Steps to Take When Health Insurance is Unaffordable

It’s no secret that healthcare costs in the United States are high. If you’re one of the millions of Americans who don’t have health insurance, those costs can be even higher. But there are options available to help make sure you can get the care you need, even if you don’t have health insurance. 

Reasons Why People Can’t Afford Health Insurance 

There is no single answer to this question, as everyone’s situation is different. However, some of the most common reasons why people can’t afford health insurance include the following: 

  • Low income: According to the United States Census Bureau, the average individual income in 2011 was $57,617. This means that a large majority of Americans who cannot afford health insurance have incomes below the national median. 
  • Having a chronic illness or disability: Medical expenses are often costly, and those with pre-existing medical conditions are at an increased risk for expensive out-of-pocket expenses. Additionally, people with disabilities may face additional challenges accessing coverage due to limitations placed on their policies by insurance companies. 
  • Employer exclusions: A significant number of people who cannot afford health insurance work for small businesses or self-employed entrepreneur (SOE) firms that do not offer coverage through their employer. These businesses can be excluded from many government programs that provide affordable healthcare options, such as Medicaid and Medicare, due to state laws known as “work mandates.” 
  • Unaffordability penalties from Obamacare: As of January 1st, 2014, individuals who did not have any form of health insurance were subject to a tax penalty ($95/person/year for singles and $147/person/year for couples filing jointly), unless they had specific qualifying medical conditions. 

Understanding and Exploring Your Insurance Options 

Your health insurance options can depend on various factors, including your employment status, income level, and preferred medical care. Below are some key things to keep in mind when looking into your options: 


If you’re employed, your health insurance probably comes from your employer. This means that coverage costs are typically shared between you and your employer. In most cases, employers offer various plans with varying rates and benefits. You can compare the multiple options available online or through your human resources department.

Self-Employed Individuals 

If you’re self-employed, however, you’ll likely need to obtain an individual policy (rather than an employer policy). Individual policies often have more bells and whistles (such as lower premiums), but they also tend to be more expensive overall. To get a good deal on this type of policy, it’s important to shop around and compare quotes from multiple providers. 

The Type of Plan 

As mentioned earlier, there are several different types of plans available when it comes to health insurance: 

  • Group plans (which cover employees at multiple companies) 
  • Family plans (which cover spouses and children) 
  • Standalone policies (for people who don’t have access to group or family coverage)
  • Limited-benefit policies (whose only benefit is that they don’t have deductibles or coinsurance)
  • High-deductible policies (where consumers must pay out-of-pocket for doctor visits and other medical expenses before their insurer pays anything) 
  • Catastrophic coverage (covering certain serious illnesses or injuries) 
  • Pregnancy coverage, dental/vision/copays, long-term care, etc. 

It’s essential to research each option carefully to find the best fit for yourself and your finances. 

Assessing Your Financial Situation 

You can do a few things to assess your financial situation and see if you qualify for health insurance. First, figure out your annual income. Then subtract any major debts, such as mortgages and car loans. This will give you your annual surplus. 

If your annual surplus is less than $50,000, you likely don’t qualify for federal subsidies that help lower the cost of coverage. If it is between $50,000 and $75,000, you may be able to get government assistance through the Healthcare Marketplace or State Medicaid programs. 

You might also be eligible for private health plans offered through employers or unions. If your annual surplus exceeds $75,000, you can probably afford to buy an individual policy on the Healthcare Marketplace or through a state Medicaid program without government help. 

Making Health Insurance More Affordable 

Affordable health insurance coverage is a pressing issue in the United States. A recent study by The Commonwealth Fund showed that 26 percent of Americans could not afford care when they needed it and that this number was increasing due to rising healthcare costs.

One way to make health insurance more affordable for American citizens would be to create a system where individuals could purchase health insurance through an employer or government program instead of having it provided through their healthcare providers. This system would introduce competition into the healthcare industry, which could drive down prices and improve quality. In addition, expanding Medicaid eligibility would enable more people in need to gain access to affordable coverage. 

Utilizing Government Programs 

There are many government programs available to help individuals and families obtain health insurance coverage. Some of the most common programs include the Medicaid program, the Children’s Health Insurance Program (CHIP), and the Medicare program. 

Most people who qualify for Medicaid or CHIP also have access to private health insurance. However, if you are not covered by a private health insurance plan, these government-provided programs can be a great way to get affordable health care coverage. These programs offer significant benefits, such as preventive and maternity care. 

The Medicare program is particularly important for seniors and people with disabilities. It provides free or low-cost coverage for people aged 65 or older and those with certain medical conditions. Medicare also pays some of the costs of prescriptions, doctor visits, and hospital stays. If you are eligible for Medicare, it is essential to sign up soon so that your benefits will start immediately. There is no waiting period when you enroll in Medicare Part A or Part B. 

Exploring Non-Traditional Options 

Health insurance is essential to many people’s lives, but it doesn’t have to be the only option. There are a variety of other options for coverage out there, and some can be very affordable. 

One option is health savings accounts (HSAs). HSAs are similar to traditional health insurance plans in that they cover medical expenses and give you access to a certain amount of money each month to use however you want. However, unlike standard health insurance plans, HSA contributions aren’t tax-deductible. 

That means that if you don’t use all your deposited funds each year, you can pay taxes on them at full value. Nevertheless, HSAs offer great flexibility in how you use your funds and can be an excellent way to save for long-term health needs or specific expensive treatments or medications. 

Another option is group health insurance policies offered through workplaces or associations. These policies often cost less than individual policies and provide benefits such as accident coverage and discounts on specialist visits. Group health insurance policies may also include rider clauses that allow members to add additional benefits such as dental or vision care onto their policy.

Finally, there are various types of flexible spending accounts (FSAs) available that allow employees to set aside money specifically for healthcare costs. These accounts often have lower contribution limits than HSAs or group health insurance policies, meaning that employees can deposit more money into them without impacting their taxable income too much. 

Moreover, FSA contributions can be used tax-free when making qualified medical expenditures such as doctor’s appointments, prescription drugs, and medical equipment purchases. 

Final Thoughts 

Don’t let a lack of health insurance keep you from getting the care you need. There are resources and programs that can help. Talk to your doctor or another medical professional to learn more about your options. You can also contact Insurance Enterprise for more information on health insurance plans. 

Call us at 888-350-6605 or email us at to speak to a licensed agent and learn more about getting an affordable health insurance plan.