I Don't Have Health Insurance. What Can I Do?
Reading time: 5 minutes
Throughout the Coronavirus/Covid-19 pandemic, it’s become increasingly clear how important accessible and affordable health insurance is for Americans. Uninsured individuals are much less likely to seek out needed medical care than those who have insurance, and when they do visit a doctor or hospital, they face significant, even financially devastating bills.
Luckily, even if you’re unable to obtain health insurance through your employer, or have been recently laid off due to the Covid-19 pandemic, you still have options available. It’s important to know where you can find and obtain insurance coverage, long before you actually need to use it.
Do I really need health insurance?
When faced with the prospect of having to find and purchase their own health insurance, some otherwise healthy people may wonder whether it's necessary. The answer to that question is a resounding: Yes.
For people without health insurance, dealing with the costs of an unexpected accident or serious illness can be financially devastating. Luckily, obtaining coverage for yourself or your family without the help of your employer is much easier than it used to be. Insurance companies can no longer deny coverage because of preexisting medical conditions. Additionally, policies must provide health screenings, yearly checkups and other preventive services with no out-of-pocket costs to you.
Where can I find health insurance?
The health insurance marketplace, located at healthcare.gov, is a website run by the federal government to help consumers find affordable coverage. You can use the marketplace to explore the types of policies and insurance companies (such as BlueCross BlueShield or Kaiser Permanente) available in your area and purchase the coverage that best meets your needs.
Typically, you’re only eligible to purchase health insurance during a period known as open enrollment, which generally occurs during November and December prior to the year for which you are enrolling. Open enrollment for 2020 has already passed; however, certain life events may qualify you for a special enrollment period (SEP). For example, if someone in your household has married, divorced, had a baby or passed away within the past 60 days, you may be eligible for an SEP. The same may be true if you’ve recently moved to a new ZIP code or lost your health insurance coverage within the last 60 days. It’s a good idea to review the marketplace guidelines to see if you qualify for any kind of SEP.
Additionally, if you lost your job-based health insurance due to Covid-19 within the past 60 days, or if you anticipate that you will lose your coverage within 60 days, you may qualify for a special enrollment period to find new insurance. However, these rules are unlikely to apply to you if you have lost a job where you did not previously have an employer-provided health insurance plan.
In addition to what’s available on the marketplace, there are select health plans that serve specific groups of people. For example, Medicare covers senior citizens and the disabled, while Medicaid provides health insurance and services for low-income families and adults. The Children's Health Insurance Program (CHIP), similar to Medicaid, covers children of low-income families. Medicare payments are deducted from your Social Security benefits, while coverage under Medicaid and CHIP is provided as a government benefit to those who qualify for them.
The qualifications and enrollment periods for each of these programs typically vary from state to state. Visit the links below to see if you qualify:
What do you need to keep in mind when looking for new coverage?
There are four basic types of health coverage to choose from:
Preferred Provider Organization (PPO). A PPO is a network of doctors, hospitals and specialists formed by insurance companies that contract with providers to serve their patients. You typically pay less to see providers inside of the network, and more for providers outside of the network.
Health Maintenance Organization (HMO). An HMO is a group of doctors, hospitals and other health care providers networked into one organization that agrees to provide care at a lower cost to its members. You are typically not covered, however, if you choose to seek care outside of your network.
Exclusive Provider Organization (EPO). EPOs are managed care plans. As with HMOs, you must use their doctors, hospitals and specialists, and can't seek medical care outside of the network without paying for the services yourself.
Point-of-Service (POS). POS plans are a combination of an HMO and PPO. Although these types of plans vary, patients must choose a network physician to be their primary care provider but can normally use out-of-network doctors and hospitals for other health care services, so long as you’ve received a referral.
How do you know what you’ll be able to afford?
When you're shopping for coverage on the health insurance marketplace, the first thing you'll do is answer questions about your income. If you meet certain financial qualifications, the federal government may cover a portion of your cost with what is called a premium subsidy. If you don't make enough money to qualify for a subsidy, the marketplace will show you low-cost or no-cost options, such as Medicaid, that are specific to your state.
To give consumers insurance coverage options at affordable prices, the marketplace breaks down each type of plan (HMO, PPO, EPO and POS) into four major "metal" categories: Bronze, Silver, Gold and Platinum.
The metal categories have nothing to do with the quality of the health care you will receive. In fact, all policies available through the marketplace provide the same basic coverage. The categories are based on the way you and your insurer will split the cost of your health care services.
In general, Bronze plans have the lowest premiums (the monthly cost of your insurance), but they also have the highest deductibles (the amount of money you will have to pay before your insurance company will begin covering your costs). On the other end of the spectrum, Platinum plans have the highest premiums but the lowest deductibles.
Here is a look at the differences you might see between the portion of your health care costs that are covered by the insurer and the portion you might pay out of pocket for each of the metal categories:
|Paid by Insurance||Paid by Patient|
There are two important questions to ask yourself when choosing a new health insurance policy: Do you want to stay with your current doctor? And do you prefer using a certain hospital? If you answer yes to either of these, you need to check the provider directory of prospective health plans to make sure that your doctor or hospital is in that network. Otherwise, you may have to change to a new physician or go to a different hospital that is farther away from your home.
What if your income is too high to qualify for a federal premium subsidy?
Even if you don't qualify for a premium subsidy, the federal marketplace can still help through its Plan Finder website.
Plan Finder is designed to help you find private health plans in your area that will fit not only your medical needs but also your budget. As with the marketplace, the policies are broken down by type, premiums, deductibles and metal category to give you an overview of the options that are available.
Whatever your financial situation may be, the most important thing to remember is that having health insurance is critical to ensuring you don’t pay a hefty price for an unexpected medical expense.