What Are Your Options for Health Insurance With No or Low Income

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About 8% of people in the U.S. were without health insurance in 2022, according to KFF. Most of the people who were uninsured lived in working households with low incomes.

Special protections during the COVID-19 pandemic helped ensure Medicaid coverage for millions of people. But the unwinding that restarted eligibility reviews in 2023 has purged more than 20 million adults and children nationwide from Medicaid.

Still, health insurance options for people with no or low income are available. So, where do you look for health insurance if you don't have the means to pay - or can't pay much? Below, we break down the major coverage options if you have no or low income.

Free and low-cost health insurance options

Regardless of your stage in life, you may be able to access free and low-cost health insurance options. Some of them include:

Your parent's health plan

Because of the Affordable Care Act (ACA, also known as Obamacare), you may stay on your parent's health plan until age 26. You can do so even if you:

• Get married

• Have or adopt a child

• Live in or out of your parent's home

• Decide against having job-based coverage

A handful of states including New Jersey have extended the age to 30 or older. But at age 26 and after, state eligibility rules may be tighter than the federal ACA standard.

Student health plan

If you are enrolled in higher education - including technical schools, colleges, and universities - check with your institution about student health plans. You'll want to weigh the cost and coverage against other options.

Employer-sponsored health insurance

If you or your spouse have an employer that offers health insurance, see if you qualify for this benefit or if you can join outside of open enrollment during a special enrollment period. However, the options available on a job-based health plan may not be affordable for you.

How can you find health insurance plans if you're an adult with low or no income?

A good place to start if you're younger than 65 is Healthcare.gov. This site can tell you if you or your household members qualify for Medicaid, the Children's Health Insurance Program (CHIP), or subsidized health insurance on the ACA marketplace - all with one application.

Family members in the same household may be eligible for different programs. For example, children may qualify for Medicaid or CHIP, while parents may be eligible for low-cost ACA coverage. If you qualify for an ACA plan, you can enroll outside the open enrollment period based on losing or gaining income or coverage if you have a life change, such as:

• Getting divorced

• Getting married

• Having or adopting a child

• Moving

Healthcare.gov will direct you to your state marketplace, if needed. On either website, you can enter your basic information, including the number of people in your home and your estimated household income. You also can speak with a Healthcare.gov representative or navigator at no cost by calling 800-318-2596.

Medicaid

Medicaid is a federal and state program that provides health insurance to people with limited resources and low income. Eligibility varies by state, but coverage is usually free or at a very low cost for those who qualify. Pregnant women, children, and people with disabilities may still be eligible even if they don't meet the income threshold.

Emergency Medicaid provides limited coverage for people in medical crisis who are not U.S. citizens. It's available to people with a sudden critical health need who would qualify for Medicaid except for their citizenship status.

Children's Health Insurance Program

The Children's Health Insurance Program (CHIP) covers children who live in families with income that is too high to qualify for Medicaid but too low to afford private health insurance. It's available to people under age 19 who are uninsured, meet immigration requirements, and meet a CHIP eligibility income threshold. Some states offer CHIP to low-income, uninsured pregnant people and infants boto them.

Affordable Care Act (ACA) plans

ACA health plans come with subsidies known as premium tax credits for many applicants. This financial assistance can reduce costs for people who buy insurance on the federal Healthcare.gov site or through their state marketplace.

How do you apply for Medicaid?

You can apply for Medicaid via Healthcare.gov or your state marketplace, or you can go directly through your state Medicaid agency. There is no open enrollment period for Medicaid, so you can apply at any time throughout the year.

Is Medicaid eligibility based on income?

Yes. Income in the form of your modified adjusted gross income (MAGI) is typically used to identify your financial eligibility for Medicaid, CHIP, and subsidies for the ACA health insurance marketplace.

You also must be a resident of the state in which you will get Medicaid and a U.S. citizen or lawful permanent resident. There are special rules for "spending down" to Medicaid for adults age 65 and older with too much income to qualify for long-term care.

Most states (40 states and the District of Columbia) have expanded their Medicaid programs to cover adults up to age 64 with slightly higher incomes, up to 138% of the federal poverty level. But 10 states have not expanded their Medicaid eligibility.

How much can subsidies offset your insurance costs, and how do you use them?

If you have low income, you may be eligible for premium subsidies, also known as premium tax credits, on the ACA marketplace. You may find a health plan for as low as $10 a month.

Premium tax credits work with any of the four metal-tier levels of coverage, but you get the most generous subsidies if you select a silver plan, known as the "benchmark" plan. When you choose a silver plan, you also may qualify for extra savings to assist you with out-of-pocket expenses, known as cost-sharing reductions - which can help you pay for deductibles, copays, and coinsurance.

You can estimate your premiums and subsidies by using KFF's health insurance marketplace calculator.

What if you only need short-term health insurance?

A short-term health plan lasts from a few months to a year, and you can renew it for up to 3 years. It can be a stopgap if you're between jobs or in a transition period. For a low monthly premium, you get financial protection from medical catastrophes.

But these plans don't have to follow ACA rules, so routine care typically isn't covered. Most short-term health plans also don't cover preexisting conditions or prescription drugs.

Catastrophic health plans are for people under age 30 and persons of any age who have a hardship exemption. Premiums are low, but the plans come with very high deductibles ($9,450 for an individual in 2024). And you can't get a premium tax credit for catastrophic plans.

Catastrophic health plans must follow ACA rules and cover 10 essential health benefits. This makes them more comprehensive than short-term health plans.

What are low-income health insurance options if you're 65 or older?

Medicare is the federal health insurance program for people age 65 and over, younger individuals with disabilities, and those with certain conditions, such as end-stage renal disease and amyotrophic lateral sclerosis (ALS). Original Medicare includes Part A and/or Part B.

Medicare Part A, known as hospital insurance, is available premium-free for those 65 and older who worked and paid Medicare taxes for at least 10 years. See if you qualify and get an estimate of your expected premium via the Medicare eligibility tool.

Medicare Part B, or medical insurance, is available for a monthly premium. But if you have low income, you may qualify for one of the Medicare Savings Programs (MSPs) that pay for your premiums - and sometimes Part A and Part B deductibles and coinsurance. These programs are run by states, and you can apply by contacting your state Medicaid office.

You also may qualify for Extra Help - and you're enrolled in this program automatically if you qualify for certain MSPs. Extra Help covers your Medicare prescription plan's premium, as well as out-of-pocket costs when you receive care. If you live in any state or the District of Columbia, you can apply through the Social Security Administration.

When you first enroll in Medicare, you'll have original Medicare, unless you make another choice. There are different ways that you can get Medicare coverage. If you are dually eligible for Medicare and Medicaid, another option is a Medicare Advantagespecial needs plan, which provides coordinated care with very low out-of-pocket costs.

For help with Medicare choices, contact the State Health Insurance Assistance Program (SHIP) for free counseling.

It's also important to note that older adults who attend college may qualify for student health plans while in school.

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GoodRx Holdings Inc. published this content on 01 July 2024 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 01 July 2024 15:01:19 UTC.