This section evaluates state regulation of short-term, limited-duration (STLD) health plans.
NORD supports the Affordable Care Act (ACA) and its requirements that health insurers offer comprehensive coverage with strong patient protections, and opposes efforts to expand access to short-term, limited-duration health plans.
What are short-term, limited-duration health plans?
Short-term, limited-duration (STLD) health plans are temporary insurance policies that are not required to meet Affordable Care Act quality standards. Unlike comprehensive health insurance, STLD plans may deny coverage based on pre-existing conditions and often exclude essential health care services. While the federal government establishes baseline rules for STLD plans, states may impose additional restrictions. States can limit the duration of these plans, require certain coverage standards, or prohibit them entirely.
Why it matters
Rare diseases frequently require ongoing, specialized, and complex care. STLD plans can deny coverage for pre-existing conditions and often fail to cover the specialists, treatments, and medications that rare disease patients depend on. For individuals who are undiagnosed, a rare disease diagnosis can result in being locked into inadequate coverage until a short-term plan expires. Additionally, when healthier individuals enroll in STLD plans, those with complex medical needs may face higher premiums and costs in the comprehensive insurance market.
What we’re measuring
This measure assesses how extensively states restrict STLD plans beyond federal baseline requirements, including through shorter duration limits, enhanced coverage standards, or outright bans.
How we grade
States that impose stronger restrictions on the availability of STLD plans receive higher grades. States that adhere only to federal baseline requirements or allow expanded access to STLD plans receive lower grades.
Critical 2025 update: federal enforcement deprioritized
In August 2025, the U.S. Departments of Labor, Health and Human Services, and the Treasury announced they would deprioritize enforcement of existing federal rules governing short-term, limited-duration (STLD) health plans. With reduced federal oversight, state-level restrictions on STLD plans now serve as the primary protection for patients against inadequate coverage. Read the federal statement →
Patient protections of the Affordable Care Act (ACA)
The Affordable Care Act established a set of critical protections that are especially important for individuals living with rare diseases. These protections include prohibiting insurers from denying coverage based on a pre-existing condition, charging higher premiums based on health status, or excluding certain benefits to discourage enrollment by individuals with complex health needs. The ACA also created health insurance marketplaces, or exchanges, to facilitate access to affordable coverage and establish a minimum standard of quality for all health plans.
Need help understanding your health coverage?
Navigating health insurance can be confusing, particularly when comparing different types of plans.
NORD’s Claim Your Care program provides tools and resources to help rare disease patients and caregivers better understand health insurance and coverage-related challenges.
The program offers educational materials on:
Sources
1. Commonwealth Fund. What is your state doing to affect access to adequate health coverage?
2. Commonwealth Fund. How states can step up on short-term health plans.
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