Many people are concerned that there is a penalty for no health insurance, which can be stressful. If you find yourself in this position, you might be wondering, “what happens if you don’t have health insurance?”. If you have no medical insurance, do you have to pay a fine? While there is currently no tax penalty assessed at the federal level for not having health insurance, there are risks associated with being uninsured.
It is in most people’s best interest to have insurance that can help cover healthcare costs such as doctor’s visits, prescription drugs, and potential visits to the emergency room, however, it’s not always accessible to everyone. There are many different reasons why people might go without health insurance for a period, from the cost of coverage to changes in employment.
It is important to understand what you can expect if you go without health insurance, as well as your options for getting coverage no matter what your current situation might be. Keep reading or use the links below to learn more.
Why do people go uninsured?
The number of uninsured has been steadily increasing in recent years. According to a publication from the Kaiser Family Foundation (KFF) in November 2020, the number of uninsured, nonelderly Americans increased for three straight years, beginning in 2017. In 2019, there were 28.9 million who were uninsured for a variety of reasons.
The KFF report found that families with low incomes were the most likely to be uninsured, with more than 73% citing the high cost of insurance as their primary reason for lacking coverage. Other reasons people stated for not having health insurance included:
- Not eligible for coverage (25.3%)
- Do not need or want coverage (21.3%)
- Signing up was too difficult or confusing (18.4%)
- Cannot find a plan that meets their needs (18%)
- Lost their job (2.8%)
According to the report, adults were more likely than children to be uninsured and people of color were at higher risk for not having insurance than non-Hispanic white individuals. Over 73% of families without insurance had at least one full-time worker in their family.
Despite this, more recent data has shown a change in these trends. According to HHS.gov, as of early 2022, only 8% of U.S. residents are uninsured—an all-time low. Additionally, 5.2 million people have gained health coverage since 2020.
If you find yourself without coverage for any reason, eHealth can help. We offer a wide range of plans in every state to meet every individual’s needs and budget. Our representatives are available online or by phone to answer your questions and help you find the right coverage for you and your family.
What happens if you need medical services but don’t have health insurance?
The Affordable Care Act made it easier for people to get health insurance, but many people still have no medical insurance. In this case, you might be required to pay for your health services out of pocket. If you go to a doctor for a routine physical and you don’t have health insurance, you will be asked to pay for the visit out of pocket.
As a result, you might not be able to afford the cost of care. Even though you might be denied some medical services due to an inability to pay, you can still access emergency room care. If you have a medical emergency, you can still go to the emergency room and not be turned away.
What happens if you don’t have health insurance? The risks
The risks of going uninsured are primarily cost-related. Some of the main risks that you could face by going uninsured include:
Higher charges for the same services
Without health insurance you may get charged much more for care that would otherwise be covered by your plan. This is because no one—usually the insurance company—will be subsidizing your cost of care. As a result, you may have to pay higher charges for the same services. You will have to pay for everything out of pocket, and if you cannot afford the cost of care, the hospital or medical practice could take legal action against you.
Since you might be charged out-of-pocket full price for any healthcare you receive while not having insurance, you may find that you’re quickly drowning in medical bills. Medical debt can become quickly overwhelming for many individuals and affect other aspects of their finances. Carrying extra debt could make it harder for you to apply for a student loan, a mortgage, or a car loan.
State Tax Penalties
While the individual mandate was repealed and no longer applies from 2019 on at the federal level, there are states with their own health insurance penalties. If you don’t have health insurance, you could end up paying a penalty for no health insurance. Therefore, you should make an effort to find health insurance that works for your needs.
Check to see if your state still has a state-level individual mandate that could affect you if you’re uninsured.
Postponing or neglecting health care
Because you may not be able to afford medical care, you may end up postponing necessary doctor’s visits. This could include visits to the dentist, the eye doctor, or the regular doctor. According to the KFF report, three in 10 uninsured adults went without medical care they needed due to the high cost of uninsured healthcare. By hesitating to put your health first, you run the risk of health issues becoming worse over time.
Inability to afford medication
Because of rising prescription drug prices in the US, many prescription drugs are incredibly expensive, especially without a health insurance plan to help out. As such, some people without health insurance forgo medications they need to manage acute and chronic medical issues, often leading to worsening conditions and higher long-term medical costs.
According to the KFF, uninsured adults were more than three times more likely to delay or fail to purchase needed drugs due to the cost.
Can a hospital deny you care if you have no insurance?
A hospital may be able to deny some forms of care, but not all of them. If you have a medical emergency, a hospital will still be required to treat you; however, if you want certain types of care that are not emergencies, the hospital may be able to deny those treatment options. You may find that you have fewer options when you go to the hospital because you don’t have health coverage.
Can I get insured after losing coverage through employer, family member, or Medicaid?
If you lose coverage through a spouse or parent, or become ineligible for Medicaid, you can still get insurance coverage. These coverage losses are examples of qualifying life events that may give you eligibility in a special enrollment period. A special enrollment period allows you to enroll in major medical health insurance plans outside of the open enrollment period (which ran from November 1st through December 15th, 2020 and will run from November 1st through January 15th, 2022 for 2022 coverage).
If you qualify for a special enrollment period – which typically last 60 days – you will have to prove that you experienced a qualifying life event in order to purchase a health insurance plan off the federal or state marketplace, or through a licensed broker.
If you lose coverage through an employer or family member and you believe that you may qualify for federal assistance, you can apply anytime throughout the year for Medicaid and CHIP – two government programs seeking to provide low-cost or free health insurance to low-income individuals and families.
Even if you do not think that you will qualify for Medicaid or CHIP based on income alone, it is a good idea to apply anyway, especially if you are disabled, have children or are pregnant.
Is it ever worth it not to have healthcare?
There are some situations where it might be necessary for you to go without healthcare for a short time, but preventive care is the best way to avoid more serious issues. If you go to the dentist, the eye doctor, and the regular doctor as you should, you can prevent chronic medical conditions from developing. A medical professional can catch potentially serious health issues before it leads to symptoms, helping you stay healthy. Therefore, you should make sure you have access to the health services you need by carrying solid health insurance if at all possible.
Fortunately, there are more affordable plans available to you that may make health insurance more accessible.