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What to do if You Absolutely Can’t Afford Health Insurance

Let’s get this point out of the way upfront: everyone should have health insurance. We all know this without anyone emphasizing the point. But with job losses in recent years, companies canceling their coverage, and the cost of independent plans spiraling out of control, millions of people have been forced to drop coverage in favor of just surviving. Many just can not afford health insurance any longer.

If you’re one of them, or think you might be in the near future, here are some suggestions that might help in the event that you absolutely can’t afford a traditional health insurance plan. One or a combination of several may at least partially offset the loss of the typical $1000-plus per month plans that cover all of the things we’re used to.

AFLAC

This isn’t health insurance in any sense of the term, but AFLAC offers plans that will pay flat amounts for specified illnesses and injuries. Far less expensive than health care plans, you can buy a plan for well under $100 per month that will pay thousands of dollars at the time of a covered injury or illness.

Healthcare providers won’t accept it as health insurance, but the company pays direct to you so that you will have some opportunity to pay bills at your option after the fact.

Take care of yourself

What to do if You Absolutely Can’t Afford Health Insurance
What to do if You Absolutely Can’t Afford Health Insurance
We’re told relentlessly by healthcare providers to take better care of ourselves, but that advice becomes critical if you can not afford health insurance. It goes beyond the standard eat-better-and-exercise-more advice. That’s important if you have no coverage, but perhaps even more so is avoiding dangerous behaviors.

Playing tackle football with your buddies on the weekend might help you blow off steam but it’s an accident waiting to happen. Alcohol consumption brings all kinds of potential for disaster, as does climbing a ladder to clean your gutters. And reckless driving is a complete no-go. Slow down and be more aware of what could go wrong, because now there’s no back up plan if it does.

Mini clinics

In the past few years, in house mini clinics have opened at retail outlets by the thousands. If you can not afford health insurance these are a definate option.

We had problems with a health plan conversion recently, during which time my wife had an ear infection. Since our insurance was invalid (though fully paid!) we opted to go to a clinic at Walgreens. They diagnosed the problem and prescribed three medications. Total cost: $49 for the visit, plus $63 for the prescriptions.

Now with a plan in place, we’d have paid $40 for the office visit and $20 each for the meds, or about $80. But for just $112, we took care of it at Walgreens. I’m not minimizing spending $112, but it’s quite a bit cheaper than $1000 per month for a plan, plus $80 for treatment co-pays.

Non-prescription substitutes for prescriptions

If you need a prescription and don’t have coverage, ask the pharmacist about a non-prescription alternative.

We’ve had two situations in the past couple of years where prescriptions were not covered under our plan for one reason or another. The alternative was for us to pay out of pocket. In both cases, the pharmacist recommended an over the counter alternative, and each time it did the job. Many over the counter meds were once prescription only.

We probably should be doing this all the time in an effort to keep healthcare costs down but it’s critical if you have no coverage.

Get your kids into a plan

If you can not afford health insurance for your entire family, at least try to get your children covered. I can think of no more tragic situation than a parent facing a medical emergency for their child with severely constrained treatment options due to finances.

You can generally get a plan for a child in the low 100s per month, and well below with reduced coverage. Eliminate your cable TV, cut back to eating rice and beans every day, sell your second car, or do what ever you need to do to make room in your budget to get your kids into a plan.

Government programs

Check and see what coverages may be available through Medicaid or state agencies. The income qualifications are stiff, but again try to at least get coverage for your kids, and to see what other benefits might be available.

Buy the LEAST EXPENSIVE plan available

Finally, consider buying the cheapest health insurance possible, sometimes referred to as “catastrophic coverage”. This isn’t the kind of coverage that will pay for all of your healthcare needs, but it will cover the big ones where it matters most.

As an example, let’s assume a married couple, both 40, with two children, considering a plan under Assurant’s popular CoreMed Plan. (This is not an endorsement of Assurant, but their website is extremely user friendly!)

With a $1000 deductible, $35 office co-pay, 80% coinsurance (to $3500) and a $6 million lifetime maximum, the monthly premium is $1213. That’s the size of a typical house payment! And your out-of-pocket maximum could be as high as $4500 (deductible plus coinsurance) on any single event.

But by going with a $10,000 deductible, no office visit coverage, but zero coinsurance with a $6 million lifetime maximum, the monthly premium falls to $303, or about the size of a modest car payment. You wouldn’t have much coverage for routine care, but your out of pocket maximum would be limited to $10,000—true catastrophic coverage.

Many people view the quality of a health plan by the routine care it covers, such as doctor visits and tests, but that kind of coverage is where the expensive premiums are and if you’re reading this article you probably can’t swing that level of protection right now.

While it’s true that the cheaper plan would leave you paying for most (or even all) of your medical costs in most years—in addition to your monthly premiums—it will offer undeniable advantages:

  1. Just having an insurance ID card will make it far easier to be admitted to a hospital
     

  2. You will be part of a network that requires providers to discount their services. My son had surgery a few months back in which the providers discounted their fees by up to two-thirds; absent network coverage, we’d have been on the hook for 100%.
     

  3. Though you will pay for routine procedures, you WILL have coverage for the truly big ones—the kind that land people in bankruptcy court when they have no coverage
     

  4. In a truly serious medical situation—where costs exceed $10,000—you will have coverage available that will enable you to have access to what ever treatment options are available.
     

Get a part-job with health insurance

Many people are unaware that there are companies that offer health insurance to their part-time employees. I’ve compiled a list of prominent employers with health insurance for part-timers in the post, 20 Part-time Jobs With Health Insurance.

