ACCESS Act Expands Short-Term Health Plans to Three Years, Adds Guaranteed Renewability Option

The Affordable Care Economic Stability and Small Business Act, or the ACCESS Act, is aimed squarely at changing the landscape of temporary health coverage. Essentially, this bill takes what we call Short-Term Limited Duration (STLD) insurance—the kind of coverage people often grab when they’re between jobs or waiting for a new plan to kick in—and makes it a much bigger deal.

The Three-Year Temporary Plan

Right now, these STLD plans are generally defined by their short lifespan. The ACCESS Act formalizes the definition, stating that while the initial contract still has to be less than 12 months, the total maximum duration can now stretch up to three years from the original start date (Sec. 3). The stated goal is to offer more affordable, flexible options for consumers and small businesses struggling with escalating costs (Sec. 2). Think of a small startup owner who can’t afford comprehensive group coverage but needs to offer something: a three-year STLD plan could look very attractive.

The Guaranteed Renewability Catch

Here’s where the bill attempts to add a layer of consumer protection while simultaneously introducing a major wrinkle. The ACCESS Act extends the guaranteed renewability rules—the ones that stop an insurer from kicking you off your plan just because you get sick—to these newly expanded STLD plans (Sec. 3). This is a big deal because it adds stability to coverage that has historically been unstable. However, the bill gives the individual applicant a choice: you can decline the guaranteed renewability option when you sign up. If you choose to opt out, the contract has to clearly state that you did so.

For a busy person, this is the fine print you absolutely have to read. If you choose the guaranteed renewability, your plan is more stable, but that stability might come with a higher premium. If you opt out, you might get a lower initial price, but you’re effectively signing up for coverage that could vanish if you develop a chronic condition, leaving you scrambling for a new plan later. This choice puts the burden of understanding long-term risk squarely on the consumer.

Who Benefits and Who Takes the Risk?

This legislation creates a clear trade-off. For small businesses, the ability to offer a three-year, lower-premium plan provides a much-needed tool to attract and retain employees without the massive cost burden of comprehensive coverage. For an individual in transition—say, a contractor or a recent graduate—it offers a cheaper bridge for a longer period than currently allowed.

However, it’s crucial to remember what STLD plans typically don’t cover. They are generally exempt from the requirements of the Affordable Care Act (ACA), meaning they often don't have to cover essential health benefits like maternity care, prescription drugs, or mental health services, and they can still exclude coverage for pre-existing conditions. By expanding the lifespan of these less-comprehensive plans to three years, the bill risks drawing healthier individuals away from the comprehensive market. If too many healthy people choose the cheaper, less-robust STLD options, it could potentially raise costs for those who rely on comprehensive plans—like people with chronic illnesses—by destabilizing the risk pool.