What Can I Do if I Can't Get Health Insurance?

Sometimes you find yourself in a position where you are unable to find health coverage.  Whether you simply don’t have an enrollment period or let your prior health insurance or COBRA coverage lapse, many people face the reality of not being protected.  Fortunately, there are options.

Private Insurance

Private insurance is usually the same type of insurance you would find from the Marketplace or through an employer.  The difference is that you are (or a broker on your behalf) reaching out to the insurance company directly.

This method can get you a really good plan.  The coverage can be nationwide, deductibles are reasonable, and a lot of plans have some really great features.

The downside is that these plans are expensive.  When you purchase insurance through a group, your employer is often picking up part of your premiums, something you are now on the hook for.  Also, a lot of people receive subsidies with a Marketplace plan, something you will not get when you purchase private insurance.

Limited Medical Plan

Generally, limited medical plans offer much lower benefits and much more restrictive benefits than a major medical plan.  They are usually indemnity plans that pay you directly when you need to use a service.  Because these types of plans are not regulated by the ACA (read more about that here), they are not suitable to serve as the only plan you have, at least not for very long.  

Because they do not cover as much as a major medical plan, they do not cost a much.  Premiums for these plans can be very reasonable and often times the plan themselves do a great job filling the gaps in your other health coverage.  For example, a hospital indemnity or critical illness plan can supplement a high deductible major medical plan really well.

Critical Illness Policy

This is one of the main types of Limited Medical plans.  Critical Illness Policies usually cover the serious health concerns, like cancer, heart attack, and stroke.  Some also cover things like needing an organ transplant or being diagnosed with Alzheimer’s.

The amount the policy pays out is determined when you first sign up and is the biggest determinant of your monthly premiums.  Payout amounts can range from as low as $5000 up to $250,000 or higher.  The money is usually paid directly to you to spend on what you feel is needed most.

Some insurance companies offer riders for these plans that will reimburse you all your premiums if you have paid into the plan long enough and not needed it.  

Hospital Indemnity Plan

This is another type of Limited Medical plan.  These plans help cover the cost associated with a hospital stay.  The plans pay when you are admitted into the hospital for an injury or illness, and the plan makes payments directly to you.

With the payments going directly to you, you can use the funds to pay for cost not covered by your health insurance, such as deductibles and copays, or even childcare or cost of living expenses.

Most plans have no deductibles, and you are not limited to a provider network.

Accidental Insurance

Accidental Insurance is the third type of Limited Medical plan.  These plans can do a really good job at complementing a major medical plan by helping to pay for expenses that come up with an unexpected accident, including x-rays, ambulance services, and even deductibles and copays.

They are similar to a Critical Illness policy, but usually cover much more specific accidents, such as a broken bone or a cut finger or a burn.

Like all of the limited medical plans, the payments usually go directly to you use to spend as you need it most. 

Cost Share Plan (Medi Share)

Cost share plans, or health sharing companies, are organizations where members share medical expenses.  They operate on a voluntary participations basis and usually rooted in common religious or ethical beliefs.  Popular options include MediShare, Liberty, HealthShare, Sedera, Zion, and OneShare.

Unlike traditional insurance, your coverage isn’t guaranteed.  Members pay a monthly share that goes into a collective pool.  When needed, members can request funds from this pool.  The request isn’t always granted, and the member would be required to pay the full amount out of pocket.  Pre-existing conditions are not always covered, not all medical procedures are covered, and coverage can be limited as it is reliant on other members to pay their monthly shares promptly.

With traditional insurance, if you have a dispute over the payment of claims, you have right to negotiate and the state you live in will help you with this as health insurance is regulated.  However, when you participate in a cost share, you are on your own as these plans are not regulated.

Short Term Coverage Health Insurance

If you are stuck waiting for open enrollment to apply for an ACA plan or looking to bridge your coverage until you are Medicare eligible, short term coverage may be a great fir for you.

These plans do not cover everything.  Preexisting conditions are not guaranteed, not all essential health benefits are included, and preventative care may be excluded from your policy.  In return, your liability is limited for urgent care, prescription drugs, and doctor visits.

With these plans you are able to chose your deductible, allowing you to also adjust the premium to better fit your budget.

As the name implies, these plans do not last long. Most plans only cover between 1-3 months, with some as long as 3 years.  Coverage can be dropped at any time without fees or penalties in most cases.

Pros & Cons

The biggest pros for all of these plan types is that they can help cover some of your cost when needed.  Insurance can be expensive, but not as expensive as not having it when you need it.  And while none of these plans will cover everything, some do a great job either filling in the holes of a major medical plan, or providing gap coverage until you are able to purchase a major medical plan.

The downside to all of these is that they require underwriting.  You can be told no and not be allowed to join the plan, or that certain preexisting conditions won’t be covered.

None of this is to say that these plans are good.  There are some really great insurance options that I would recommend in most of these categories.  They just should not be looked at as an alternative to a true health insurance policy as they are not designed to be that.

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