This is an excellent source to consider if you don’t have health insurance on your primary job, can’t qualify for private coverage due to pre-existing conditions, or you just can not afford health insurance at the going rate.

 
There’s a saying in the health insurance business, ”any coverage is better than no coverage”, and that’s generally true. Better to have low premium/high out of pocket coverage than none at all. One serious medical emergency will have made it money well spent.

Are you in, or have you had, a situation where you had to drop health insurance coverage due to job loss or financial problems? What did you do to deal with it?

(Photo courtesy of Official U.S. Navy Imagery )


70 Responses to What to do if You Absolutely Can’t Afford Health Insurance

  1. I’m an emergency physician. By federal law, if you present to an emergency room with an EMERGENCY CONDITION (Note – that does not include a rash you’d had for a year!) the emergency department and the entire hospital must stabilize you up to their maximum capability, regardless of your ability to pay – that may include such things as a heart bypass or brain surgery. Of course, the hospital will send you a (huge) bill. But – if you have no assets (or no locatable assets), the hospital can’t get water out of a stone, and will write off the bill.

  2. Good points. I have 2 brothers without health insurance. They do need at least catastrophic coverage. They’re minimal wage earners and don’t manage money well.

  3. Ishabaka – That’s an excellent point about true emergency cases. But it won’t help the person who needs something critical that falls short of an emergency.

    But even if you’re accepted to the ER with a true emergency, you could come out with a catastrophic financial situation absent any insurance coverage at all.

    Ken – If they’re minimum wage and don’t manage money well, they may be banking on the fact that they’re too poor to ever be forced to pay. But that still would leave them with very limited options in the event of a health problem, particularly one that’s progressive.

  4. For me it’s not about being unable to afford health insurance, it’s about being unable to qualify for private insurance if I were no longer employed. Supposedly HIPPA is supposed to help with that, but I’ve heard horror stories.

  5. So true Jackie. The health insurance companies are able to turn you down for just about anything. Some will turn you down if you’re on too many prescription therapies–like three or more.

    It was said however that under President Obama’s healthcare bill that companies will no longer be able to decline applicants for pre-existing conditions. That’s one of the changes that needed to happen, but we’ll have to see what the insurance companies will charge. Approving coverage at 2-3 times the going rate will have the same net affect as a declination for most people.

  6. Kevin, there is also an alternative out there called Short Term Medical – there are some reputable companies selling this and basically the way it works is you pay month by month and you have the choice of several different plans including lower or higher deductibles – coverage is really good, but it only lasts for 6 months. But, at least it’s something!

    My brother-in-law signed up for this b/c he had no insurance and shortly after developed some pretty serious conditions – the insurance company paid their portion no problem – his premiums were right around or just under $100/mo!

  7. Thanks Jason, that sounds like something worth looking into, especially if the uninsured period is expected to be temporary.

  8. Several general comments: most health insurance plans are health care “financing,” NOT health care “insurance.” Insurance is, by definition, the pooling of risk for an unexpected financial loss (like your house catching fire or a tree falling on your car during a tornado, or, health-wise, having heart surgery for $87,000). Question: does your auto insurance pay for oil changes, new tires, or that brake job? Of course not; those are routine maintenance items that you pay for on your own. What if your auto insurance offered to cover them – think your premium would go up? Same thing with health insurance: the “better” the coverage, the more expensive it is. When looking into this:
    1. How “much” health care to you generally use? Don’t buy a Lexus if all you need is a used car.
    2. What’s your real risk? Big, expensive stuff (like hospital stays & surgery)? Most folks could find a way to finance $5-10k if they had to, but how about $50,000+? That’s what health insurance is for.
    3. While it’s okay to shop online “on your own,” most folks are better off dealing w/ a broker who specializes in health insurance. Find a broker near you by visiting http://www.nahu.org, the probessional association for brokers (full disclosure: like me) who specialize in health insurance. He’ll be able to present you with a wide range of plans and options designed to give you the best, most cost-effective coverage.
    4. If you find it hard to get coverage, especially due to health reasons, remember: there are a LOT of different plans & companies around and, to be frank, there are very few people who find themselves completely out of luck. Again, deal w/ an NAHU broker who has a “vested interest” in helping you (remember: if you’re not happy, he doesn’t get paid!).
    5. Finally, stick with the “brand name” companies. This stuff is too important to “play around” with and, sadly, there are a bunch of plans around that, frankly, are not all that great.

    While there are certainly a lot of things that could/should be changed about our current health care & health insurance system, getting mad at your insurance company because of high prices is rather like being mad at the waiter because the food at the restaurant is too expensive. Your premium cost reflects (1) the cost of health care (MD, hospital, drugs, & lots of gov’t regulations), (2) how much health care “financing” you want or expect (i.e., routine care benefits like MD & drug copays, etc.), and (3) your specific “situation” (age, sex, dependents, location, &, especially, health because, just like auto insurance, if you have a bunch of tickets or accidents, you’re gonna’ pay more for your car insurance).

    We don’t really have a health “insurance” crisis in this country. It’s the health “care” that’s expensive, and that’s reflected by the premium cost. Control the cost by:

    1. Finding a good broker (see above).
    2. Buy a plan with a big deductible.
    3. Consider supplementing that big deductible plan with critical illness and accident coverage (73% of claims over $10,000 are due to either accident or the “big things” – heart, stroke, cancer, etc.).
    4. Take better care of yourself; eat right, exercise, be smart about it.

  9. Art – Very well said, and I endorse all that you’ve said for anyone in a position to be able to afford a health insurance plan.

    What Art has pointed out is the critical difference between a true health insurance plan–a plan that pays for true catyclisms–and the better understood, but much more expensive health benefit plans that pay for all things medical. The former is what we all need, the latter is what we increasingly can no longer afford.

