What can I do if I can’t afford health insurance? If you are low income, you may qualify for Medicaid, marketplace insurance, or subsidized care.
Health insurance in the U.S. can be very costly. If you have difficulty getting your other bills paid, health insurance may not be a financial priority. Even when you feel alright, it is still very important to have health insurance. A small monthly payment is far better than a massive medical bill that could put you into debt for years.
If you cannot afford health insurance, you have some options. Low income individuals may qualify for Medicaid; even if you were previously above the income limit, you may now qualify due to the recent Medicaid expansion. You may be able to get subsidized healthcare, which makes it more affordable.
Individuals who are unable to get insurance through work and don’t qualify for Medicaid can also get healthcare through marketplace insurance. This option is normally cheaper than regular healthcare and you may qualify for certain discounts. If you are ineligible for low-income health insurance programs, you can always find ways to save on regular insurance by purchasing short-term coverage, choosing a high-deductible plan, or getting care at clinics.
Sources include Healthcare.gov, Insure Kids Now, Very Well Health, Healthinsurance.org, and GoodRX.
How to Qualify for Lost-Cost Health Insurance
If you are having difficulty affording health insurance, there are several programs that can provide you with healthcare at a lowered cost. To qualify for these programs, you will need to check your eligibility and apply. Some programs differ on a state-by-state basis, so you will need to check your state’s requirements.
How Do I Qualify For Medicaid?
Medicaid is a program that provides low-income people, pregnant women, people with disabilities, and children with health insurance. The eligibility requirements for Medicaid vary by state, so you will need to check the requirements for your state.
There are 4 factors that determine if you are eligible for Medicaid benefits:
- Income level
- Age
- If you are pregnant or have a disability
- Number of dependents in the household
In some states, Medicaid has been expanded to cover people who previously made too much to qualify. If you were previously denied Medicare coverage, you may qualify now. The number of dependents and people in your household are also factored in when determining income eligibility. Families with lots of kids can still qualify for Medicaid even if they have a slightly higher income. Families with children who have developmental disabilities may also qualify for Medicaid regardless of their income.
Another factor for Medicaid is age. When you hit 65, you will become eligible for Medicare. There are no income limits for Medicare. In some circumstances, seniors may be eligible for coverage through both Medicare and Medicaid; this is called dual eligibility. If you are over 65 and meet the income requirements for Medicaid, then you can be covered by both programs. For low-income seniors, dual coverage can significantly lower healthcare costs and provide you with more coverage.
What is CHIP?
If you have children and have trouble affording health insurance, you may qualify for CHIP. CHIP stands for Children's Health Insurance Program. The requirements and qualifications for CHIP vary by state, so you will need to check your state’s requirements.
CHIP only covers the children in a low-income family, as well as women who are pregnant. Your family may qualify for CHIP if you make slightly too much to qualify for Medicaid.
Under CHIP, your children’s dental care and doctor check ups are free. Additional services like hospital care, MRIs, X-rays, lab tests, and ER visits come with a small copay. Some states require families to pay a monthly premium for CHIP, but this amount is capped at no more than 5% of your family’s income.
What is Marketplace Insurance?
If you and your family make too much to qualify for Medicaid, marketplace insurance may be an option. Marketplace insurance is not an insurer, rather a method of price shopping for qualified insurance plans; the insurance marketplace was created by the Affordable Care Act in 2010.
In order to be eligible for marketplace insurance, you must:
- Not qualify for Medicare or Medicaid
- Be unable to get health insurance through a spouse or family member
- Be a U.S. citizen, green hard holder, refugee, asylum seeker, or have any kind of visa.
- Not be incarcerated.
There are no income limits to qualify for marketplace insurance, but if you make below a certain income level, you may qualify for subsidized insurance premiums.
How Can I Get Subsidized Health Insurance?
If you can’t afford health insurance, you may qualify for insurance subsidies. Under the Affordable Care Act and the American Rescue Plan, low-income Americans receive tax credits to help them pay for their insurance premiums.
Subsidized health insurance is only available through marketplace insurance; if you are already on Medicare, Medicaid, or CHIP, then you will not be able to get the tax credit.
How to apply for and use the health insurance tax credit:
- Look up your state on Healthcare.gov to see if you can apply through the federal program or your state’s marketplace.
- Check your state’s income requirements.
- Apply for marketplace insurance.
- Apply for subsidized health insurance.
- Once you qualify, there are 2 ways to use the tax credit. The first is by receiving a lump sum with your tax return that can be used to offset premium costs. The second way is for the credit to be sent directly to your insurer to lower your monthly cost.
Do I qualify for subsidized health insurance?
To qualify for a health insurance tax credit, you or a member of your household must:
- Be eligible through marketplace insurance.
- Be unable to get insurance through work or a family member.
