If you don’t currently have health insurance, you’re not alone. In 2019, 26.1 million people in the United States were uninsured, according to the U.S. Census Bureau.
For a few years before 2018, if you didn’t get insurance, you had to pay an extra fee when you filed your taxes because of the individual mandate under the Affordable Care Act (ACA). As of 2019, the individual mandate penalty is gone, meaning there’s no cost for not having health insurance, right?
Not so fast. Even if you’re young and healthy and have no fear of the tax collector, there are still plenty of reasons buying health insurance is the smart thing to do.
Important Reasons to Get Health Insurance
Although you won’t pay a tax penalty if you decide to skip buying a health insurance plan, there are other financial factors to consider. In many cases, the benefits of being covered by a plan far outweigh the drawbacks and costs.
1. Insurance Minimizes the Cost of Unexpected Medical Bills
According to the Peter G. Peterson Foundation, the U.S. has some of the most expensive health care in the world, and the cost of U.S. health care is expected to increase. The National Health Expenditure Accounts estimates U.S. spending on health care increased by 4.6% in 2019, up to around $11,582 per person, or $3.8 trillion total.
When you’re uninsured, you’re on the hook for paying for any medical bills on your own. If you’re only paying for annual checkups or a course of antibiotics, those bills might not be too high. But if something should happen to you, such as an injury or acute medical condition, like kidney stones, you’ll be responsible for all the costs of treatment and care.
Although medical costs vary considerably based on your location and the type of provider you see, HealthCare.gov notes that some common medical expenses are as follows:
- Broken Leg: $7,500
- Cancer Treatment: over $100,000
- Three-Day Hospital Stay: $30,000
At this point, you might argue that most health insurance plans have a deductible, which you pay out of pocket for treatment and care before your coverage kicks in and picks up the bill for you. That’s both true and not-quite-true.
Unless you purchase the Cadillac of health insurance plans, the platinum plan, you’re likely to have a deductible. The deductible amount varies based on the type of plan you purchase and whether you’re buying an individual plan or a plan through your employer. Deductible amounts also differ if you have a family plan or an individual plan.
If you break a leg and need a cast and other treatment, and you have a deductible plan, you must pay whatever the amount of your deductible is before your insurance offers coverage. So if your deductible is $6,150 – and you have no copays or coinsurance – and the treatment for your broken leg costs $7,500, you’ll pay $6,150 and insurance will pay $1,350.
Should you need any other medical care during that year, insurance will pick up the tab as long as you go to an in-network provider. If you do have coinsurance or copays, you still have to pay those after you’ve paid the full deductible until you reach your maximum out-of-pocket limit for the year.
But there are cases when insurance will swoop in and cover your costs even if you haven’t yet met your deductible. Insurance plans need to cover the cost of preventive care, like your annual flu shot, Pap test, and wellness checkup. With an insurance plan, you don’t have to pay out of pocket for preventive services.
Your insurance coverage also helps you pay less for the services you receive. For example, if you see a doctor because you have a sinus infection and don’t have insurance, the bill might be $350. But if you have a plan and the doctor is in the insurance company’s network, the doctor will have an agreement with the insurance provider.
For example, under the agreement, the doctor may accept a payment of $150 for treating your sinus troubles. You’ll still have to pay your deductible if you still owe one, but you’ll end up saving $200.
Pro tip: If you choose a high-deductible plan to lower your monthly premiums, you can also use a health savings account (HSA) from Lively. An HSA allows you to save for medical expenses while reducing your taxable income.
2. Insurance Reduces Your Risk of Bankruptcy
During the 12-month period ending on June 30, 2020, there were 659,881 nonbusiness bankruptcies, according to United States Courts. Although U.S. Courts doesn’t have data on the number of bankruptcies filed because of medical costs, CNBC reports that medical issues play a role in more than two-thirds of bankruptcies.
A 2018 study published in the New England Journal of Medicine noted that there seems to be a correlation between hospital admissions and bankruptcy filings. A person’s likelihood to file for bankruptcy tends to increase in the years after they’re admitted to a hospital.
Having health insurance coverage won’t keep you from having to pay medical bills or visiting the emergency room. But it does put a limit on those bills, helping you avoid bankruptcy. Most individual health insurance plans have a deductible, coinsurance or copays, and an out-of-pocket maximum per year.
You are responsible for the amount of your deductible, whether it’s $1,000 or $8,000. You might also be responsible for coinsurance, which is a percentage of your health care costs you must pay after you’ve paid the full deductible. Some plans also have copays for certain goods and services, such as nonpreventitive doctor’s appointments and prescription drugs.
Your plan also has an out-of-pocket maximum for the year. Once you hit the out-of-pocket limit, your insurance company must cover all the costs of in-network care.
For example, you have a $4,000 deductible and a 20% coinsurance. You break your leg, and the hospital bills your insurance company $7,500. You’ll pay the full $4,000 deductible, plus 20% of the remaining $3,500, which is $700. Your insurance company will pay the rest.
Let’s say you have a particularly bad year, and you break your leg again. Once again, the hospital bills your insurance company $7,500. Since you’ve already paid your $4,000 deductible for the year, you’re only on the hook for the 20% coinsurance, which is $1,500 in this case.