    Knowing the differnce is critical.

  10. I’m afraid this does little to uncover the big myth about Health Care. Insurance works best when it spreads the risk of low-probability, major losses among a lot of people (the law of large numbers). It does NOT work to run all of your expenses through a middle-man.

    Catastrophic health insurance uses the insurance concept for it’s strengths. All those plans with small copay’s and coverage at the first dollar of expense are completely wrong and inefficient use of the concept of “insurance.”

    Find the lowest cost policy you can and then use your premium savings to fund a cash reserve account (or better yet, an HSA). Use that money to pay your medical costs. Don’t be afraid to negotiate with the doctor on your fee. Many will be happy to be paid today at 50% of MSRP rather than wait 90-180 days for the insurance company to pay them nearly the same “negotiated” rate.

    Unfortunately, the government doesn’t want that competition and will eventually crowd you (the individual) out of the market. Oh wait, they’ve already done that. It is called ObamaCare.

  11. So true John, they’re really benefit packages! Unfortunately, that’s what people have become accustomed to and how the prefer to consider “insurance”. That’s really caused the cost to explode.

  12. I have been looking for insurance coverage for my wife and myself and wondered if it’s worth waiting to see how the presidents Health Reform Bill impacts me purchasing our health insurance. Does anyone have any idea on this.

    Many Thanks,
    Robert

  13. I would also ask your church for help… welfare use to be the job of the church until the government took it over. It’s the church that is supposed to be helping those struggling and in need.

  14. Good idea! Churches can be good places to get help in life’s emergencies. With huge medical bills, you might find someone at Church who can negotiate a lower and more tolerable payment arrangement, even if direct financial help isn’t available. The community aspect of Church is often forgotten, and if it doesn’t exist where you’re worshipping, it may be time to find another.

  15. I also forgot to mention that it’s the church that should be helping out other Christians in trouble… and non-Christians. Many churches are struggling these days financially but it never hurts to ask. :)

    Just don’t expect the church to write you a check and not ask questions or require you to do some things yourself… a good church will ask questions, get you on a budget if you’re not already doing so, and may ask you to do some financial training or read a book as part of giving you money… .which you should cheerfully agree to if you really need and want help.

  16. hi,
    my daughter is a food server until she finds a job in marketing. she pays about 100.00 for insurance but it hardly covers anything. she has had to have a colonoscopy and her tonsils removed (tonsils should have been done when she was on our insurance)and we have had to pay so would it be better for her to just drop her insurance for now and just go to emergency room….her boyfriend just had a seizure while driving my daughters car and spent 2 days in hospital with cat scan, etc and probably won’t have to pay a dime. by the way he’s allright…thank you, susie

  17. Hi Susie – like the quote in the post reads, “any coverage is better than no coverage”, so my advice is to keep the coverage, but maybe do some digging to see exactly what it DOES cover. Hopefully, it at least covers catastrophic say anything above $5000 or $10,000.

    I don’t know why the colonoscopy and tonsils weren’t covered, unless they fell below the plan deductible. If the deductible is $5000, and she had one procedure done in 2009 and the other in 2010, she would have to satisfy the deductible in both years, but that’s just a guess. Colonoscopies may fall under well care, and while group plans generally pay for well care, individual plans often don’t.

    Did you contact the insurance company and ask why they didn’t cover anything?

  18. Lost my job with excellent health insurance then COBRA ran out … now I have a job that only pays a fraction of what I used to make and with NO health insurance. To top it off I have an “indolent” cancer. Thank God I don’t need treatment. I looked into the new program for people like me offered by the government but it is still $500 per month for me … which I just can’t afford.

    Well, I lived in Japan with my Japanese wife for 15 years so I know what a good medical system is like, and isn’t … I’ll be returning to Japan one day.

  19. Things have changed in the past year. A lot of commenters are talking about horror stories when they lost their job. For people with no group coverage and pre-existing condition, there are now PCIP plans that were not available before. You can see this information on my updated site.

  20. Shey–That’s good information on your site. The President’s plan is supposed to require health insurers to accept clients regardless of pre-existing conditions, but I don’t think that will happen until January 2013, if memory serves. Either way we don’t know what the details will be or how much they’ll charge. Hitting someone with a pre-existing and charging them $2000 a month in premiums will be the same as declining them so it may not be the advantage that it sounds at first glance.

  21. Hi Shaun–That’s true, but there are also income thresholds that are set pretty low. In many cases you’d have to be a certified poverty case to qualify. They’re always worth checking into, but don’t be surprised if your income is “too high” at $35,000 for a family of four. The healthcare problem really is greatest amoung the middle class.

  22. I can’t afford insurance, and I do not qualify for state help…so when I get sick I just wait it out. I had an ear infection a couple of weeks ago. I had to just pop an Advil and wait it out. It sucks…In my family the men have a history of high blood pressure and heart disease, and colon cancer. I know I should get myself checked, but I can’t afford it. Even if I went, and they discovered something…I would have no financial means to get well…so I just bought a life insurance policy instead.

  23. i make 26,000 a year and will not be able to afford the out of pocket 1,300 to 1,400 dollars a year for health insurance, will stay afloat until put in jail, good luck to everyone else, but my days if i stay in this country are numbered, goodbye!

  24. asashii, you’re doing it wrong if you make 26,000 a year and cannot afford 1,300 to 1,400 dollars a year. It costs about 7,200 to 10,000 a year for a decent dwelling, 2,400 a year for food, your figure of 1,300 a year for health insurance, and 3,600 a year for amenities such as cable, phone, internet, and utilities. As long as you don’t buy expensive clothing, eat out regularly, finance a car, or buy stupid things like 50 inch televisions, the remaining 10,000+ should be enough for anything else that comes up, including household necessities and emergencies. Try living off a meager 10,000 a year.

