What's Not Insurance

There is a fifth door, and it is painted to look like the other four. Then there is the no-door option, going uncovered for a while, which people choose by accident more often than on purpose. This lesson prices both honestly, because the pricing is the only thing that keeps them from being mistakes.

Short-term plans, in their current flux

Short-term limited-duration insurance is real insurance in the narrow sense that a contract exists and some claims get paid. What it is not, is ACA coverage. It can decline you for preexisting conditions, exclude whole categories of care, cap what it pays per injury or per year, and dump you at renewal when you get expensive. Several states, including California and New York, ban it outright.

The federal rules around it have been swinging. A 2024 rule limited short-term plans to three initial months and four total. In August 2025 the federal agencies announced they would not enforce those limits, longer plans are reappearing, and another rule change is expected. Treat any specific federal duration limit you see advertised as provisional: the pitch adapts faster than the rules.

What the product is genuinely for: a healthy person with a short, defined gap who accepts that the plan's exclusions decide everything. If you take one, read the exclusions page before the price page, especially the per-condition caps and the preexisting lookback window, and never buy one because the marketplace looked expensive in a month you could have enrolled in the marketplace. That is the actual harm pattern: the plan substitutes for a door that was open and closes behind you.

Health shares, plainly

Health care sharing ministries, where members pay each other's bills, are ministries, not insurance. State regulators and the National Association of Insurance Commissioners say it without hedging: these are not insurance products, payment is not guaranteed, membership rules can exclude conditions the marketing never mentions, and a share that stops arriving when you get sick has no regulator to appeal to. Some families use them happily for years at low cost. The ones who write the horror stories assumed a guarantee that was never in the contract. If you join one, join knowing it is charity with software, not coverage.

The uncovered gap, priced

Sometimes the honest option is the gap itself: you left a job, the marketplace plan starts the first of next month, and there are three bare weeks in the middle. Price that gap rather than fear it.

The exposure in a gap is not unlimited, because if disaster strikes inside it, COBRA can still be elected retroactively while the 60-day election window from "The Sixty-Day Decision" is open. The true uncovered moment is the one where the window has closed and no replacement has started, and even there, an ACA plan bought at the next open enrollment does nothing retroactively: the bills are yours. The worst realistic case for a single person is serious: an accident or an appendix can run to five figures fast, and uninsured hospital rates are the highest rates in American health care. Against that stands the premium saved, maybe $500 a month single at full freight. Two uncovered months save $1,000 and expose you to a bill that starts with a one and has four more digits.

I would not cover a known-serious condition with a gap, and I would not gap at all with a window expired. A young, healthy founder bridging three weeks into a January 1 start, with the COBRA option alive behind them, is taking a priced risk that reasonable people do take. Just make it a decision with a number, never a default.

The files that matter if you go uncovered

Keep the COBRA election notice until the window closes, because it is the instrument that retroactively kills the gap. Keep the termination letter that proves your loss date for the marketplace. And schedule the marketplace enrollment for this week, not the week the gap starts, because the failure mode is not the gap you chose but the one that extended itself.

That is the last of the warning labels. Everything needed now exists: doors priced, windows mapped, estimate built. What remains is running the sequence on real dates.