Orlando Harmon
Not having medical insurance can be a serious issue, especially in the case of an unexpected illness, accident, or emergency requiring immediate medical attention. While the worst-case scenario of not having insurance used to be a tax penalty, this is no longer the case as of 2018. However, some states in the US have their own mandates and penalties, and certain states require you to have health coverage, or you will be charged a fee when filing your state taxes. Medical debt is a leading cause of bankruptcy in America, and the average daily cost of a hospital stay in the US exceeds $2,000, with surgery costs for common procedures surpassing $100,000. While doctors can refuse patients without insurance, emergency rooms in hospitals that accept Medicare must provide emergency care regardless of insurance status or ability to pay. There are also other options for those without insurance, such as Medicaid, short-term health insurance, and charity or financial aid options.
Characteristics of not having medical insurance
| Characteristics | Values |
|---|---|
| Tax implications | No longer taxed for not having insurance due to the repeal of the tax-penalty portion of the Affordable Care Act. However, some states have their own mandates and penalties, so a fee may be charged on state taxes. |
| Medical debt | Responsible for the full cost of treatment. Medical debt is the most common type of third-party collection on consumers' credit reports and the most frequent type of debt that consumers are contacted about by debt collectors. |
| Access to treatment | Doctors have the right to refuse patients without insurance or who are unable to pay out-of-pocket expenses. However, emergency rooms in hospitals that participate in Medicare are legally obligated under EMTALA to provide emergency care, and hospitals must treat serious medical problems regardless of insurance status. |
| Cost estimates | Eligible to receive a good faith estimate of expected charges from the provider if treatment is scheduled at least 3 business days in advance or upon request. This can be used to dispute a bill if it is at least $400 more than the estimate. |
| Insurance options | Depending on age, income, and health status, may be eligible for Medicare, Medicaid, or coverage through the Health Insurance Marketplace. |
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What You'll Learn
- You won't face a tax penalty for not having health insurance
- You can ask for a good faith estimate of costs from your provider
- Hospitals must treat you in an emergency, regardless of insurance status
- You may qualify for Medicaid or coverage through the Health Insurance Marketplace
- You can call 1-800-MEDICARE for information on Medicare coverage
You won't face a tax penalty for not having health insurance
If you are uninsured, you no longer need to pay a tax penalty or a "shared responsibility payment". This fee was removed in 2018, and you do not need an exemption to avoid paying it. However, if you live in a state that requires you to have health coverage, you may be charged a fee when filing your state taxes. This is dependent on the state in which you reside, so be sure to check with your state or a tax preparer. For example, if you live in California or the District of Columbia, you can visit Covered California or DC Health Link respectively for more information. If you live in Maryland, you can visit Maryland Health Connection for information on exemptions and exemption forms.
The No Surprises Act, a federal law that went into effect on January 1, 2022, states that if you don't have insurance or are not using it, your healthcare provider must give you a good faith estimate of how much your care will cost. This estimate is not a bill, and you can request one in writing if you have scheduled care and have not yet received one. A good faith estimate is also necessary if you need to dispute your bill, and you can't use the No Surprises Act dispute process without one. Once you receive your good faith estimate, it is important to keep it in a safe place so that you can compare it to your bill when it arrives. You may be able to dispute your bill if it is at least $400 more than the estimate.
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You can ask for a good faith estimate of costs from your provider
If you don't have medical insurance, you can still get treatment at a hospital in the event of an emergency. However, you will be responsible for the full cost of the visit. It is important to be aware of your rights and options in such situations. One option to consider is to ask for a good faith estimate of costs from your provider. This can help you understand the potential financial burden of your treatment and make informed decisions.
A good faith estimate is your right to receive an estimate of the amount you will be billed for scheduled or non-emergency items or services. This includes costs for items and services anticipated with your visit, such as medical tests and hospital fees. You can request this estimate from your healthcare provider before scheduling any item or service. If you schedule an appointment at least three business days in advance, you are entitled to receive the good faith estimate within one business day. If you schedule care ten or more business days in advance, you will receive the estimate within three business days.
It is important to note that you can also request a good faith estimate if you are insured. This applies to non-emergency items and services that you plan to schedule. Having a good faith estimate is crucial if you need to dispute your bill. Without an estimate, you cannot dispute the charges. Additionally, if the estimate you receive for the anticipated items and services significantly exceeds the amount you are billed, you have the right to dispute the bill.
To obtain a good faith estimate, you can directly ask your provider for an estimate if they haven't provided one. You can also submit a complaint to ensure that you and other patients receive good faith estimates in the future. Remember, even with a good faith estimate, you are still responsible for paying the bill. However, it provides valuable information to help you understand and manage the costs of your medical care.
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Hospitals must treat you in an emergency, regardless of insurance status
If you don't have health insurance, you can still receive treatment at a hospital in an emergency. Under the federal law, the No Surprises Act, you have the right to receive emergency care regardless of your insurance status or ability to pay. Hospitals that participate in Medicare are legally bound by EMTALA to provide such care.