  25. Stevebo, In response to your last comment — I’m sure $26,000 a year is BEFORE taxes. And who can live on $200 a month for food? Some kind of fruit everyday is at least $1 a day. 1 apple is $1.00 – so that is $30 for fruit alone if you want to eat something healthy!!! How about a salad every 2 days– Lettuce 1, Peppers $1.50, Celery $1.69, Carrots $1.50 and you have a minimal salad! Not to mention DECENT ground sirloin and $4.99 a lb. If you eat 8 oz that would last 2 days; if you eat 4 oz. that would last 4 days. I mean $200 a month is NOTHING unless you eat Top Ramen. You certainly cannot eat healthy on $200 a month!!!Never mind that you don’t have a perfect car; one breakdown can be $500! What about dental work!!! 1 crown is $2,000–to have a tooth pulled is $200 – as long as you have no emergencies it is possible to live on $26,000 but its not easy

  26. Hi Patricia–I have to agree with you. Stevebo’s analysis figures a single person who doesn’t have a car (at least $4,000/year if you DON’T have a loan on it!). It would be a tight squeeze with little room for savings or extra’s. Social Security taxes alone would eat up another $2,000 and a matching amount for federal and state withholding.

    And if asashii has a family, food alone would rocket to $600-$800/month (an extra $4,800 to $7,200 per year).

    I know people who earn the kind of income asashii does, and unless they have an employer plan, they don’t have health insurance. That’s the problem.

  27. Thanks for sharing this very written article. There is no doubt that more people than ever are now facing the reality that they do not have health insurance. One thing the article mentions which I like is that one of the main things people in this circumstance can do which doesn’t cost any money is to get and stay in shape. Simple exercises like walking, jogging, swimming, whatever it may be, along with eating right could help eliminate some of the health issues many people face. That should be the first line of prevention. Another great point, especially for families is to do whatever you can to get your kids at least covered, whether from privatized insurance or a governmental program. In the meantime, when health issues need to be addressed, most of the urgent care centers are easier and more affordable to make appointments at that hospitals.

  28. what oganizations can provide medical coverage for my sister. Harbor U.C.L.A. is just giving her the runaround. At last measurment the “ovarian cyst” she had measured 26cm. * 12cm. * 24cm. I think it is a tumor. Anyway sis can not afford to pay at all. Any suggestions would be so much appreciated. Thank you.

  29. Hi Wolf Gang–Some hospitals will work with her, but she’ll at least have to agree to a payment plan. Check different hospitals and see what can be worked out. Also, look for government agencies (start with the local department of health) and see what programs are available. You may also be able to get help from charities. Does she belong to a church or temple that might provide some financial assistance?

  30. These are all great ideas, but how do you suggest it be handled when the employee group plan costs 50.00 more a month than you make. Then you still have to meet a $5000.00 out of pocket expense. Oh and the 50.00 more per month is before taxes. And that is just coverage for employee and children, not spouse.

  31. I would look into your state sponsored Medicaid program. It will generally only cover your children, not you and your spouse. For you and your spouse, you should qualify under PPACA/Obamacare come January 1, 2014. The rates are supposed to be heavily subsidized by tax credits, even if you have no tax liablity. We’ll have to see how that plays out in 2014, but it may offer hope for your situation.

  32. We currently have medicaid, but due to my husband getting a job, my kids lose their coverage in September. My twin daughters won’t even be a year old, and have no coverage. We will no longer qualify to have them covered even though we qualify for nearly the maximum amount of food stamps.

  33. Try getting private coverage for the girls, it’s usually not that expensive for children. However I’m hearing that some insurance companies are abandoning child-only policies with the onset of healthcare reform. But I imagine you’ll be able to get some sort of coverage come January 1st, 2014. The rates are expected to be favorable for lower income families under the new plans.

  34. There are surgeons out there offering surgeries for the uninsured at amazing prices. My boyfriend just had gall bladder surgery for $120 initial doc visit, $60 pre-op blood work, and $3700 for the surgery in Bakersfield, California. No additional fees! Included in this is one night in the hospital, if needed. Look up Cirugia Sin Fronteras or Surgery for People Without Insurance. Dr Jorge Enriquez performes the surgeries at San Joaquin Community Hospital in Bakersfield. They also have podiatrists, OBGYN, urologists, gastrointestinal, etc. 1-661-333-5746 or 1-661-327-1655. I understand that another doctor offers similar services in Las Vegas. Google No Insurance Surgeries.

  35. Hi Gracie–Thanks for the advice. I’m hearing that such practices will only become more common as the price of healthcare/health insurance continues to rise. Another big growth area are cross-border procedures. Its a lot less expensive to have surgeries in foreign countries than in the US. With Obamacare rolling out, I’m hearing that facilities are springing up in Mexico just accross the border. We’re truly living in interesting times.

  36. Humorous to read these comments, most of which view the issue only from their personal point of view (like Art, the broker!). As a former broker, one thing to know – you cannot fully trust a person who works on commission. That being understood, our healthcare is one aspect of our lives that should NOT be insured. It should be funded by all of us in some form. Insure my car and house and life…not my ability to obtain medical treatment for myself. I only have the one life. I can get another car…..

    Unfortunately, the middle men (insurers, brokers, medical supply companies, pharma reps) are all taking precious money out of the system that should be going to CARE. They need to be slowly eliminated.

