Accessing Healthcare Without Insurance

If you can't afford insurance, you have the option of going without, but this is not recommended. Insurance can help you save on care and be there in case of an emergency. In some places, having insurance is legally required. Luckily, there are options available to help make health insurance affordable.

The Affordable Care Act (ACA) created government subsidies to help low- and middle-income people pay for health insurance. 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.

If you don't qualify for a health insurance subsidy, you can consider other ways to shop for insurance or virtual care options until you can afford more comprehensive coverage. For example, you can browse your state's marketplace or shop insurance companies directly.

Apply for a health insurance subsidy

If you are struggling to afford health insurance, you are not alone. Many people need help to cover the cost of their plan. The good news is that there are resources available to help people pay for their plans.

A health insurance subsidy provides tax credits to qualifying individuals to make monthly health insurance premiums more affordable. If you do not get health insurance through your employer, or if you are not eligible for Medicare or Medicaid, you may be eligible for a health insurance subsidy. This subsidy covers a portion of your health insurance expenses, making the total cost much more affordable.

Who Qualifies for Subsidies?

Those who qualify for government subsidies – in the form of premium tax credits or extra savings – typically have a household income between 100% and 400% of the federal poverty line. Your income in comparison to the federal poverty line (FPL) is what determines if you are eligible for government subsidies to help offset the cost of health insurance.

There are two types of subsidies: premium tax credits and cost-sharing subsidies. Premium tax credits are the most common type of subsidy and help you save on your monthly premium. Cost-sharing subsidies help offset the costs of out-of-pocket expenses such as deductibles and copays.

To qualify for a health insurance subsidy, you must meet the income requirements and be enrolled in an ACA-compliant plan in the silver category. People who are eligible for the cost-sharing subsidy almost always qualify for premium tax credits. However, not everyone who is eligible for premium tax credits is eligible for the cost-sharing subsidy.

How to Apply for a Health Insurance Subsidy

To be considered for a health insurance subsidy, the government will look at your income in comparison to the federal poverty line (FPL). Requirements vary by program, but people who qualify typically have a household income between 100% and 400% of the FPL.

To calculate the percentage of your income in relation to the FPL, you can follow these steps:

• Determine your modified adjusted gross income
• Divide it by the poverty guideline income level for your household size
• Multiply that number by 100
• Add a percentage sign

For example, if your income is $35,000 and you are in a three-person household, divide $35,000 by $24,860 (100% FPL for a family of three in 2023) which equals about 1.41. Multiply by 100 to get the percentage. Your income level is 141% of the federal poverty guidelines, or 141% FPL.

You can apply for these health insurance subsidies through your state’s health insurance marketplace.

Consider a short-term plan

If you're unable to afford insurance, you may want to consider a short-term plan. Short-term health insurance is a temporary plan that provides coverage when you don't have a standard policy. It is generally more affordable for people who are healthy and don't need frequent medical care.

Short-term health insurance offers lower premiums than a standard health insurance policy, but it has its limitations and shouldn't be a long-term solution. Short-term plans have restricted benefits, leading to high out-of-pocket costs when certain types of medical care are needed. Short-term health insurance is typically available for limited durations of 365 days or fewer, and it is not available in every state.

Short-term health insurance is a good option for those who are between jobs, waiting for employer-sponsored health insurance to begin, or waiting for Medicare coverage to start. It is also a good option for those who missed the open enrollment for other health insurance and don't qualify for a special enrollment.

• Short-term health insurance is generally affordable for healthy individuals who don't require frequent medical care.
• Compared to standard plans, short-term health insurance provides less coverage, which can lead to higher out-of-pocket costs.
• Short-term health insurance is not available in every state, and not all health insurance companies offer this type of plan.
• Short-term health insurance does not always cover prescription drugs and typically does not cover maternal care or pre-existing conditions.
• Short-term health insurance is typically cheaper than a standard plan, but you must also consider a plan's deductibles, copays, coinsurance, and dollar limits.
• Short-term health insurance is not meant as a long-term solution, as it has limited coverage and may not cover all your health needs.
• Short-term health insurance is usually not suitable for people with pre-existing conditions, as these are often excluded from coverage.
• Short-term health insurance can be purchased at any time, as there is no open enrollment period.

Continue your work insurance under COBRA

If you've lost your job, you may qualify to keep your health coverage with COBRA, the Consolidated Omnibus Budget Reconciliation Act. COBRA is a way for workers and their families to temporarily maintain their employer-provided health insurance during situations such as job loss or a reduction in hours worked.

COBRA health coverage offers several benefits:

Continuity in Coverage

The coverage you get under COBRA will be the same coverage you had while you were an employee. This means you can continue to see the same doctors and receive the same health plan benefits.