- Not be enrolled in Medicare. If you turn 65 after the Medicare enrollment period ends, you may qualify for subsidized marketplace insurance until you can enroll.
- Be above the poverty level and unable to qualify for Medicaid.
- Not be incarcerated.
- Live in the U.S. and have a work visa, student visa, green card, or be an asylum seeker.
How Can I Save Money on My Health Insurance?
If you are unable to afford health insurance and don’t qualify for Medicare, Medicaid, CHIP, or marketplace insurance, there are other ways to save money on insurance premiums. If money is tight, consider enrolling in a high deductible plan, a short term plan, or catastrophic coverage.
What is a High Deductible Health Plan?
A high deductible insurance plan has the lowest monthly premiums, so you will have a lower monthly payment. The trade off is that these plans have a higher threshold for how much you have to pay out of pocket.
A high deductible health plan is ideal for younger people who are tight on money and physically healthy. If you anticipate few medical bills, you can save hundreds of dollars in monthly premiums. If you have a chronic condition or expect lots of medical bills in the coming months, this plan may not be the most affordable option for you.
All high deductible plans cover preventive care.
Another benefit of a high deductible plan is that you can contribute to a health savings account. If you are in a certain tax bracket, you may be eligible to pay medical bills over $3,000 with pre-tax dollars from your HSA.
Should I Get a Short Term Plan If I Can’t Afford Health Insurance?
If you are unable to afford health insurance, you should consider purchasing a more affordable short term plan. In all except 12 states, short term healthcare is an option for individuals and families who need coverage in between major life milestones.
Short term plans are best for relatively healthy families and individuals. They provide a safety net that prevents families from incurring medical debt if they find themselves without insurance.
If you:
- Missed an enrollment period
- Don’t qualify for subsidies
- Are retiring before Medicare eligibility kicks in
- Are between jobs
You should consider buying a short term plan to bridge the gap in coverage.
Short term insurance plans are significantly cheaper than traditional coverage plans; they normally cost less than $100 a month depending on the number of dependents and the amount of coverage. While subsidies are not available for short term coverage, you can still save money on insurance with a short term plan.
Different plans have different lengths of coverage. Some plans carry a maximum of 6 months, while others allow up to a year of coverage. The length of your plan will depend on where you live.
Is Catastrophic Coverage Affordable?
Catastrophic coverage is a type of insurance that is offered through both the insurance marketplace and through traditional insurance providers. Catastrophic coverage is designed to provide the bare minimum to protect an individual or a family from incurring medical debt.
This type of coverage is primarily for people under the age of 30 who have experienced qualifying hardship. If you are a refugee, experiencing homelessness, fleeing domestic violence, or have declared bankruptcy, catastrophic coverage can be available to you. Individuals over 30 may qualify for catastrophic coverage if they are granted a hardship exemption.
If you cannot afford health insurance through any other means, catastrophic coverage is the most affordable option. The monthly premiums are the lowest of any plan, but the deductible is extremely high.
Per ACA guidelines, catastrophic coverage includes the following care:
- Maternity, prenatal, and newborn care
- Mental health care
- Medication
- Rehab after physical injury
- Lab tests
- Preventive care and screenings
- Pediatric care
- Emergency services
- Outpatient medical care
- Behavioral assessments for children
- Vaccines
Unlike marketplace insurance, you are not able to get a subsidy for catastrophic insurance. This type of plan is best for relatively healthy people under 30 who do not have any chronic conditions. You should only purchase catastrophic coverage if you are unable to afford health insurance through any other means.
How To Save Money on Healthcare Costs
If you have difficulty affording health insurance, you definitely don’t want a big bill after a visit. If money is tight, there are a few ways to lower the cost of your healthcare.
Check Your Eligibility
Recently, Medicaid was expanded in 39 states to cover more individuals and families. Before this expansion, millions of Americans made too much to qualify for Medicaid but not enough to afford their own insurance. If you have not shopped around for insurance in a while, it may be beneficial to check your eligibility under the new rules.
Change Plans
Marketplace insurance offers options for insurance plans: bronze, silver, gold, and platinum tiers. The bronze tier has the lowest monthly premium but the highest deductible. The platinum tier is the opposite: high monthly payment and high cost coverage. If you have difficulty affording your monthly premium, you can always change plans to a tier with more affordable premiums.
Visit Clinics
Most areas have smaller clinics that are cheaper to visit than going to the ER. Some clinics offer a sliding scale for payment, so you may be able to receive care for a lower copay. If a health concern is not urgent, consider going to a clinic instead of the ER to save money on healthcare.
Utilize Telehealth Visits
Due to COVID, telehealth has been significantly expanded and made more widely available. Compared to traditional doctor’s visits, telehealth visits are far more affordable with a lower copay. If you have a medical concern that does not require hands-on attention, a telehealth visit is a great way to save money. Some providers even offer mental health counseling and prescriptions online.