    We do NOT need groups and industries enriching themselves from what should be our healthcare system. We have this now.

    To minimize the risk, everyone must participate in paying, everyone must be covered. Thank you Mr. Obama for risking it enough to try to help us. Reform is not perfect, but it is a step in the right direction simply in eliminating insurers ability to DENY applications for coverage from citizens. It will be worked out over time. What we have now hasn’t been working since the 1970’s when I first sold it.

  37. Spoken like a true, redistributionist Socialist, FormerBroker; the government knows best, how to handle my money better than I do, how to make decisions for me better than I do, how to take care of me better than I do … I should be glad that there are those “betters” who are willing to sacrifice themselves by going into government / public “service” so they can take care of us ignorant peons. Who was it that said “from each according to their ability; to each according to their needs?” (Hint: look it up)

    The government does few things well or efficiently … It’s hard for me to see how trusting them to handle my health care needs and decisions will be better for me. While there is certainly more than enough “blame” to go around in the lousy system that we’ve “jury-rigged,” there’s also a lot of things that could have been done to improve our health care system that wouldn’t have entailed a complete takeover of it by the government. Fact is, there’s very little in the “Affordable Care Act” that actually does anything to control or lower the cost of health care, but there is a lot that will raise costs and increase wait times for care significantly.

    As an evil, blood-sucking “middle man” who takes money out of the system (money better entrusted to the government, who will be far more efficient with it than I will), I simply find it hard to believe that a bureaucrat living and working in the DC “bubble” (I.e., not working in the real world, etc.) will do a better job at handling my money and making my decisions than I might. On the other hand, perhaps I’m simply to “dumb” to know the difference or how better off we’ll all be in the future.

    Thank you, FormerBroker, for opening my eyes!

  38. Hi FormerBroker–I have to agree with Art here, I don’t see the government doing a better job. I’ve studied Obamacare a good bit. There’s a lot that I like – applicants cannot be turned down, rated up or dropped due to health conditions – we should have had that all along. But the bill does nothing on the cost containment side, which I believe to be the core problem with the US healthcare system. Some friends of mine who work in healthcare believe that reform has been set up to fail so that it ultimately can be replaced by a single payer system. That’s basically an expansion of Medicare, which is no longer even a standalone system in that people need to have generous private insurance supplemental policies to cover the increasing amounts Medicare won’t.

    I don’t believe any system – private, public or the disasterous hybrid system we’ve got now (and will continue under “reform”) will fix anything until cost containment is implemented. The grab bag system isn’t workking because it can’t. To simply turn the system over to the government under the “they always know best” mentality won’t fix the problem.

  39. Hi Debra–Does you employer offer health insurance coverage under the COBRA plan? It’s usually expensive but it could work for a month or two. Longer term, you can either consider a private plan with a very high deductible to keep the premiums low, or you could look for a part time job that has health coverage. You can start by checking out this post: http://outofyourrut.com/20-part-time-jobs-with-health-insurance/ . For what it’s worth, I talked to a girl who works at Starbucks last week and she raved about their health insurance coverage. You only have to work 20 hours per week to qualify. Good luck Debra, and please report back with what you work out.

  40. Here is my problem, a year ago my husband got a compression fracture in is spine, we have no health insurance, we went to the same back dr he has seen over the years. He needed x-rays and an MRI. Since we put it all on a credit card (sucks) we got discounts for paying cash, if we had insurance we would have forked out much more. They gave us 60% off for the office visit 50% off for x-rays and 60% off the MRI. So we spent out of pocket $1500 total, with insurance we would have paid way more. This is the problem with insurance, you can get a “cheap” plan with a $10,000 deductible but the Dr’s charge twice as much as they normally do if you HAVE insurance, and people wonder why health care is so expensive. There is no such thing as “affordable” health care with these kind of practices. Imagine what they charge to those living off of welfare benefits, and I(we all) pay taxes for that crap.
    Very disappointing. Our health should not be a commodity, but it is.

  41. Hi Christy–You make an excellent point. I’ve seen and heard this elsewhere too. It’s a bit of a vicious circle in that the insurance companies are constantly lowering payments to providers, so providers raise their prices to compensate. No matter how it plays out, we always seem to pay more. What’s becoming discouraging is how even with insurance, people are still paying out thousands of dollars, or going into debt. There’s a price spiral that’s making everything worse accross the board.

  42. So, really, what does Obama care do for the ones that cant afford insurance? Say you make 10 grand a year and have no insurance because you just cant afford it, you don’t qualify for medicare because you are a single male that works a low paying or part time job. They are just lucky that they have never been sick, after you pay your bills, ie pay rent, utilities, food, child support, then there just is no money left. I don’t see Obama care doing anything for these people. I see them getting a penalty for not having any insurance. so now they have even less money to work with, doesn’t sound like much help there does it. They couldn’t get insurance before and will still be unable too. Sounds like all it really is, is just a big money grab! Seriously, I know people that fit this description, and it sounds like they are now #$%^@&!# more so under Obama care.

  43. That part is fuzzy for me too Marcel. Supposedly, the working poor will get generous tax credits, but those don’t come until your taxes are filed and the refund comes in the following year. How do they pay for the coverage in the year prior to filing their income tax return??? You need coverage in order to get the tax credit, but if you can’t afford the premium until you get the credit, then the whole thing falls apart.

  44. I’m sixty two years old. I live on $8520.00 per year. I owe nobody anything. I haven’t seen a doctor for thirty years, or more, Nobody seems to get it… I can’t afford to buy any health insurance. And now they are going to fine me for not having what I can not afford? I challenge anyone to try to live on my income. And look, if I get sick, just let me die. That’s easy enough and it won’t cost anyone anything. Otherwise, leave me alone. And yes, I subscribe to an Internet service, but have no other entertainment, or link to the outside world. In reality, I am already a dead man walking.

