: California requires residents to have health coverage or pay a penalty on their state taxes. Short-term plans do NOT satisfy this requirement.

2025 Penalty Amounts

  • Per adult: $900
  • Per child: $450
  • Family maximum: $2,700
  • OR: 2.5% of household income (whichever is higher)

If you choose short-term coverage, you'll pay the penalty PLUS your premiums, which often eliminates any cost savings.

Risks of Short-Term Plans

Claims Denied

Pre-existing conditions can be excluded. Even conditions you didn't know about may not be covered.

Surprise Bills

Without out-of-pocket maximums, you could owe unlimited amounts for a serious illness.

No Rx Coverage

Many short-term plans don't cover prescriptions at all, leaving you to pay full price.

Rescission

Plans can cancel your coverage retroactively if they discover undisclosed health issues.

Better Alternatives

If you need coverage outside Open Enrollment, consider these options first:

  • Special Enrollment Period: Qualify through job loss, marriage, moving, birth, etc.
  • COBRA: Continue employer coverage (expensive but comprehensive)
  • Medi-Cal: Free coverage if income qualifies (enroll year-round)
  • Marketplace with subsidy: Bronze plans can be very affordable with subsidies
Bottom Line: In California, short-term plans rarely make financial sense due to the state penalty, limited coverage, and availability of subsidized marketplace plans.

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Our agents can help you find qualifying events for Special Enrollment or explore affordable Covered California options.

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