Pivot Health Insurance Review

Pivot Health offers proprietary health insurance products, including short-term medical and supplemental health plans. Plans are available for quoting and purchase online. This coverage may be appropriate for individual health insurance buyers who have specific life situations where temporary coverage is needed. Pivot's short-term health insurance and supplemental health insurance partners include Companion Life Insurance and Fidelity Security Life Insurance Company. Non-insurance member benefits are offered through its affiliate, Communicating for America, a non-profit organization. Keep in mind that these plans aren't eligible for subsidies, and don't meet the same essential benefits require for ACA plans. This type of coverage is suited for individual health insurance consumers who are generally healthy and looking for temporary health insurance coverage. Plans may not be available in all states.

What’s Included with Pivot Health?

We're including some of the coverage highlights we thought were most relevant. However, since it's your healthcare you're considering, make sure you review Pivot's official plan brochures (found on Pivot Health's enrollment site) to make sure you understand the coverage.

• Up to $1 million of maximum coverage per coverage period
• Coinsurance maximum out-of-pocket as low as $3,000 per person, per coverage period on select plans
• Prescription coverage on certain plans - separate $500 prescription drug deductible, plus generic and brand prescription co-pay options
• Includes doctor visit co-pays on certain plans (Choice and Deluxe)
• Child-only coverage is available
• Medical services and treatment - coverage subject to deductible and co-insurance
  • Hospitalization
  • Surgery
  • Ovarian cancer screening
  • One annual pap smear
  • Doctor consultations
  • Local ambulance or air transportation for injury or sickness
  • Mammogram coverage
  • Mental health services
  • Physical therapy
• Once you're enrolled, you'll be given an online account where you can download and print your digital insurance card

This is not a complete list of benefits. Exclusions and limitations apply. Find plan details and a full list of exclusions in the Pivot Health short term medical insurance brochure.

Types of Health Insurance Plans

Plans Offered

Economy Plan

The Pivot Health Economy plan is the most affordable short-term health plan the company offers. Lower-cost plans typically include higher deductibles and out-of-pocket expenses. If you don’t anticipate needing to use your insurance, you can select a $10,000 deductible plan for the lowest rate. But if you might need to see a doctor or have a procedure done, there is a $3,000 deductible Economy plan option.

Buyers have a choice between a 20% or 30% coinsurance level. Co-insurance is the percentage you have to pay once you meet your deductible. Like the deductible, if you choose to take on more financial responsibility, the higher 30% co-insurance level will help keep the cost of your monthly insurance down. Since most benefits are subject to deductible and co-insurance, you need to review the plan’s exclusions and limitations to make sure the Economy plan is the right fit for you. There are no doctor office co-pays or a prescription benefit (but a discount drug card is available).

Choice Plan

Pivot Health’s Choice plan is the most popular plan among consumers, according to company data. It offers multiple deductible options, including a low $1,000 deductible, and doctor office copays for primary care physicians, specialists, and Urgent Care. (Having fixed doctor co-pays can provide an added savings of $100 or more for office visits.)  Individuals can also pick between 20% and 30% co-insurance levels. Other benefits include a maximum coverage benefit of up to $1 million.

Most of Choice plan benefits are subject to deductible and co-insurance. The emergency room deductible is the lowest Pivot Health offers at $250, and there is no deductible for inpatient hospital admissions, compared to other plans. However, it is always a good idea to read the plan brochure and review exclusions and limitations that affect how the coverage works.

Standard Plan

Standard Plans have a lower out-of-pocket coinsurance maximum than Economy and Choice plans, and offer up to $500,000 in benefit protection during the policy’s coverage period. There is also prescription drug coverage above and beyond a discount card. After a $500 deductible, Rx drugs are $10 for generics, $50 for preferred, name-brand drugs and $75 for non-preferred brands. Specialty drugs are not covered.

While potentially a good option for individuals with prescription drug needs, there are no doctor office copays included with this plan. If you want those included, go for Choice or Deluxe. See exclusions and limitations listed under the Plan Details page of the website to get a better idea of what is and is not covered.

Deluxe Plan

Offering the most benefits of any Pivot Health short term health insurance products, Deluxe plans include low deductible options, doctor office co-pays, and $10 generic drugs without having to meet a separate pharmacy deductible. Like Choice plans, coverage benefits can extend up to $1 million during the plan duration. There is also a low $250 emergency room deductible and no deductible for inpatient hospital admissions.

Deluxe plans might be good for individuals who anticipate needing to see a doctor during the coverage period or fill prescriptions. But it is best to review the exclusions and limitations of the plan to find out if the coverage is right for you.

Core Plan

Pivot Health’s Core plans are low-deductible, short-term medical insurance coverage. The only Pivot Health plan with a PPO network, those insured under the Core plan have access to First Health, a PPO that includes medical providers in urban, suburban and rural markets throughout the country. There are two deductibles to choose from, either $1,000 or $2,000 for each coverage period, plus doctor office visit co-pays for primary care, specialists and Urgent Care centers. One plan also offers prescription drug benefits with a $10 generic drug copay and no separate pharmacy deductible. However, hospital and surgery benefits are limited and out-of-network providers are not covered so it is important to read the plan’s brochure, check the network, and review the exclusions and limitations associated with the coverage.

Coverage Overview

Pivot Health short term health insurance plans include deductibles, coinsurance and out-of-pocket maximums that cap what insureds have to pay should they reach the limit due to unforeseen medical expenses. Some plans offer doctor office visit copays for primary care, and prescription drug benefits with copays for medications. Note that these plans are not required to adhere to the essential mandate of the Affordable Care Act and are meant to fill a gap in coverage temporarily or during the course of the year when enrollment in an ACA plan is not available.

Carrier Reputation

Pivot Health’s STM plans are underwritten by Companion Life Insurance Company, an A+ rated insurer by A.M. Best, a widely recognized rating agency that rates insurance companies on their relative financial strength. You can find the A.M. Best rating report for Companion Life here.

Pivot Health, which designs and markets these plans on behalf of Companion Life, is regulated by insurance commissioners in the states it operates in. Each plan type along with rates must be filed and updated with any changes. Based on our analysis, Pivot Health’s regulatory standing appears to be good with no material issues or actions from any state.

Consumers should note that Pivot Health's privacy policy permits it to "use your information, or permit selected third parties to use your information, to contact you about goods and services that may be of interest to you." 

Read more at: https://www.pivothealth.com/privacy/| Pivot Health

Summary

Pivot Health offers customizable short-term health insurance as well as supplemental health insurance programs that are designed to help meet individual client needs. They provide a quote-and-enroll website experience that helps consumers apply in 5 minutes or less. Multiple deductible and additional benefit options are also available on plans. Pivot Health may be a short-term health insurance another option when you are temporarily uninsured.