  45. Frank, I understand what you’re saying (on several different levels). Fact is, and according to Obamacare, you shouldn’t have to pay any tax penalty because (a) your income puts you below the poverty level (so no tax penalty is assessed) and (b) you are, therefore, eligible for coverage under Medicaid (which, I gather, you either didn’t know about or or have chosen not to use). Now I recognize that this doesn’t address the underlying crux of things – should the government be allowed to “take over” a major portion of the economy and then tax us if we don’t wish to purchase a product? I think not, and personally don’t think it’s Constitutional (despite what Chief Justice John Roberts thought as he unilaterally rewrote a portion of the law), but that’s what the law allows (sad but true). While there was a lot wrong with the old system, there were also far easier – and less expensive and intrusive- things that could have been done to fix things. Sadly, (and in my opinion) this had less to do with improving health care or even access to health care and more to do with power and control.

    Sorry for the rant….. We, as a business (health insurance agency) have spent months – and a lot of money- preparing for the Obamacare tidal wave and how we might help individuals and small businesses find the best solution for their own needs. Much has changed; we’re trying to help people adapt and work through the new system.

  46. Seriously would like a definitive answer to something.. have medicaid already because yes we are poverty level income and on food stamps.. as much as it is an embarrassment to admit.. IT has become a USA mainstay for probably more american families than the wealthy will ever consider or care to know about.. You have Medicaid, then you have a job that is part time (less than part time.. I mean less than 20 hours a week if that) who after 6 months offers you a health ‘discount’ program.. it is NOT insurance.. how the hell do you get Medicaid to accept that this is NOT insurance that Medicaid is primary ?

    Medicaid went and paid hospital bills from a broken foot injury.. the hospital discounted the state heavily as they typically do .. so I’ve learned. Then 6 to 7 months later medicaid retracts payment to the hospital ‘claiming’ you had ‘other insurance’ when in reality all you had was a discount program.. you get on the phone with the medicaid rep and try to explain this and he adamantly disagrees with you telling you // maam.. ! that IS insurance. ? what do YOU do ??? now the hospital is taking away the heavy discount. and now you are being sued in excess of $40K .. again, what do you do ? you do NOT have insurance, your employer has as much as written that you do NOT have insurance.. .. this is insane. I do not have money to pay this hospital bill and now being sent to collections.

  47. That’s a very specific question that I don’t have anything close to an answer to. And I’m very sorry you’re in that position. The healthcare situation in the US is a MESS! Hopefully Obamacare will fix some of this going forward, though I’m not entirely confident of that outcome.

    I did a stint in health insurance, and it it was made clear that discount programs are discount programs, not health insurance. You may have to take your case higher.

    I’m not an expert in this area, but here’s what I would do…

    Start by contacting your congressman/woman. (I’m assuming you don’t have the money to hire an attorney to fight this.) I’d start with a phone call, then follow up with written correspondence. If that doesn’t get results, I’d write the White House. Seriously. My understanding is that someone will follow up with a letter to the agency, and because it’s on White House stationary, it will be acted upon.

    If not, you may need to consider talking to an attorney about filing for bankruptcy to discharge the debt. Then I’d change to a job that either has health insurance, or nothing at all. That will remove the issue going forward.

    Sorry that isn’t more definitive, but your situation is not typical.

  48. Reply to Privately Private: Sounds like you’re working with a government employee (CMS, I assume) who has no actual experience with health insurance in the “real world.” This is – or should be – a “no brainer,” as there’s no way this should be a problem.

    I would probably start with the discount program itself: contact them and ask for a written statement from them (referencing your specific program and contract number) specifying that the coverage is NOT insurance in any way, shape, or form. Most of the various discount programs I’ve dealt with in my role as a health insurance and employee benefits broker will state very clearly and unequivocally that they are most definitely NOT insurance. It should be relatively easy to get a statement, copy of a contract, marketing material, etc. ALL of which will say this. Send it off to the Medicaid office or person you’re dealing with; if that person still refuses to approve it, file an appeal with his supervisor. I would also “copy” all correspondence to the hospital person, an attorney, and possibly your US Congressman. Also, if one of your local TV stations has a “consumer advocate,” this would make for a great TV spot: “Medicaid recipient claim wrongly denied (or better, rescinded, as that’s something that’s been “played up” in Obamacare; something that insurance companies did that was going to fixed by Obamacare), person now being used by hospital,”etc., etc.

    Anyway, that’s how I’d likely start fighting back.

  49. I lost my Hospital job of 20 years due to Hospital closing. My Husband died leaving very small ins. Policy. Both of my daughter’s are covered. One is 18 ,covered by M’caid. The other by College. As of today, I have not found work. I cannot afford any health insurance & wonder if by January 2014, will there be any options available?

  50. Hi Susie – Have you tried the health insurance exchanges at Healthcare.gov? I know they’re mess right now, but with no income, you should qualify for a plan for practically no cost. At least that’s what the hype is telling us.

  51. I did go to healthcare.gov and you are exactly right! It is a mess. I have tried again today & will continue to. Thank you for your reply & this site Kevin.

  52. I have multiple pre-existing conditions. I have a minimal part-time job that barely keeps a roof over my head and barely keeps me on all of the medications I need to be on. Luckily, pharmacies have programs where I can get most of my meds for $4.00 for a month’s supply. I have no one that I can depend on for help (all of my family is gone). I have to keep working in order to survive. As I can barely afford to live, I cannot afford to pay for insurance coverage at all. What is a person supposed to do when they get too sick to work to keep themselves alive, but not sick enough to pass away or get on government aid?

