If you don’t have health insurance, you’re not alone. In January of 2019, the National Center for Health Statistics (NCHS) estimated that 29.7 million Americans of all ages were uninsured as of September, 2018.1
Of that total, 25.8 million of the uninsured individuals were non-elderly Americans (between the ages of 18-64).2
The good news is that these numbers show that since the passage of the Affordable Care Act (ACA), nearly 20 million more Americans have gained health insurance. That’s because in 2010, before President Obama signed the ACA into law, the Centers for Disease Control (CDC) estimated that 48.6 million Americans (all ages) had no health insurance.3
The bad news is this means there are still millions of Americans who are bearing the cost of paying for healthcare expenses on their own. If you’re uninsured, you’re also well aware of the potential risks to your financial security if you experience a costly medical emergency.
So, what should you do if you missed the annual open enrollment period for major medical insurance, or can’t afford to purchase insurance through the ACA exchange? We review some options later in this post but you can jump ahead now and find out what to do if you don’t have health insurance.
A Closer Look at Uninsured Individuals in America
One of the primary goals of the ACA was to make affordable health insurance available to more people.4 With that objective in mind, the question remains nearly 10 years after the law was passed – “who are the remaining uninsured Americans?”
A number of reports including data compiled between 2017 and 2018 by different government and private agencies have focused on answering this question. The following details provide insights about which individuals in the U.S. still don’t have health insurance, based on specific demographics, including:
Age – The millennial generation continues to lag behind other adult groups in the U.S. when it comes to insurance coverage. The January, 2019 CDC report indicates that as of September, 2018, adults aged 25-34 were the largest uninsured group (17.1%), compared with other age groups. In contrast, adults aged 45-64 were the least likely to have no insurance (9.9%).5
Financial status – Given the cost of health insurance, it probably comes as no surprise that among uninsured American adults aged 18-64, 52% were poor or near poor, while only 8% of those who were not poor had no health insurance, according to the January, 2019 CDC report.6
Education – Correlating to the finances demographics, figures from an American Community Survey published in September, 2018 indicate that as of the end of 2017, people who did not complete their high school education were more likely to be uninsured (26.9%) than the overall population (11.8%).7
Race and ethnicity – The CDC report also highlights that there’s a significant range in uninsured rates among various racial and ethnic groups in the U.S. Of adults aged 18-64 with no health insurance, 26.3% were Hispanic, 14.7% were non-Hispanic black, 8.8% were non-Hispanic white, and 8.2% were non-Hispanic Asian.8
State residency – Depending on where you live in the U.S., there may be a higher or lower rate of uninsured individuals around you. An analysis by the Kaiser Family Foundation of insurance rates by state showed that at the end of 2017, Massachusetts had the lowest rate of uninsured adults in the country (3%), while Texas had more than five times the number of adults with no health insurance (17%).9
Gender – Even though women comprise a higher percentage of the American population than men, the American Community Survey shows that as of the end of 2017, 54% of uninsured adults were male.10
Has the ACA Helped Americans Gain Access to Health Insurance?
ACA statistics show that approximately 8.4 million Americans purchased individual health insurance coverage through the federal Healthcare.gov marketplace exchanges for 2019.11
That’s a lot of people. However, the number of Americans enrolled in marketplace ACA plans has continued to decline slightly each year since 2016 according to the Kaiser Family Foundation.12
There are two factors that may play a role in the decline of marketplace enrollment:
- The employment rate in the U.S. has risen, which typically means that more people have access to employer-sponsored health insurance coverage, as noted by the Centers for Medicare and Medicaid Services (CMS)13
- The repeal of the federal tax penalty for not having individual health insurance became effective January 1, 2019, meaning you no longer have to pay a fine if you don’t have healthcare coverage.14
Medicaid Expansion Helps Americans Gain Access to Coverage
In addition to making individual insurance plans available for purchase under the marketplace exchanges, the ACA also recommended expanding eligibility requirements for Medicaid, to allow more people to receive healthcare coverage.
