American Insurance · PUBLISHED 15 JUL 2026 · VERIFIED 15 JUL 2026 · US EDITION

Your Guide to the 4 Things Short-Term Plans Legally Skip

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A federal short-term plan can look cheap up front, yet it can legally skip maternity care, mental health care, preventive care, and prescription drugs—the exact services that often turn a “temporary” gap into thousands of dollars in uncovered bills.

The number that matters

71% of short-term health plans offered on eHealth and/or Agile Health Insurance across all states did not cover outpatient prescription drugs in the Kaiser Family Foundation review, making drug coverage the single largest routine gap in that sample.

How it quietly costs you

The first silent cost is that short-term plans are not required to cover ACA essential health benefits, so insurers can omit whole categories like maternity, mental health, preventive care, and prescription drugs. In KFF’s review, 43% of plans did not cover mental health services, 62% did not cover substance use treatment, 71% did not cover outpatient prescription drugs, and 0% covered maternity care. The “old vs better” contrast is stark: ACA-compliant individual plans must cover the 10 essential health benefits, while short-term plans have no specific coverage requirements for those categories.

The second, compounding trap

A second layer of cost is the pre-existing-condition exclusion: short-term insurers can medically underwrite applicants, deny them, or exclude conditions they had before enrollment. That can turn a low premium into full self-pay for ongoing care, because short-term plans can also impose benefit caps; KFF found many policies capped covered benefits at $2 million or less, and some prescription-drug benefits were capped at $3,000. The concrete long-run risk is that someone who develops or already has a chronic condition can lose coverage for the very care that drives most spending, while still paying premiums for a plan that may not pay those claims.

What this looks like in practice

Megan, 39, freelance graphic designer, $58,000 income, $0 employer coverage, $5,500 savings, short-term plan, 16 years from retirement.

• She discovers that the “cheap” plan may still leave her paying 100% of maternity costs because no short-term products in KFF’s sample covered maternity care.
• She discovers that if she needs meds, the gap can be immediate: 71% of sampled plans did not cover outpatient prescriptions, versus ACA plans that are required to cover essential health benefits.
• She discovers that even when a short-term plan covers something, caps can be tiny: KFF found prescription-drug caps as low as $3,000, which is far below the cost of many serious treatment courses.

The full cost of doing nothing

For Megan, combining the two risks means paying both for excluded services and for pre-existing-condition-related denials/caps, which can produce four-figure to five-figure out-of-pocket exposure in a single bad year. A conservative model basis is: one year on a short-term plan, one uncovered maternity or specialty-drug event, and one capped or excluded follow-up condition; because the exact cost depends on the event, the lifetime/career cost is best framed as potentially tens of thousands of dollars rather than a fixed average.

What to do about it

• Check your state’s marketplace plan options in HealthCare.gov and compare the required essential health benefits against the short-term plan’s exclusions.

• Go to the plan comparison section and look for maternity, mental health, prescription drugs, and preventive care.

• Confirm whether the plan is ACA-compliant or short-term limited-duration.

• Compare deductible, copay, and out-of-pocket maximum side by side.

• Good looks like a plan that covers all essential health benefits and has an out-of-pocket maximum, unlike many short-term plans.

• Review the plan’s Summary of Benefits and Coverage on the insurer’s enrollment page or PDF.

• Find the sections on pre-existing conditions, exclusions, and annual/lifetime caps.

• Search for “mental health,” “prescription drugs,” “maternity,” and “substance use.”

• Note any dollar caps such as $3,000 or annual maximums such as $2 million or less.

• Good looks like no hidden service caps and no exclusions for the care you are most likely to use.

• Estimate worst-case exposure using the federal ACA marketplace comparison as your benchmark, then compare it to the short-term quote.

• List three likely services you would need this year.

• Mark each as covered, limited, or excluded.

• Add up the uncovered share and compare it to the premium savings.

• Good looks like premium savings that do not come at the expense of large uncovered categories.

A myth worth clearing up

Myth: Short-term plans are basically cheaper versions of ACA health insurance. Fact: They are not required to cover ACA essential health benefits, can exclude pre-existing conditions, and may impose dollar caps or other limits that ACA-compliant plans cannot use in the same way.

Sources

• https://www.kff.org/affordable-care-act/understanding-short-term-limited-duration-health-insurance/

Researched 2026-07-15.

Corrections & disclosure: an AI-assisted, human-reviewed guide. Every figure is dated and sourced above. Spot something out of date or wrong? Tell us and we’ll correct it — corrections are noted here and in the video description.