  53. Hi Cathy – That’s what Obamacare is supposed to remedy, but it looks like it’s a long way from happening. Can you get a job at Starbucks or one of the other companies that offer health insurance for part-timers? Please try this link to get started… http://outofyourrut.com/20-part-time-jobs-with-health-insurance/ Not a perfect solution but maybe it will work until Obamacare gets the bugs out…if not, we can always hold out for Medicare! Also, if you’re going to work in a part-time job it may as well be one with health insurance.

  54. Cathy – Sounds like a really difficult situation you’re dealing with right now. Based on the bit of information you included, it seems highly probable that you should qualify for Medicaid, which will at least give you access to health care and pay for most of it. You need to contact your state’s Medicaid office directly or try to enroll via healthcare.gov, which will direct your data / info to the nearest Medicaid office. Your situation sounds like exactly the sort of situation these programs were originally designed for … Give it a try.

  55. “Let’s get this point out of the way upfront: everyone should have health insurance.”

    I quit reading after this. Because you basically just told me I am wrong and stupid. So WHY should I even READ any further?

  56. David – WHY should (you) even READ any further? So that, perhaps, you might learn something or at least show a willingness to hear other points of view or perspectives – that’s why.

    “Everyone should have health insurance” is, of course, a very generalized comment. Donald Trump or LeBron James don’t really need health insurance (though I suspect they both have it); they have the money to pay for whatever healthcare they might need. Sadly, the vast majority of us don’t live in that financial house. If you “choose” to not have health insurance and are NOT in a position to pay for a sizable claim (say a $25,000 knee replacement or $150,000 bypass surgery) then – whatcha’ gonna’ do? Either (a) go bankrupt and effectively “stiff” the doctors, nurses, hospitals, etc. that treated you, or (b) be dependent on someone else to pick up your tab for you (i.e., family members, taxpayers, etc.). I submit to you that, if that’s your “plan,” then that makes you, in essence, a gambler who’s willing to roll the dice and bet with somebody else’s money (which is sorta’ what the government does, because it’s a lot easier for them to spend someone else’s money on stuff).

    While I strongly disagree with Obamacare and its requirements that force everyone to purchase health insurance or pay a penalty/tax enforced by the I.R.S. (everyone’s favorite government organization), I do believe that – for most of us, as reasonable, responsible adults – the need/desire to have health insurance is a logical and prudent thing to do. (Now, if it were only more affordable…. )

  57. I have a job I file for bankruptcy. I get paid every two week,sny way it pey all my bills except medical that my job offer. Bankruptcy take all my pay,dont leave my with nothing,my Husband recive SSA Disbility check trhat cover most of the thing and his bill but dont have enould to cover my health care at eork .Im 57 year old not able to draw Social Security, how can i afford health care.

  58. Deloris – You’re in a tough spot. Based on what you’ve written I suspect that you might be eligible for help from the government for you health insurance, either in the form of a premium subsidy or (depending on the level of your taxable income) maybe even Medicaid. If you’ve not done so already you should visit a website like http://www.healthsherpa.com, which will give you a really good idea about what your options might be.

  59. Many good comments about health insurance /health care plans on this site but both BEFORE and AFTER the Affordable Health Care Act (which I did support) – I still claim the following:

    1. Decent health care is NOT affordable for a large percentage of the population. (*Read below for definition of “decent”)

    2. The Affordable Care Act has worked. As of July 2014 statistics indicate that MOST states have a much lower percentage of people with no health insurance coverage than they did one year prior. The states with the highest increase in people with health insurance coverage are those (essentially, the Democratic states)that opted in to the federal exchange system.

    For example, Massachusetts now has only 11% of its population without any health insurance coverage, compared to 23% one year earlier in 2013. Texas, a state that strongly disagreed with Obamacare, has one of the highest levels of people without any health insurance at 22% currently – but even this number is better than in 2013, when the percentage was 34%. Likely the rate in Texas could be lower (17 – 18%) had the stated opted in to the federal exchange instead of choosing to go with their own state-run exchange.

    Again, per recent statistics, the groups who have benefited most are Latinos, and those earning a poverty level income or slightly above. Not only has the percentage of those covered with a health insurance plan increased significantly for these groups, but in surveys members of these groups say the plans work, and they ARE using them to obtain quality health care services.

    All of the above said, the Affordable Care Act has, of has expected, NOT made health insurance plans affordable for most at or slightly above or below what is defined as “middle-class” in this country. The insurance companies have increased plans cost even more.

    As noted above, now I can define “decent” in terms of health care coverage. Most of the world tends to define things in relative terms, so it is becomes very easy to maintain a point and make an argument for that line of thinking. I don’t. I define many items (especially critical need items such as health care) in ABSOLUTE terms.

    Here is an example. Only 5 years ago, I could obtain a solid health care plan (on my own OR through my employer) that would, for example, pay in full, or at least 80% for doctor’s visits, 80% for hospital, 80 to 90% of prescription cost, dental, vision, etc., and LOW deductible, usually about $500, but definitely no more than $1,000.

    The monthly cost of that type of plan was approx. $300 – $350 per month if purchased individually, or about $100 – $150 per paycheck (bi-weekly) if from an employer.

    That same level of plan today will cost me about $1,000 to $1,200 a month. If I am willing to “accept” a higher deductible (somewhere in the range of $3,000 to $6,000) then I might be able to get the plan for somewhere between $520 – $700 a month.

