If you work for a company or organization, you are probably like 49% of people that have access to health insurance coverage through an employer. Employer-sponsored plans typically pay for a portion of health insurance, and then the employee is responsible for picking up the rest of the monthly premium amount, usually deducted directly from each paycheck.
For 7% of Americans that are self-employed or don’t have access to employer health insurance, they have to buy it on their own, either through the federal marketplace exchange, a web entity, insurance agent, state exchange or directly through an insurance company.
With no employer to help alleviate the cost of monthly premiums, these individuals pay 100% of the cost of their health insurance. Financial subsidies are available if an individual buys a federally-mandated Affordable Care Act (ACA) plan and qualifies for assistance based on their total household income – or they pay full retail price.
In 2017, more than 27.7 million people were uninsured, which is 9% of the total population. For individuals who cannot afford even a subsidized ACA plan, the stress of risking their health and financial wellbeing could be crippling. But there are options.
Health Insurance Plans That Can Be More Economical
Before you think you can’t afford health insurance at all, think again. Here is a quick look at some of your options
The Affordable Care Act (ACA) officially became law in 2010, and in 2014 Americans who buy their own health insurance went through their first open enrollment period, purchasing health insurance from either the federal exchange at healthcare.gov or from a designated state marketplace.
Today the ACA, also known as Obamacare, is still the health care law of the land. If you fall between 100%-400% of the federal poverty guidelines, you can be eligible for financial assistance that lowers the cost of the plan each month during the open enrollment period. About 90% of Americans who apply for ACA coverage are eligible for a subsidy. Yet the original structure of the ACA law has been altered somewhat by the current administration.
Whereas having an ACA health insurance plan was required when people starting signing up in 2014, this rule no longer holds true. Instead of paying a penalty for not having an ACA plan like you had to in 2014, the Trump administration has waived that rule and consumers now have the freedom to purchase any type of health insurance plan they choose (in most states).
Short-Term Health Insurance
With the elimination of the ACA health insurance penalty, individuals can consider other plans when weighing their options for health insurance coverage.
Short-term medical insurance, also known as temporary health insurance, is an economical plan option that can pay for doctor office visits, hospitalizations, outpatient surgeries and other benefits that help you take care of your health should an unexpected accident or illness occur.
Short-term plans are not a permanent solution for your long-term health insurance needs, but they can provide coverage when you are waiting to make a decision, can’t afford COBRA or seeing how the 2020 election might impact health care in this country.
You can purchase a temporary health plan for as little as 30-days or up to 364-days, depending on your state of residence. In some states, you can even extend your coverage up to three years with just one application.
A temporary health insurance plan is not for everyone. Since they are not required to abide by the ACA health law, specific medical benefits, like preventive care, are not required to be covered on a short-term plan. Short-term medical insurance also has the ability to ask questions about pre-existing conditions and reject an application if there is a history of a medical event or not pay for treatment if it can be traced back to a pre-existing medical condition after coverage is granted.
Fixed Indemnity Insurance
Also known as limited benefit health insurance, fixed indemnity plans were originally created to supplement an individual health insurance plan like an ACA plan. With the dawn of high deductible health coverage, out of pocket exposure became more and more the responsibility of the insured person.
So fixed indemnity coverage was marketed to offer relief for doctor office visits, hospitalizations, diagnostic lab work, surgery and more. There is typically zero deductible on a fixed indemnity health plan, providing immediate cost relief on medical visits. There is also no coinsurance or copayments, simplifying the insurance process.
Zero deductible insurance is affordable coverage that offers a variety of benefits at rates that meet any budget. It includes specific cash payments for both sickness and accidental injuries regardless of other coverages.
Depending on state rules, you are not always required to have an individual health insurance plan in order to buy a fixed indemnity, zero deductible plan. There is also no network – you can see any doctor of facility you would like. Just save your receipts from the billing administrator or your doctor as proof of payment for your reimbursement.
Like short term medical plans, there are underwriting questions that allow a health insurance company to reject your application due to a pre-existing condition. But it is free to apply and you will know in minutes if you qualify for the insurance coverage before committing to purchase a plan.
Faith-Based Sharing Ministry Memberships
A lesser-known budget-friendly option is faith-based health plan memberships. While not health insurance, faith-based plans are a self-funded program where everyone who is a member pays into the program’s membership “pool” each month. The reserves are saved to pay for qualified member medical treatments that meet the standards of the program. Like short term health insurance
When examining your options, whether it is a subsidized ACA plan, short term health insurance, or a different coverage alternative, be sure to compare the deductible, copayments, coinsurance in addition to monthly premiums to see what coverage type might be best for you.
Apply For Medicaid
If you can’t afford Obamacare, you might qualify for Medicaid if your total household income meets the federal requirement of no more than $12,500 (for one person) or $25,750 (for a family of four). Every state offers Medicaid. But if you make less than 100% to 200% of the federal poverty guidelines and are pregnant, elderly, disabled, a caretaker of a parent or a child, there is a very good chance you could qualify for some assistance. (Note, all states run Medicaid programs. There is no federal interaction.)
Pull out your last tax return and look for your adjustable taxable income. If your household adjustable taxable income is close to the figures listed above, it’s worth checking in to see if you qualify.
If you decide to apply for Medicaid, keep in mind that the application process is a long and tedious process. You have to prove your income level with tax documents, bank statements, and if you are disabled, medical records. States then have 45 days to review your application, and 90-days if you are claiming disability.
Ways To Save Money on Healthcare Services
Now that we’ve discussed how to investigate paying less for health insurance, here are some additional ways to save money on medical services. Like the health insurance side, there are multiple options:
Talking to a doctor over the phone or through video chat on your smartphone is called “telemedicine” services. Instead of making an appointment, driving to a clinic and waiting in the lobby to be called while feeling miserable, telemedicine calls allow you to get immediate access to a board-certified physician from the comfort of your home with no transportation or wait times.
If you need a reason to use telemedicine – visits are usually half the cost of an urgent care visit, if not more. Health insurance typically doesn’t cover telemedicine, but the cost savings can still be less than seeing a traditional doctor and filing a claim.
Community health centers
Health centers throughout the country offer primary and preventive care to nearly 26 million people regardless if they can pay for their medical services. To find a health center in your community, check the national Health Resources & Services Administration (HRSA) database.
The National Association of Free and Charitable Clinics, founded in 2001 by a group of medical providers who recognized that healthcare was not being provided in local communities to the working poor, uninsured and underinsured that was cost-effective, easily accessible and affordable. You can find a clinic near you using the NAFC’s database warehouse.
Public health clinics
Many counties offer public clinics to help protect and improve the health of people and the environment around them. Typically used for preventive care, education and immunizations, many offer a sliding scale for payment based on income.
Know before you go
Use websites like Fair Health Consumer to find out how much medical procedures, office visits or hospital stays could cost in your local area before making an appointment. While more of an estimate than an exact figure, it can give you a ballpark range of what specific procedures cost. You might be surprised how expensive healthcare really is.
These are just a few ways to help curb your out of pocket costs when it comes to healthcare and health insurance. But the good news is, there are options and many ways to reduce your healthcare costs in the future.