However, it is important to note that this only applies to emergency situations and does not extend to non-emergency medical care. In non-emergency cases, doctors and healthcare providers have the right to refuse treatment to patients without insurance or those who are unable to pay out-of-pocket expenses.
To mitigate potential financial burdens, you can request a good faith estimate from the healthcare provider before scheduling non-emergency care. This estimate should outline the expected charges for the services and facilities, although it is not a guarantee of the final bill. Obtaining this estimate is crucial for disputing any unexpected or excessive charges, as outlined in the No Surprises Act.
Additionally, you can explore alternative options to access affordable healthcare. These include investigating your eligibility for Medicaid, a state-based assistance program for low-income individuals, or exploring the Health Insurance Marketplace, which can offer cost-saving opportunities on premiums and other expenses. Furthermore, non-profit organizations like the Patient Advocate Foundation provide financial aid and support to individuals facing chronic, life-threatening, or debilitating illnesses.
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You may qualify for Medicaid or coverage through the Health Insurance Marketplace
If you are uninsured, you may qualify for Medicaid or coverage through the Health Insurance Marketplace. The Affordable Care Act (ACA) provided all states with the option to expand their Medicaid programs. Currently, 28 states have expanded their programs. For information regarding the Medicaid program in your state, you can call the Centers for Medicare and Medicaid Services (CMS) at 1-877-267-2323 or visit www.medicaid.gov. If you are under 18 years of age, you may qualify for coverage under your state's Children's Health Insurance Program (CHIP). CHIP provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid but who cannot afford private coverage.
Medicaid is a state-based assistance program serving low-income people under the age of 65. Patients usually pay no part of the costs for covered medical expenses, although a small co-payment may be required. The Health Insurance Marketplace can help ensure you have access to affordable healthcare, and you may even qualify for cost savings on your monthly premiums and other costs like co-pays and deductibles. With one Marketplace application, you can review lower costs based on your income, compare your coverage options side-by-side, and enroll.
If you have Medicare, you do not need to apply for coverage through the Health Insurance Marketplace. Medicare's open enrollment period is October 15–December 7. During this time, all people who have Medicare can make changes to their health plans and prescription drug coverage. To find out how to make such changes, visit medicare.gov, or call 1-800-MEDICARE. If you have End-Stage Renal Disease (ESRD) and haven't signed up for Medicare, you can get a Marketplace plan.
If you have Marketplace coverage and become eligible for Medicaid or CHIP, you should consider ending your Marketplace coverage. If you don't end your Marketplace coverage when your Medicaid or CHIP coverage starts, you may have to pay back some or all of the premium tax credit you used when you file your federal taxes.
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You can call 1-800-MEDICARE for information on Medicare coverage
If you don't have medical insurance, you won't face a tax penalty. The "Shared Responsibility Payment" or "mandate" fee for not having health insurance ended in 2018. However, if you live in a state that requires you to have health coverage, you may be charged a fee when filing state taxes. For example, residents of Maryland, California, and the District of Columbia need to visit their respective state websites for information on exemptions.
If you don't have medical insurance, you can call 1-800-MEDICARE (1-800-633-4227) to get information on Medicare coverage. This helpline has a 24/7 speech-automated system that will direct your call by asking you questions that you answer with your voice. You can also say "Agent" at any time to speak to a customer service representative. Additionally, you can call this number to get telephone numbers for your local Quality Improvement Organization and State Insurance Department.
When calling 1-800-MEDICARE, it is recommended to call from a quiet area and have your Medicare card in front of you. You can also start a live chat or contact the Social Security Administration (SSA) to sign up for Medicare Part A and/or Part B, change your address, or apply for Extra Help with Medicare drug costs.
Medicare offers a "Medicare & You" handbook and Medicare Summary Notices (MSNs) that can be accessed electronically to provide faster information about your coverage. It is important to review your plan to understand what drugs are covered, as your out-of-pocket costs for covered drugs may be capped at a certain amount.
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Frequently asked questions
If you don't have health insurance, you can ask for a good faith estimate for the cost of care. This applies when you don't have insurance or are choosing not to use it. You can dispute a bill if it's at least $400 more than the estimate. Doctors have the right to refuse patients without insurance, but emergency rooms in hospitals that participate in Medicare are legally obligated to provide emergency care, regardless of a patient's ability to pay.
The fee for not having health insurance ended in 2018, so you no longer pay a tax penalty for not having health coverage. However, some states have their own mandates and penalties, so you may face a fee depending on the state you live in.
If you are under 65 and have a disability, you may be eligible for Social Security Disability Insurance (SSDI). If you have end-stage renal disease, you can get coverage through Medicare. You can also look into whether you qualify for Medicaid or coverage through the Health Insurance Marketplace.
