486 / Is short-term care insurance subject to the ACA market reform requirements?

The Affordable Care Act (ACA) enacted hundreds of market reforms, including many which affect the individual and group health insurance markets. Title 42, Section 300gg-91 defines these terms (such as “individual health insurance coverage”), but it also itemizes a number of “benefits” which are exempt from the subchapter’s requirements.

Among these are “benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof” (if such benefits are offered separately).¹ Thus, a broad category of coverage is excluded based on its function rather than its identification.

Furthermore, in the explicit definition of “individual health insurance”, there is a carve-out: it “does not include short-term limited duration insurance”² although this is more likely a nod to short-term medical (see Q 483).

1.     Other excepted benefits include “hospital indemnity or other fixed indemnity insurance” (if offered as independent, non-coordinated benefits), and coverage for a specified disease or illness.