What to Do If You Can’t Afford Your Health Insurance

“Even plans that have high deductibles or copayments can provide incredibly valuable coverage for care that would be completely unaffordable otherwise if you have high health care needs, which is always a risk for people as we age,” says Katherine Baicker, an expert in health care policy and provost at the University of Chicago. “So I would urge people to look around for plans that still offer good catastrophic coverage, even if the up-front coverage is less generous than they would have liked.”

Catastrophic coverage mostly protects you from very large medical bills — for example, from an accident, serious illness or hospital stay.

Another aspect to be aware of when comparing plans is that options with so-called narrow networks may be less expensive. These plans use a smaller, more selective group of providers and facilities “but use that as a mechanism for lowering the premiums,” Baicker says.

“So look at all of those features of a plan, and make a decision about what makes the most sense based on your priorities and your health care needs and what’s available and affordable,” she says.

Check subsidy, Medicaid eligibility

Be sure to check if you qualify for subsidies for marketplace insurance. While expanded premium tax credits are expiring, some people whose household income falls within a specific range will still be eligible for savings on their health coverage. You can see if you qualify on HealthCare.gov.

It’s also a good idea to see if you qualify for Medicaid or other public insurance programs, Baicker says. “Eligibility rules are different in every state, and people might be eligible for care based on their income or disability status or veteran status.”

Some states have nonprofit organizations that can help people who are disabled, older or have low income find affordable health care plans.

You can check your state’s eligibility requirements on Medicaid.gov.

Community clinics provide routine care

For routine care, clinics in almost every community provide health services at a free or reduced rate, Anderson says. Just know: “They are not equipped to handle the more sophisticated services.”

Also check with local providers about subsidized or sliding-scale coverage, Baicker says.

“There are lots of clinics that have a mission to offer care to people who couldn’t otherwise afford it,” she says.

You can search for health centers near you using findahealthcenter.hrsa.gov.

Research potential costs for some services

If you know you need a high-cost service — say, a routine but expensive surgery — you can compare costs at various facilities in your area.

Hospitals are required to post the prices of their services, including the discounted rate for cash payments, on their websites, says Frank McStay, an assistant research director with the Duke-Margolis Institute for Health Policy. It’s part of a price transparency law that took effect in 2021. Just know some reports have found that not all hospitals are compliant with the rule.

“It’s not consumer-friendly yet,” McStay says, but consumers can try to get a sense of how much they may have to pay for services in the coming year. You can also compare prices between hospitals and pinpoint the more affordable providers in your area.

Additionally, nonprofit hospitals are required to provide some level of financial assistance, Volk says.

“So if you have a bill that you can’t afford, you should find out what the hospital’s financial assistance policy is,” she says.

Have a high-deductible plan? Consider an HSA 

Health savings accounts (HSAs) are designed for people enrolled in high-deductible plans. The account allows you to set aside pretax money from your paycheck and use it to help pay for certain medical costs before your insurance kicks in.

They tend to “work better for people who have enough money to sock away in them,” Volk says, and aren’t as beneficial to people with lower incomes.

“The problem, of course, is you have to put the money aside in advance, and many people don’t have three or $4,000 to put aside in advance,” Anderson says.

McStay says HSAs are absolutely another tool to help with routine care. “But by no means should people think of it as the only tool.”

Beware of scammers, high-pressure offers

Unfortunately, many companies sell discount and limited coverage products disguised as insurance solutions. Beware of anything that involves a high-pressure sales tactic, Volk says, such as an offer that’s good today but gone tomorrow.

If a company can’t produce a “summary of benefits and coverage,” which is a standard template summarizing what your plan covers, that’s another warning sign, she says. 

Also, find out how long the company behind the product in question has been in operation.

“If they are coming into the market new, I would be very concerned that they’ll be there tomorrow,” Anderson says. And be cautious of health insurance ads on social media that offer cash or other perks.

Finally, if you want help or have questions and are shopping for a plan in the marketplace, “find a broker in your community that comes with a recommendation from someone in your neighborhood or has a brick-and-mortar shop downtown, where you have to go in and look them in the eyes to help you understand your plan options,” Volk says.