What to Do When You Can’t Afford Health Insurance

HealthCare Writer

Updated on February 17th, 2021

At PivotHealth.com, we want to make health insurance easy to understand so you can make better decisions. This post may have links to lead generation forms or direct you to our trusted insurance brokers, which is how we make money. However, this will not influence our writing.

According to the Census Bureau, 8% of Americans did not have health insurance at any point during 2019. In addition, between 2018 and 2019, the percentage of people without health insurance coverage decreased in one state and increased in 19 states. The study also found people with higher income levels were insured at a higher rate. In 2019, more than 87% of people at or above the 400% federal poverty level had private coverage, compared with 60% for those with incomes 100% to 399% of the poverty level. Only 26.6% with incomes below poverty levels were covered by private insurance.

It’s particularly troubling that so many who don’t have employer-sponsored health insurance coverage also feel that they are unable to turn to the marketplace exchanges for subsidized coverage. The departure of some insurers from the exchanges, plans that restrict provider networks, skyrocketing deductibles, and rising premium rates – especially for those who don’t qualify for premium subsidies – have caused many to feel that they have no choice but to forego health insurance coverage.

The good news is that even if you believe you can’t afford medical insurance, there are low-cost coverage options that may meet your budget requirements. From short-term health insurance to Medicaid, to catastrophic coverage – we’ll take a closer look at which option may work best for you.

Short-Term Medical – Flexible, Affordable Coverage

Have you heard of short term health insurance, but aren’t exactly sure what it is? Simply stated, short term medical plans are designed to provide you comprehensive coverage that you can afford, until you find a more permanent health care coverage solution. Short-term health insurance can also help provide you financial protection from costly medical emergencies.

What Do Short-Term Plans Cover?

Short term medical coverage offers many of the same benefits as offered by marketplace exchange health insurance plans. The Pivot Health short term medical plan includes:

  • Up to $1,000,000 in benefits per coverage period
  • A range of deductible choices, from $1,000 to $20,000, plus choices for out-of-pocket maximum amounts, to meet your budget
  • Affordable 20% coinsurance amount, and flexibility to choose copayment amounts
  • Hospitalization, surgery and medical services coverage
  • Physical therapy
  • Mental health services
  • Home health care and extended care facility
  • On select plans, separate prescription drug benefits and copays on physician visits

How Much Does Short-Term Coverage Cost?

Although short-term health insurance does not provide comprehensive health insurance coverage, you’ll find that it costs significantly less than plans purchased on the marketplace exchange.

How Long Does Coverage Last?

Just as the name implies, short term health insurance is limited to providing coverage for specific periods of time. Currently, federal regulations state that short term medical plans may provide a minimum of 30-days and up to 364-days of coverage per insurance certificate. In most states, you may even purchase an additional two years after your initial policy expires.

Applying for coverage is fast and convenient. You can use your phone, tablet or computer to complete a brief medical history and provide other key details for your application to be processed.

Choose a coverage start date that works for you – anywhere from 24 hours up to 60 days after applying. You also may cancel your coverage at any time, with no penalty. And to ensure that you’re truly satisfied with your coverage, Pivot Health offers a 10-day “free look” period. If you purchase a plan and cancel within the first 10 days, and haven’t filed any claims, you’ll receive a full refund of your premium.

Are There Other Advantages to Short Term Medical Coverage?

Short-term health insurance can have no provider network restrictions – enabling you to visit any health care providers you want. This is particularly beneficial because several major insurance companies have already withdrawn from providing plans on the marketplace exchange, and many of the plans that remain have restrictive provider networks to help control costs.

In addition, when you choose Pivot Health’s short-term medical plan, you’ll receive valuable non-insurance discounts on vision care services and products, a prescription drug savings card for use at pharmacies nationwide, and 24/7 telemedicine consultations which allow you to connect with a doctor whenever it is convenient for you.

Medicaid Coverage

Medicaid provides health insurance coverage to millions of low-income adults, children, pregnant women, elderly adults and people with disabilities. Jointly funded by both the states and the federal government, the program is administered by the states. In addition, although each state must meet federal minimum requirements for program eligibility, most states choose to provide additional services beyond the federally-mandated minimum guidelines for Medicaid.

How is Medicaid Eligibility Determined?

Many people do not realize they may be eligible to enroll in their state’s Medicaid program.

It is possible that some Medicaid-eligible individuals may not be enrolled in the program due to much confusion over Medicaid program changes which have taken place over the past few years. When the Affordable Care Act (ACA) was signed into law in 2010 it included provisions that significantly reduced eligibility requirements for Medicaid across the country, which was viewed as a major expansion of the program. Although the federal government planned to provide all funding for the expansion during the first several years, the ACA required states to take on an increasing percentage of the program costs over time.

Many lawmakers protested the expansion, concerned about the financial impact on the states. In June of 2012, the U.S. Supreme Court sided with those lawmakers, finding that the ACA’s provision to expand Medicaid was in fact unconstitutionally coercive of states. As a result of the ruling, states were given the option to extend Medicaid, and not all states chose to do so.

What Is Medicaid Expansion?

In states which chose to expand Medicaid, all low-income Americans (including non-parent adults) making 100 – 138 percent of the Federal Poverty Level (FPL) are now eligible to enroll in Medicaid. Prior to the program expansion – and in those states which chose not to expand the program – families were required to earn less than the FPL to qualify for Medicaid benefits. The expansion has had a significant impact on reducing the number of uninsured individuals in the country – particularly on non-parent adults.

To date, a total of 31 states and the District of Columbia have either opted into the expansion as planned by the ACA provisions or expanded Medicaid through a state-specific program with a federally-approved waiver. Of the remaining 19 states, none have acted to expand Medicaid, except for North Carolina. In early 2017, that state’s governor announced plans to expand Medicaid through executive action, but a federal judge has put a temporary stay on that action. It is estimated that more than 2.5 million individuals would qualify for Medicaid if those states adopted the program expansion.

How Do I Enroll?

If you believe that you may qualify for Medicaid benefits, these tips may get you started:

Finally, you may not be eligible for Medicaid, but depending on your circumstances, you may be eligible for federal premium tax credits and subsidies to significantly reduce your costs when you purchase insurance on the marketplace exchange. By completing an application, you will be informed about benefits for which you may qualify.

Catastrophic Health Plan Coverage

One of the least-discussed plans available through the health insurance marketplace exchanges is the catastrophic health plan. As the name implies, it is a plan that provides you coverage in case of true medical emergencies.

This plan meets all the minimum essential coverage requirements of ACA-eligible plans; however, until you meet the plan’s deductible, catastrophic health plans will not cover any benefits other than three primary care visits per year, plus certain preventive services. For 2017, the catastrophic plan deductible is $7,150. This means that for all other health care services, you must meet your deductible before the plan will cover any costs.

One benefit to a catastrophic plan is that it has very low premiums, just like premiums for short-term health insurance. However, the ACA limits eligibility for catastrophic coverage to individuals under 30 years of age, or for those individuals who receive a “hardship exemption” because the marketplace has determined they are unable to afford health coverage.

You Can Afford Health Insurance Coverage

Finding room in your budget for health insurance coverage can be daunting for many individuals. But the potentially devastating impact – financially, physically and emotionally – that a medical emergency could have on your life is truly frightening.

Insurance options such as short term medical insurance, catastrophic coverage or Medicaid all provide very low-cost solutions to ensuring that you have access to the health care coverage you need for a healthy, happy life.

Learn what a short term health insurance plan might cost.

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