What Happens If You Don’t Have Health Insurance? – Forbes Advisor

More than 90% of the U.S. population has health insurance, which can keep your medical bills much lower than if you had to pay for care yourself.

But there were still 27 million Americans, 8% of the U.S. population, who didn’t have health insurance in 2021, according to the U.S. Census.

What Happens if You Have No Health Insurance?

Not having health insurance can lead to large debt, affect your health if you delay care and may even hurt you at tax time, depending on your state.

Here are aspects of being uninsured that you should understand.

Medical debt

Medical debt is a major problem in the U.S., with 17.8% of individuals having medical debt in collections, according to a 2021 study published in the Journal of the American Medical Association (JAMA).

If you don’t have health insurance, you’re at much greater risk of accumulating medical bills that you may not be able to pay. In a worst-case scenario, you could be sued and have your wages garnished. You might even be forced into bankruptcy.

The JAMA study also says that medical debt leads to people not getting needed health care and may result in worse mental health.

Tax penalties

The Affordable Care Act initially required that nearly all Americans have health insurance or get hit with a tax penalty. Congress later eliminated the federal penalty, but some states have their own health insurance mandates.

States with individual mandates include:

• California
• District of Columbia
• Massachusetts
• New Jersey
• Rhode Island
• Vermont

The tax penalty for not having health insurance varies by state:

• California charges as much as $800 per adult and $400 per dependent.
• New Jersey charges at least $695.
• Vermont requires residents to have health insurance, but there’s no penalty if you don’t have coverage.

Medical devices

Some people need special medical devices to treat their health conditions. For example, if you have sleep apnea, you might need a continuous positive airway pressure (CPAP) machine to help you breathe at night.

There are an estimated 2 million medical devices available to treat health conditions. In some cases, these devices are implanted into the patient’s body. About 10% of Americans will use an implanted device at some point during their lives, according to the American Medical Association.

You will have to pay for these devices yourself if you don’t have health insurance. Health insurance may cover many types of medical devices, though newer technologies may not be covered.

Health insurance companies typically follow the lead of Medicare in deciding whether to cover these devices, and Medicare is usually conservative with new devices and therapies.

Medical care costs

If you have health insurance, you probably have found yourself grumbling about all the costs you pay, including premiums, deductibles, copays and coinsurance. These costs are a bargain compared to what you might pay without insurance.

Most people who are uninsured don’t receive their care for free or even at a lesser charge, according to the Kaiser Family Foundation (KFF). In fact, just 27% of the uninsured receive such price breaks.

To make matters worse, hospitals often charge uninsured patients two to four times more than what health insurers and public programs typically pay for hospital services, KFF says.

Without health insurance, you could be on the hook for thousands of dollars in medical bills. Your bills could be so substantial as to be financially ruinous.

Medications

The average American spends more than $1,000 a year on prescription drugs, according to the Congressional Budget Office. A health insurance plan typically helps cover the cost of medications.

Medications listed on your health insurance plan’s formulary, which is the insurer’s approved list, will be less expensive for you.

That doesn’t mean you should assume health insurance will always lower your medication costs. For starters, you often owe a copay, deductible or coinsurance cost when getting these drugs. There are also situations when a prescription drug may cost less without health insurance.

Why Do People Go Uninsured?

People often don’t have health insurance because they think they can’t afford it. That’s the most common reason people don’t have health insurance, according to the KFF.

A KFF survey found that the top reasons people don’t purchase health insurance are:

• Coverage not affordable: 73.7%
• Not eligible for coverage: 25.3%
• Do not want or need: 21.3%
• Signing up was too difficult or confusing: 18.4%
• Cannot find a plan that meets needs: 18%
• Lost job: 2.8%

Can I Get Health Insurance After Losing Coverage?

There are multiple avenues to get health insurance if you lose coverage.

COBRA health insurance

If you lose employment and the health insurance tied to it, you typically can extend your workplace-based coverage through COBRA. That’s an expensive option since your former employer likely won’t help pay for care anymore, but it does mean you get to keep your workplace coverage temporarily.

The health insurance marketplace

You could purchase a plan on the Affordable Care Act health insurance marketplace. An ACA plan generally costs more than an employer-sponsored group health insurance plan unless you qualify for subsidies that reduce the cost of ACA plans.

Directly from a health insurance company

You could purchase an individual health insurance plan directly from a health insurance company. But those plans don’t qualify for subsidies like plans on the health insurance marketplace do.

From a spouse’s health plan

Another option if you’re married is to try to get on your spouse’s plan. Employer-sponsored health insurance is typically more affordable than getting an individual health plan yourself, though adding you to your spouse’s plan may increase premiums.

Medicaid

Medicaid is another possibility if you qualify. Medicaid offers low-cost, comprehensive coverage to low-income Americans. State income requirements differ, so you want to check the rules for your specific state.

How to Get Affordable Health Insurance

The most affordable health insurance for many people is to get coverage through their workplace or a spouse’s health insurance plan, when possible. If this isn’t an option for you, health insurance plans are available through the health insurance marketplace.

These plans can be expensive without subsidies. The good news is that millions of Americans qualify for subsidies from the federal government that can dramatically lower the price tag. If your income is a bit higher, you likely won’t qualify for subsidies, making coverage more expensive. The federal government offers a tool to help determine whether you qualify for such cost-sharing reductions.

One way you can cut your costs is to purchase a high-deductible health insurance plan and pair your coverage with a health savings account, which offers tax incentives that can put more money back in your pocket. On the ACA marketplace, Bronze and Silver plans are often high-deductible health plans, which have lower premiums but higher out-of-pocket costs when you need care.

When Can You Get Health Insurance?

You can generally choose or change health insurance during open enrollment. The open enrollment period varies by the type of health insurance.

The ACA marketplace generally starts on Nov. 1 and ends on Jan. 15 in most states. Some states that have their own marketplace have longer open enrollment periods.

Employers are how most pre-retirement Americans get health insurance coverage. Businesses have their own open enrollment period, so check with the employer for the specific open enrollment period.

Another option is a special enrollment if you face a qualifying life event. Qualifying events include getting married, having a child, getting divorced or moving to a new state. You may be eligible for a special enrollment period to choose a new health insurance plan in those cases.

What Happens If You Don’t Have Health Insurance FAQ