Coverage for Dependents

Your dependents (i.e., spouse, former spouse, or children) are also eligible for COBRA coverage, even if you (the former employee) do not sign up for it yourself.

Avoiding a Lapse in Coverage

COBRA can fill the gap in health coverage between losing job-based coverage and beginning other health coverage.

Time to Enroll

You have a generous 60 days to enroll in COBRA once your employer-sponsored benefits end. Even if your enrollment is delayed, your coverage will be backdated to the day your prior coverage ended. Your employer will notify you with information about enrollment deadlines.

Long-Term Coverage is Available

While COBRA is temporary, you can usually stay on it for 18 to 36 months. This gives you ample time to find other health insurance options. However, cost is an important consideration as you may have to pay the entire group rate premium out of pocket, plus a 2% administrative fee.

Get on a spouse's or parent's plan

If you're married, you are eligible to join your spouse's employer-sponsored health insurance plan. Typically, employees can only make changes to their health insurance during the open enrollment period, which takes place once a year. However, marriage is considered a "qualifying event", which means you can make changes to your health insurance within 30 days of getting married. Note that if you don't make changes immediately after your wedding, you'll have to wait until the next open enrollment period.

If you're thinking of joining your spouse's health insurance plan, it's a good idea to compare the features and costs of your individual policies with those of a family plan. In some cases, the cost of two individual policies can be less than one family plan. Additionally, you may be subject to a "spousal surcharge" where the employer charges more for a family health insurance plan if they know that the spouse has access to a health insurance plan through their own employer.

If one spouse receives health insurance from their employer, while the other buys private insurance, it may be cheaper to take advantage of the employer-sponsored plan. Again, check the costs of your policies against the cost of a family plan to ensure that both the price and coverage are better.

If both spouses are self-employed and have their own policies, it may be more cost-effective to consolidate your policies into a family plan. To purchase a family plan, you and your spouse will need to file your taxes jointly, which may disqualify you from receiving health insurance subsidies in the future.

If you're not married but are in a domestic partnership, you may still be able to add your partner to your health plan. A domestic partnership is typically defined as a committed relationship between two adults who live together, but the specific rules vary depending on the state. You will usually need to provide documentation to prove your relationship meets all the rules, such as letters from family and friends verifying the relationship, sharing the same permanent residence for at least six months, and sharing household costs. Additionally, neither partner can be married to anyone else or be blood relatives. There may also be a waiting period of up to a year before health coverage can begin.

It's important to note that not all states recognize domestic partnerships, and even in states that do, it may be up to the employer or health plan to decide whether they'll allow you to add a domestic partner to your plan.

Apply for government programs

If you are unable to afford insurance, there are several government programs that provide health coverage. To qualify for these programs, you must meet certain requirements, primarily based on income level. Here is an overview of some of the available government programs:

Medicaid

Medicaid is a government-sponsored program that provides health coverage for individuals who cannot afford private insurance. Qualification for Medicaid is typically based on income level, and the requirements vary by state. Some states have expanded Medicaid eligibility under the Affordable Care Act (ACA), while others have not. If your state has not expanded Medicaid, the eligibility guidelines may be strict, and you may find yourself in the coverage gap if you earn below the poverty level but do not qualify for Medicaid. However, if your state has expanded Medicaid, you may be eligible for coverage if your income falls within a certain range.

Medicare

Medicare is another government-sponsored program that provides health coverage, but it is specifically designed for individuals over the age of 65 and people with disabilities.

Children's Medicaid or CHIP

Children's Medicaid or the Children's Health Insurance Program (CHIP) offers health coverage for children and pregnant women. This program ensures that children from low-income families have access to essential healthcare services.

Affordable Care Act (ACA) Subsidies

The ACA, also known as Obamacare, has created government subsidies to assist low- and middle-income individuals in paying for health insurance. These subsidies come in the form of premium tax credits and cost-sharing reductions. Premium tax credits help reduce your monthly insurance premiums, while cost-sharing subsidies lower your out-of-pocket expenses like deductibles and copays. To determine eligibility for these subsidies, the government considers your household size, income, and the average cost of health coverage in your area.

American Rescue Plan Act (ARPA)

The ARPA, signed into law in 2021, has expanded eligibility for health insurance subsidies, making it easier for more Americans to afford coverage. The ARPA eliminates the "subsidy cliff," allowing individuals and families with incomes just above the 400% poverty level threshold to qualify for subsidies. Additionally, the ARPA reduces the amount that individuals and families between 100% and 400% of the poverty level need to pay.

Frequently asked questions