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 population1:
- 27 percent of uninsured adults in 2014 went without needed care in the past year due to cost.
- Those without insurance for an entire year pay for one-fifth of their care out-of-pocket and are typically billed for any care they receive, often paying higher charges than the insured.
- In 2014, nearly one third of uninsured adults said they were carrying medical debt, and medical debts contribute to 52 percent of debt collections actions that appear on consumer credit reports in the United States. Uninsured people are at higher risk of medical bankruptcy than those with insurance.
So, what are your options if you missed open enrollment and are currently uninsured? Here are five of the most common:
1. Enroll in a short term health insurance plan.
While you are in between Obamacare plans you can buy temporary benefits for 30 to 364 days, depending on the duration limit in your state. 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.
2. Take advantage of a special enrollment period, if you qualify for one.
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.2 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.
3. See if you are eligible for Medicaid.
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.3 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.
4. Pay for healthcare out of pocket.
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.
5. Purchase supplemental products to help with your medical bills.
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:
- Dental insurance to help you pay for preventive, basic and major dental care and may include additional cost-saving benefits
- Critical illness insurance that provides lump sum payments upon diagnosis of a covered critical illness
- Medical gap plans that provide lump sum payments for covered accidents or illnesses
- Telemedicine, which provides access to over-the-phone consultations with board-certified doctors for minor ailments—for a cost that’s fraction of a doctor office visit
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.