Jane Dotson
Many people struggle to afford health insurance, especially those who earn too much to qualify for Medicaid but not enough to purchase private insurance. The high cost of health insurance is a significant burden for many, with monthly premiums, deductibles, copayments, and coinsurance adding up quickly. However, being uninsured can lead to even higher costs if a medical emergency arises. While some choose to go without insurance, it is not recommended, as it can result in unexpected expenses and a lack of access to necessary healthcare services.
| Characteristics | Values |
|---|---|
| Date of latest data | April 2025 |
| Percentage of US adults unable to pay for healthcare and prescribed medicine | 11% |
| Percentage of Americans borrowing money to pay for healthcare expenses | 12% |
| Percentage of Americans concerned about medical debt | 28% |
| Percentage of White adults categorized as "Cost Secure" | 58% |
| Percentage of Black adults categorized as "Cost Secure" | 41% |
| Percentage of Hispanic adults categorized as "Cost Secure" | 34% |
| Alternative to health insurance | Health-care sharing, e.g. CrowdHealth |
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What You'll Learn
- Government subsidies and tax credits can make health insurance more affordable
- Medicaid and Medicare can help cover health insurance costs
- Short-term health insurance plans are an affordable alternative to comprehensive coverage
- Unemployed people may be able to get affordable health insurance through the Marketplace
- Free or low-cost health care is available at community health centres
Government subsidies and tax credits can make health insurance more affordable
Health insurance can be expensive, and many people struggle to afford it. However, government subsidies and tax credits can make health insurance more accessible and affordable. The Affordable Care Act (ACA) provides government subsidies to help low- and middle-income individuals and families purchase health insurance. These subsidies come in the form of premium tax credits and cost-sharing reductions, which lower the overall cost of health insurance.
Premium tax credits are refundable credits that help eligible individuals and families cover the premiums for their health insurance purchased through the Health Insurance Marketplace. The size of the premium tax credit is based on a sliding scale, meaning those with lower incomes receive larger credits to help cover the cost of their insurance. When enrolling in Marketplace insurance, individuals can choose to have the Marketplace compute an estimated credit that is paid to the insurance company to lower their monthly premiums (advance payments of the Premium Tax Credit, or APTC). Alternatively, they can choose to receive the full benefit of the credit when filing their tax return for the year.
To be eligible for a premium tax credit, individuals must meet specific requirements and file a tax return with Form 8962, Premium Tax Credit (PTC). For tax years 2021 and 2022, the American Rescue Plan Act of 2021 (ARPA) expanded eligibility by eliminating the rule that taxpayers with household incomes above 400% of the federal poverty line could not qualify. To determine eligibility, the government considers household income, family composition, and whether enrollees are eligible for other non-Marketplace coverage.
In addition to premium tax credits, the ACA offers cost-sharing reduction (CSR) subsidies, which help reduce enrollees' deductibles and other out-of-pocket costs associated with medical care. This type of subsidy is available to those who enroll in a silver-category plan and meet the income requirements. By utilizing government subsidies and tax credits, individuals and families can make health insurance more affordable and ensure they have access to the medical care they need.
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Medicaid and Medicare can help cover health insurance costs
The cost of health insurance can be a significant burden, and many people struggle to afford it. Fortunately, Medicaid and Medicare can help cover these costs and provide access to essential healthcare services.
Medicaid is a government-funded program that offers health coverage to individuals and families with low incomes and limited resources. It is available in all states and is a key source of funding for the US healthcare system, covering 19% of all healthcare and hospital spending. Medicaid provides comprehensive benefits, including prescription drugs, home care, long-term care, and non-emergency medical transportation. It also covers services required by federal law, such as births, children with special healthcare needs, nursing home residents, and adults with mental illnesses or HIV. As of 2023, Medicaid covered nearly 4 in 10 children and almost half of adults in poverty.
Eligibility for Medicaid is based on income and resource limits set by each state. Some states allow individuals to "spend down" their income to qualify for Medicaid. This means that if an individual's income is above the state's limit, they can pay for non-covered medical expenses until their income is lowered to a qualifying level. To determine eligibility and understand the specific benefits covered, individuals can contact their State Medical Assistance (Medicaid) office.
Medicare, on the other hand, is a federal health insurance program primarily for individuals aged 65 and older, as well as younger people with disabilities or specific health conditions. It consists of several parts, including Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare can help cover the cost of prescription drugs, and if an individual has both Medicare and full Medicaid coverage, Medicare pays first, followed by Medicaid for any remaining costs.
In addition to Medicaid and Medicare, other financial aid sources are available to help with the cost of health insurance. The Affordable Care Act (ACA) created government subsidies to assist low- and middle-income individuals in paying for health insurance. These subsidies can offset the cost of monthly premiums, coinsurance, copays, and deductibles. There are two types of subsidies: premium tax credits and cost-sharing reductions. Premium tax credits pay a portion of the monthly health insurance premiums, while cost-sharing reductions help lower out-of-pocket expenses like deductibles and copays.
Short-term health insurance plans are another option for those who cannot afford comprehensive coverage. While these plans do not offer the same level of coverage as major medical insurance, they provide an affordable alternative and can be renewed annually in most states.