    Bottom line: The plans, to be “reasonable” for a vast majority (NOT everyone) of Americans – need to cost around $350 a month. Period. That is what I mean by absolute cost, not “relative to other costs”.

    3. Now we get to the reason why we can’t get health insurance at “decent” cost: Pure American greed. Of course, in our society today no major player will accept blame – its always “the other player”. Let’s spell it out: Insurance companies, brokers, hospitals, doctors, pharma companies, etc. – everyone “in the game” is to blame for the exorbitant cost. Good example: Don’t care what anyone says to this: A 5 star hotel can cost $1,000 per night. Why? I DON’T HAVE to stay there – its a choice. A hospital – I may NOT have a choice if I have to be there for an operation or procedure to save or at least change my life. NO WAY in the world a hospital stay should cost $1,000 per night.

    Answer to this: Well, the moderator of this forum said it best. Current laws (and, I should add, no past laws that I am aware of either) properly address and “go-after” cost containment. But I am not stating this in the terms normally considered. I am consider cost containment in ABSOLUTE terms.

    For example, (yes – you knew this was coming, did you not?). For at least a period of time (5 years ?) a hospital, or an insurer, or other medical player has a “profit max” restriction. In other words, their ceiling will 10 to 15 % profit (not the range of 20 to 30% or more that many organizations aim for). And they will simply have restrictions on what they can charge. No more than $2,000 can be charged for “xxxx” operation, no more than $400 per night for a hospital room stay, no more than $60 for a primary care physician visit.

    Of course, I made up these absolute figures, but we are all big boys and girls – sure that “acceptable” figures could be agreed upon. Not asking to have a gall bladder operation for $150, but not at $10 or $12,000 either – get the idea?

    Oh, if you think this smacks of the “S…” word – it does. But if stops some American greed, even for a while – I am all for it.

  60. Hi Geoff – I wish you had emailed me before writing your comment – I would have set up a separate post, which is what your comment is.

    Anyway…

    If only hospitals did cost $1,000/night – we wouldn’t be in this mess!

    I’m going to take your comment about American greed as step farther…our problem is that we want gold plated healthcare, but we don’t want to pay for it at all. That’s the “reform” people want, even if they don’t express it in those terms. The $350 per month premium that you think is fair won’t sustain the level of healthcare that the public believes its entitled to. That’s the problem. No one talks about cutting costs, the “debate” always centers on funding. That kind of thinking has driven our healthcare crisis since long before Obamacare came in.

    We won’t fix healthcare until we agree that cuts in price and in service levels need to come about. There’s no way healthcare can ever be affordable if people want their healthcare to be a bottomless pit of service.

    If you think about it, it makes perfect sense.

  61. Even this article is wrong right out of the gate.”and the cost of independent plans spiraling out of control,”. That “selling point” that every knuckle head uses including out leer-less feeder Barry is wrong. My “independent plan” was an 80/20 plan with $40 co-pay for $495 a mo. Now, thanks to obama care, it’s $632 a month for a 60/40 plan and $60 co-pay. Also, I have never paid so much for blood work or ultra sounds before in my life. What a rip off. They are just taking more money from the people who get up and go to work every day because we have it… like pick pockets… only under the guise of “making things better because we are too stupid to and they know best etc”. it’s like Socialist or something. (ha-ha) What will they do when they run out of MY money? This law has to get unwound some how. How about: you do you… and I’ll do me? My only charity is my wife and three children thank you very much.

  62. Why Doug, you really are “disgruntled”! Unfortunately there’s a lot in Obamacare to be disgruntled about. My own thought is that Obamacare is just the latest version of the failed US healthcare system. It’s costing us twice as much per person in the US as it is for the rest of the industrialized world for “the best healthcare in the world”. Meanwhile we’re paying ever higher out of pocket costs, millions are going without “affordable healthcare”, and most of the population is being fed prescription drugs. And we’re only 26th in the industrialized world (which is near the bottom) in life expectancy.

    So what’s wrong with the US healthcare system? Where do we start???

  63. This is so messed up. I lost my job when my Hospital closed due to finiancial woes. I worked 38 years in healthcare. Lose a good job by no fault of my own. Now no one is hiring me, and I cannot get health insurance! Oh, of course if i want to pay 456.00 per month out of pocket, then I can with a independent agent. What a joke. HHS (Obamacare) told me I did not have any options for healthcare since I was unemployed and since Ga. has opted out of M’caid, no help there . So I just forego any check ups and do the best I can with exercise and healthy eating. If any emergency comes up, guess I’m done for.

  64. Hi Susann – Obamacare didn’t eliminate the problem of tens of millions of people not being able to afford health insurance. A recent report showed 4 million fewer people without coverage, but it was due mostly to the expansion of Medicaid. People who couldn’t afford health insurance before still can’t. And they’ve done away with the catastrophic plans that used to be the last best hope of the uninsured. No easy answers here, but take good care of yourself and make use of mini-clinics when necessary. Also if you’re a committed Christian, you should look into health sharing ministries, like MediShare. They offer a form of coverage at greatly reduced rates. Otherwise you may have to hang on until you qualify for Medicare. This is such a mess!

  65. Last time I looked, I could get a top of the line BXBS or Aetna plan for something on the order of 900-1200 per month. Do the math. That’s between 10800 and 14400 per year I’d spend for plans that pay EVERYTHING, with no copays, and a very low copay of like $50. that was a couple of years ago while I had a ‘normal’ job.

    Under Obamma Care, whether it be a free (sic) plan, or the top of the line plan… the potential max out of pocket for a year is about the SAME. who do they think they’re kidding? (add up the copays, the deductibles, etc. plus what the ins does NOT pay)

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