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You missed Obamacare open enrollment, and now you are uninsured. What will healthcare cost you? How will you pay for it?
Going without health insurance has different implications for different individuals based on their financial situation, healthcare needs, and exemption status under the Affordable Care Act, among other factors.
The cost of going without health insurance can be more than a tax penalty. It can also be medical bills paid out of pocket. According to a 2015 Kaiser Family Foundation report on America’s uninsured population:
So, what are your options if you missed open enrollment and are currently uninsured? Here are five of the most common:
While you are in between Obamacare plans, you can buy temporary benefits for as few as 30 days and up to 364 days, depending on your state’s laws. A short term health plan, which is known in the industry as short term medical insurance or STM, includes benefits for a range of covered expenses such as hospital room and board, surgical services, emergency room treatment and doctor office visits. Some short term plans, such as Connect Net, which is sold through healthedeals.com, may even include a few preventive care benefits.
When to buy: You can purchase a short term health plan year-round and even start coverage as soon as the day after you apply. Take our short term health quiz or check out our infographic on short term health insurance myths to learn more.
What to know: Short term coverage is not ACA-compliant, which means having it may not prevent you from owing an Obamacare tax penalty (i.e., the individual shared responsibility payment) and you may not be eligible if you have a pre-existing condition. However, it can help you pay for unexpected healthcare expenses while you are uninsured.
You may be able to enroll in an ACA-compliant major medical plan outside of open enrollment, if you experience certain life situations in the year to come.
Getting married, adopting or giving birth to a child, moving or having income changes that impact your eligibility for Obamacare subsidies are a few of the qualifying life events that may make you eligible for a special enrollment period.
When to buy: For individuals and families without job-based coverage, special enrollment periods last 60 days from when your qualifying life event occurs. The law requires job-based special enrollment periods to last at least 30 days.
Speak with a health insurance producer or contact your state-based or federally facilitated health insurance exchange to discuss your eligibility and enroll. During a special enrollment period, you can buy Obamacare plans through your state-based or federally facilitated exchange as well as in the private market.
What to know: Depending on how long you went without minimum essential coverage that fulfills the ACA’s individual shared responsibility provision and whether or not your circumstances made you exempt, you could still owe a tax penalty for the time in which you were uninsured.
Medicaid is a program that provides access to free or low-cost health coverage to certain populations, including low-income individuals and families, pregnant women, the elderly and people with disabilities. Typically, eligibility criteria have varied by state. However, states were given the option to expand their Medicaid programs under the Affordable Care Act.
When to buy: Medicaid enrollment is available year-round.
What to know: In states that did not expand Medicaid, state-specific eligibility criteria will apply. Visit your state-based or federally facilitated health insurance exchange or Medicaid.gov to learn more about eligibility and enrollment where you live.
If you are ineligible for a special enrollment period or Medicaid and opt not to enroll in temporary benefits, you will likely have to pay entirely out of pocket for any healthcare you need while you are without an Obamacare plan or other minimum essential coverage.
When to buy: N/A
What to know: If you are struggling to pay unexpected medical bills, you may be able to negotiate with the provider or work with a patient advocate to make them manageable. Consider using retail walk-in clinics for minor care.
There is an array of standalone products to help consumers with out-of-pocket healthcare expenses, whether or not they have health insurance. These products include but are not limited to the following:
When to buy: Supplemental products are available all year long. In addition to purchasing coverage through a health insurance producer, you can apply and enroll through healthedeals.com any time of day, any day of the year, wherever you have access to the Internet.
What to know: Supplemental products are not ACA compliant, and having it may not prevent you from owing an Obamacare tax penalty (i.e., the individual shared responsibility payment). Eligibility criteria and state availability vary by product.
Which solution is right for you is dependent on your situation. Consider working with a health insurance producer (i.e., agent, broker, certified advisor) who can help you navigate your options.
Call the number at the top of your screen to speak with a certified advisor who is ready to answer your questions and assist you with the quoting, selection and enrollment process.
 The Henry J. Kaiser Family Foundation. “Key Facts About the Uninsured Population.” Oct. 5, 2015. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
 HealthCare.gov. “Having a Major Life Change? You May Qualify for a Special Enrollment Period.” Sept. 5, 2014. https://www.healthcare.gov/blog/special-enrollment-period/
 HealthCare.gov. “Medicaid & CHIP Coverage.” https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
 The Henry J. Kaiser Family Foundation. “Status of State Action on the Medicaid Expansion Decision.” Updated Jan. 12, 2016. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
 HealthCare.gov. “Medicaid Expansion & What It Means for You.” https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/
This document is for general informational purposes only. While we have attempted to provide current and accurate information, this information is provided "as is" and we makes no representations or warranties regarding its accuracy or completeness. The information provided should not be construed as legal or tax advice or as a recommendation of any kind. External users should seek professional advice from their own attorneys and tax and benefit plan advisers with respect to their individual circumstances and needs.
SHORT-TERM MEDICAL EXPENSE (STM)
THIS IS A SHORT TERM HEALTH BENEFIT PLAN THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. THIS POLICY INCLUDES A PRE-EXISTING CONDITION EXCLUSION PROVISION.
THIS PLAN DOES NOT MEET MINIMAL ESSENTIAL COVERAGE REQUIREMENTS FOR PEDIATRIC DENTAL SERVICES AS PART OF THE ESSENTIAL HEALTH BENEFITS IN ACCORDANCE WITH THE AFFORDABLE CARE ACT (ACA) PROVISIONS.
A CRITICAL ILLNESS INSURANCE PLAN PAYS OUT LUMP-SUM CASH BENEFITS UPON DIAGNOSIS OF CERTAIN COVERED ILLNESSES AS SHOWN IN THE CERTIFICATE. THIS PRODUCT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA).
METAL GAP and METAL GAP 2
THIS PLAN IS NOT CONSIDERED TO BE MINIMAL ESSENTIAL COVERAGE AS DEFINED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA). ENROLLING IN AND MAINTAINING THIS PLAN WILL NOT EXEMPT YOU FROM THE SHARED RESPONSIBILITY PAYMENT (TAX) THAT MAY APPLY IF YOU DO NOT HAVE PLAN WITH ACA-COMPLIANT COVERAGE.
About The IHC Group
The IHC Group is an organization of insurance carriers and marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions to groups and individuals for over30 years. Members of The IHC Group include Independence Holding Company (NYSE:IHC), American IndependenceCorp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company. Each insurance carrier in The IHC Group has a financial strength rating of A- (Excellent) from A.M. Best Company, Inc., a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations. (An A++ rating from A.M. Best is its highest rating.) Collectively, the companies in The IHC Group provide insurance coverage to more than one million individuals and groups. For more information about The IHC Group, visit www.ihcgroup.com.
About IHC Specialty Benefits, Inc.
IHC Specialty Benefits, doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products through general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit www.HealtheDeals.com.