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Short-term health insurance plans are an affordable alternative to comprehensive coverage
If you are unable to afford health insurance, you are not alone. Many people struggle to cover the cost of their plan without help. While going without health insurance is an option, it is not recommended. Health insurance can help you save on care, protect you in case of an emergency, and may include added perks and benefits.
Short-term health insurance plans are not regulated by the Affordable Care Act (ACA) or other federal health insurance rules, and they are exempt from federal insurance regulations. This means that there can be significant differences between what one policy covers compared to another, and you will need to check the policy for lists of exclusions. These plans also tend to have high deductibles, copayments, and coinsurance, and because they are temporary, they have a set benefit cap and may come with a one-time enrollment fee.
Short-term health insurance is not considered a long-term solution, and it may only work for some individuals. These plans are best suited for those who are young and healthy and do not need many medical services or prescription drugs. They can be a good option if you have a brief gap in coverage, such as between jobs, or if you are waiting for other insurance coverage to take effect.
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Unemployed people may be able to get affordable health insurance through the Marketplace
If you have lost your job and your health insurance with it, you can find coverage through the Marketplace. You have 60 days after losing your job-based health coverage to enrol in a Marketplace plan. Losing your job and your job-based health coverage qualifies you for a Special Enrollment Period, a period of time outside of Open Enrollment when you can enrol in or change your Marketplace plan.
The Affordable Care Act (ACA) gives more people access to health insurance. The ACA's Health Insurance Marketplace can be used to find more affordable health insurance options. There is no income limit to be eligible to enrol in health coverage through the Marketplace, but you must be a U.S. citizen or national (or be lawfully present) and meet other eligible immigration status requirements. The amount you pay for your health insurance may depend on where you live, your income, and the size of your household.
The ACA created government subsidies to help low- and middle-income people pay for health insurance. These subsidies help offset the cost of monthly plan premiums, coinsurance or copays, and deductibles. There are two types of subsidies: premium tax credits and cost-sharing. You can apply for these health insurance subsidies through your state's health insurance marketplace. Premium tax credits pay a portion of your monthly health insurance premiums. The credit can be sent directly to your health plan each month, or you can claim it on your federal tax return. To determine if you're eligible for a tax credit, the government will look at the size of your household, overall income, and average cost of health coverage in your area. A cost-sharing subsidy can help offset out-of-pocket health care expenses like deductibles, coinsurance, and copays. To qualify for this subsidy, you must enrol in a plan in the silver category.
If you don't qualify or feel you can't afford a Marketplace plan, you can find low-cost health care at a nearby community health centre. You may also be eligible for COBRA continuation coverage if you lost your job and your former employer offers it. COBRA is a federal law that allows you to maintain health coverage temporarily after your employment ends. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit.
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Free or low-cost health care is available at community health centres
If you can't afford health insurance, you're not alone. Many people struggle to cover the cost of their health plans, especially those who earn too much to qualify for Medicaid but not enough to buy private insurance. While going without health insurance is not recommended, there are resources to help you pay for a plan. These include government subsidies and tax credits, which can help offset the cost of monthly premiums, deductibles, and other out-of-pocket expenses. You can apply for these subsidies through your state's health insurance marketplace.
However, if you are still unable to afford health insurance, even with these subsidies, free or low-cost health care is available at community health centres (CHCs) in both urban and rural areas. CHCs are nonprofit corporations that provide comprehensive medical care, including dental, vision, and pharmacy services, at low or no cost. They are open to everyone, regardless of age or insurance status, and offer a sliding scale for payment based on your income level and family size. This means that if you are uninsured or underinsured, you can receive discounts on your medical care.
CHCs also offer behavioural and mental health care, mostly on an outpatient basis, although some clinics do provide inpatient care. Additionally, substance abuse treatment services are available at many CHCs, including medication-assisted treatment (MAT) for opioid use disorder. These centres are located throughout every state and territory and are easily accessible.
It is important to note that CHCs are different from rural health clinics, which operate under different federal rules, and community mental health centres, which have distinct funding sources and missions. Nonetheless, CHCs provide a valuable resource for those who cannot afford health insurance, ensuring that everyone has access to the medical care they need.
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Frequently asked questions
If you are unemployed, you may be able to get an affordable health insurance plan through the Marketplace, with savings based on your income and household size. You can also look into short-term medical insurance, which is an economical plan that can pay for doctor visits, hospitalizations, and surgeries. Another option is a faith-based health plan membership, where members pay into a "pool" each month to cover medical treatments.
Health centers throughout the country offer primary and preventive care to those who cannot pay for medical services. You can find a clinic near you using the National Association of Free and Charitable Clinics (NAFC) database. Telemedicine is also a more affordable option, as visits are usually half the cost of an urgent care visit.
Government subsidies help low- and middle-income people pay for health insurance by offsetting the cost of monthly premiums, coinsurance, copays, and deductibles. There are two types of subsidies: premium tax credits and cost-sharing subsidies. You can apply for these subsidies through your state's health insurance marketplace. To determine eligibility, the government will look at your household size, income, and the average cost of health coverage in your area.
The ACA, also known as Obamacare, has evolved to make healthcare more accessible for low-income households. It created government subsidies to help with insurance costs and requires insurance plans to provide specified benefits. The American Rescue Plan Act (ARPA) expanded eligibility for subsidies, allowing people with incomes below 150% of the poverty level to enroll in silver plans with no premium.