The Medicaid expansion has enabled millions of Americans to receive health insurance, according to the Medicaid and CHIP Payment and Access Commission (MACPAC).15
Medicaid enrollment increased by 14.9 million in the District of Columbia and 31 states that implemented the federal plan’s expansion recommendation from July, 2013 through July, 2018, with an estimated 80.2% of this number attributed to newly eligible individuals.
Several states decided to expand their Medicaid programs using their own, rather than federal, guidelines. However, 14 states have chosen to make no Medicaid expansion at all. A March, 2019 report by the Kaiser Family Foundation indicates that if these 14 states were to expand Medicaid eligibility based on federal guidelines, approximately 2.5 million Americans who are currently uninsured would have access to healthcare coverage.16
What to Do If You Don’t Have Health Insurance
Regardless of how healthy you are, it’s a fact of life that illnesses and injuries happen. If you don’t have healthcare coverage, you run the risk of paying all of your medical expenses out of pocket should you experience a medical emergency.
ACA-qualifying major medical insurance also enables you to visit a provider for low-to-no cost routine exams and immunizations, which are important for prevention as well as early detection of potential medical conditions.
The bottom line: there can be risks to being uninsured, so consider your options for health insurance.
ACA Marketplace Exchange Plans
If you missed this year’s open enrollment deadline, you may still be able to purchase an ACA-qualifying major medical insurance plan on the marketplace if you experience a qualifying life event, such as marriage or divorce, birth or adoption, moving or a job change.
You typically have 60 days from when your qualifying life event occurs to enroll in coverage.
Depending on your income, you may be eligible to enroll in Medicaid. Traditionally this free or low-cost health coverage was provided only for low-income families and children, pregnant women, people with disabilities and the elderly.
However, under the terms of the ACA, some states have expanded their Medicaid programs to cover all people with income levels below 138% of the federal poverty level.
You can apply for Medicaid any time during the year. Learn more about Medicaid eligibility and find out where to apply.
Children’s Health Insurance Program (CHIP)
Do you have children? Even if you choose not to purchase coverage for yourself, consider whether you are eligible to enroll your children in CHIP. The program provides coverage for children and in some state, pregnant women, in families with incomes too high to qualify for Medicaid, but too low to pay for private insurance.17
While CHIP benefits differ by state, typically they cover check-ups, immunizations, doctor visits, prescriptions, dental and vision care, hospital care, lab and X-ray services.
You can apply for CHIP year round. Learn more about eligibility requirements and apply for CHIP.
Short Term Health Insurance
Short term health insurance (also known as short term medical) offers an affordable coverage option. Federal guidelines allow these policies to provide coverage for 30 to 364 days depending on your state.
It’s important to recognize that short term health insurance does not meet the requirements of the ACA; it is not considered minimum essential coverage and is not guaranteed issue, meaning it doesn’t cover pre-existing conditions and you must be approved by the carrier in order to enroll.
This type of insurance is designed to help you pay for unexpected medical expenses, such as doctor office visits, hospital room and board, surgery and emergency room treatment.
Short term medical policies typically offer you a lot of flexibility. You may choose how long to keep your policy, as well as selecting a coverage start date, usually within 24 hours of being approved for coverage.
Finally, the premiums for a short term medical policy are usually significantly lower than premiums for an ACA marketplace exchange plan. That’s because short term health insurance has less coverage, as it does not provide all of the essential health benefits required by ACA-compliant plans.
However, premiums for short term health insurance will vary depending on the benefits you choose.
A telemedicine product is not considered insurance, but it does offer you the opportunity to access medical services at a reduced cost. With telemedicine, you pay a monthly subscription fee and a per-consultation fee for the convenience of connecting virtually (from anywhere) with a doctor. Participating providers can diagnose minor health issues and may issue necessary prescriptions.
Summary + Next Steps
If you are uninsured, and are unable, or don’t wish to purchase individual health insurance through the marketplace exchange, you still have options to help you pay for healthcare expenses:
- Check your state’s regulations to see if you are eligible for Medicaid
- Determine whether an alternative health insurance solution such as short term medical, or a non-insurance product like telemedicine, might work for your situation
You can get an instant (free) short-term medical insurance quote to see if what’s available in your state and view plan options.