Securing health insurance is essential, but what if you can’t afford it? In this blog post, we will explore various options available to individuals facing financial constraints when it comes to obtaining health insurance coverage.
Where to Start
Start at Healthcare.gov, home of the Affordable Care Act (ACA) Health Insurance Marketplace. The ACA Health Insurance Marketplace is also called the Marketplace or the exchange.
Here, you can screen to determine your eligibility for subsidies, Medicaid, CHIP, or other health insurance options. You can also contact the Marketplace by calling 1-800-318-2596 to apply. TTY users can call 1-855-889-4325.
In addition to the federal exchange, some states have their own state-run Marketplaces, where you can get an ACA-compliant health plan.
ACA Subsidies
ACA subsidies lower healthcare costs for households with incomes between 100% and 400% of the federal poverty level (FPL) if you qualify. Some households above 400% FPL can also get ACA subsidies.
There are two types of ACA subsidies:
- Premium Tax Credits help pay for part or all of your insurance premiums
- Cost-sharing reductions that reduce out-of-pocket costs (deductibles, copayments, and coinsurance) for eligible people purchasing “silver level” plans in the marketplace.
Your Marketplace application will be forwarded to your state if it indicates that someone in your household might qualify for Medicaid. Your state will make a final eligibility decision.
#1. Medicaid:
Medicaid is a public health program designed to assist low-income individuals and families. It is managed by the states, which receive matching federal dollars. It provides comprehensive coverage to more than 1 in 5 Americans.
Eligibility requirements vary by state, and income and asset limits determine who qualifies for Medicaid.
- In all states, you can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.
- In states that have expanded Medicaid coverage, you can qualify based on your household income alone if below 133% FPL.
- A few states use a different income limit. For example, Texas Medicaid doesn’t cover adults over 19 who are declared disabled by Social Security, pregnant (or postpartum), elderly, certain caretakers, or exiting foster care, regardless of how little income they make.
Applying for Medicaid can be a crucial step if you are unable to afford traditional health insurance plans. Medicaid coverage is very good, as Medicaid and CHIP are accepted almost everywhere. If you meet the eligibility requirements, which are easier for low-income pregnant women, then this is a very good health plan.
Apply for Medicaid on Healthcare.gov, or with your state’s Medicaid agency, any time of year, with no open enrollment period.
Medicaid Retroactive “Look Back:”
One benefit of Medicaid is its retroactive coverage. This means that if you qualify for Medicaid, it can cover medical bills from up to three months before your application date. This retrospective look back can provide financial relief for previously incurred medical expenses. You can read more about retroactive Medicaid coverage and how to apply in our article, “How to Submit Unpaid Medical Bills to Medicaid“.
#2. Children’s Health Insurance Program (CHIP):
If you cannot afford health insurance for your children, the Children’s Health Insurance Program (CHIP) is worth exploring. CHIP offers comprehensive benefits, including preventive care, immunizations, urgent care services, and more.
Like Medicaid, it is jointly funded by the federal and state governments. Many states operate CHIP as a program separate from Medicaid, serving families that earn too much to get Medicaid but cannot afford health insurance. Income and asset limits, premiums, cost-sharing, and coverage options vary by state.
You can apply for CHIP on healthcare.gov or with your state’s Medicaid agency, any time of year, without open enrollment restrictions.
#3. Federal Programs for Certain Populations:
There are several federal programs available to certain populations. They have strict eligibility guidelines, depending on the program, whether by income, age, tribal affiliation, or military service. Unlike Medicaid or CHIP, program coverage will be the same no matter which state you live in.
Medicare is the health insurance program for people who are 65 or older. It also covers younger people with certain disabilities. In 2021, Medicare accounted for 21% of national health spending and 10% of the federal budget.
The Veterans Health Administration is America’s largest integrated healthcare system, serving over 9 million military veterans annually. It is managed by the U.S. Department of Veteran Affairs (VA) and provides services at 1,321 healthcare facilities all around the country.
The Indian Health Service (IHS) provides comprehensive health services for approximately 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states. Indian Health Service, Tribal, or Urban Indian Health Program facilities are located throughout the country. They provide free services regardless of income.
#4. Federally Qualified Health Centers (FQHCs):
Federally Qualified Health Centers (FQHCs) make up the country’s largest primary care system, serving 1 in 12 people. Many are known as Community Health Clinics or Community Health Centers. They provide medical, dental, and behavioral health services, regardless of insurance status or ability to pay.
FQHCs are considered the safety net of our country’s healthcare system. They play a vital role, especially in rural areas and states that have chosen not to implement the Medicaid expansion to cover their low-income residents. Use the HRSA database to locate FQHCs in your area.
#5. Local Assistance Programs:
In some areas, local municipalities may offer their own medical assistance programs. Additionally, many local charitable organizations and clinics provide low-cost healthcare, dental or mental health services to their communities. Services and eligibility vary depending on the organization providing services. Contact 2-1-1 to find out about services available in your area.
#6. Hospital Charity Care or Financial Assistance Policies:
Nonprofit hospitals and some for-profit hospitals offer financial assistance policies including charity care or discounted healthcare to eligible financially disadvantaged patients. These are income or means-based sliding scale discounts that can help reduce or even eliminate your medical debt.
More options:
If you make well over the Federal Poverty Level or otherwise do not qualify for government-based healthcare, there are still options. Explore insurance outside of the ACA Marketplace in Health Insurance Alternatives to the Affordable Care Act (ACA) or Obamacare.
Additionally, if you are underinsured or uninsured, you can find options in the article Cash for Healthcare and Options for the Underinsured and Uninsured.
Takeaways
If you find yourself unable to afford health insurance, there are alternative options to consider.
- ACA subsidies can help many people between 100% and 400% of the federal poverty level (FPL), and sometimes over 400% FPL.
- Medicaid provides comprehensive coverage for eligible low-income individuals and families.
- CHIP is a healthcare program for children whose families make too much for Medicaid, but not enough for an insurance plan.
- Other government-sponsored health programs are available to specific populations, based on tribe, age, or military status.
- Federally Qualified Health Centers (FQHCs) are a vital safety net that provides primary care regardless of income or insurance status.
- Nonprofit and even some for-profit hospitals provide charity care programs that offer sliding-scale discounts.
- Finally, don’t forget to call 2-1-1 or visit 211.org to see what local programs and assistance might be available in the area where you live.
Explore these options based on your circumstances to ensure you have the necessary health coverage. Remember, it’s essential to research and understand the eligibility criteria and benefits of each program to make an informed decision that suits your needs.