But if your plan’s out-of-pocket maximum is $5,000, and you’ve already paid $4,700 during the year to repair your first broken leg, you only have $300 left before you hit the limit. You pay $300, and the insurance company pays the balance, which is $7,200.
Should you somehow break your leg a third time during that same year, your insurer would pay the entire $7,500 bill to an in-network provider. With insurance, your total out-of-pocket cost for all three broken legs would be $5,000. Without it, it would be $22,500 (3 x $7,500).
3. Having Insurance Can Encourage You to Take Better Care of Your Health
It’s a myth that health insurance is only for people with a chronic, serious illness or people who have a higher risk of developing an illness or becoming injured. Health insurance is for people who are in excellent health too. In fact, buying a health insurance plan if you’re in the best health of your life can help you stay healthy.
Under the ACA, most health insurance plans must cover a pretty long list of preventive services. According to HealthCare.gov, these services fall into three categories: those for all adults, those for children, and those for women. Preventive care services are free to you as long as you have a plan that covers them and you see a provider in your plan’s network.
A few notable examples of preventive care services are:
- Cholesterol screening
- Screening for Type 2 diabetes
- HIV screening
- Certain vaccines (such as the flu shot, HPV vaccine, tetanus shot, and chickenpox vaccine)
- Tuberculosis screening
- Tobacco use screening and cessation services
- Folic acid supplements for pregnant women or women who might become pregnant
- Pap smears
- STI screening
Having preventive services available to you for free from an in-network provider isn’t just convenient and good news for your budget. Getting preventive care also helps you get the treatment you need quickly if the doctor discovers any health issues.
For example, if your doctor orders a cholesterol screening and the results show your cholesterol is slightly elevated, you can take action right away. Your doctor might recommend dietary changes or suggest an exercise routine to help bring your cholesterol down. If you waited to have the screening, your cholesterol might have continued to climb until it was only manageable with medications and medical intervention.
Getting preventive care throughout your life also helps you stay active. The longer you stay healthy, the longer you’ll be able to work and continue to do the things you love. You won’t have to take time off work for extensive treatments if any conditions are caught early and managed with lifestyle changes.
It’s also a lot less expensive to treat conditions with lifestyle changes or moderate measures than with more invasive options like surgery or extensive medical treatments.
What You Can Do If Health Insurance Premiums Are Too High
The benefits of having health insurance are clear. But what can you do if paying $300 or so per month for an insurance premium seems too steep?
If the monthly cost of health insurance seems too high for your budget, you do have options to lower your premium.
1. See If You Qualify for a Credit
If you purchase an individual or family plan through the HealthCare.gov marketplace, you probably qualify for a tax credit or subsidy that will reduce the amount of your monthly premium. During the 2016 open enrollment period, for example, 85% of individuals selected a plan with financial assistance, according to the Department of Health and Human Services.
The size of your credit and whether you’re eligible is based on your family size, state, and income level. According to the IRS, credits are available for people with incomes between 100% and 400% of the federal poverty line for their family size. Larger credits are available for people with lower incomes.
Some people also qualify for a tax credit plus cost-sharing assistance to lower their deductible and coinsurance amounts.
2. Choose a Plan With a High Deductible
Plans with a high deductible usually have lower monthly payments compared to plans with low or no deductibles. If you don’t anticipate needing much beyond basic health care and preventive services over the next year, a high-deductible plan often makes sense.
3. Choose an HMO
The premiums charged by health management organization (HMO) plans are often less expensive than those charged by preferred provider organizations (PPOs). With an HMO, you choose a primary care provider and need referrals to see specialists.
You must also see providers who are in the plan’s network to get coverage. The requirements and limits on an HMO plan help keep its costs low.
4. Choose a Catastrophic Plan
Some people also qualify for catastrophic plans. With a catastrophic plan, you can see your primary care provider three times per year before meeting your deductible. Preventive services are also free under catastrophic plans. These plans are for people who anticipate only needing medical care in a “worst case scenario,” according to HealthCare.gov.
Catastrophic plans have higher deductibles – $8,550 for 2021 – compared to other plans. They’re also usually reserved for people under age 30 or people with a financial hardship exemption. The premiums are usually considerably lower than for other plan options but aren’t eligible for a tax credit.
5. Consider a Plan With a Health Savings Account
Another way to help lower your health care costs while getting the coverage you need is to consider purchasing a plan that has an HSA attached to it. HSAs are typically attached to health insurance plans that have high deductibles. If your employer doesn’t offer an HSA, you can set up one with Lively.
The contributions you make to an HSA must be used to cover the cost of medical and health care. Covered costs include copays or coinsurance, deductibles, and the cost of prescription medications. When you put money into an HSA, you can deduct the amount you contribute to the account from your taxable income for the year, which helps reduce your tax bill.
Any money you put into an HSA stays there until you need to use it. If you start contributing to an HSA when you’re in good health, you can save a significant amount. The annual contribution limit for an HSA is $3,600 for an individual plan or $7,200 for a family plan (as of 2021).
Contributing to an HSA now means you’ll have the funds to cover the cost of medical care in the future, helping you avoid medical debt and potential bankruptcy.
We all want to think we’re invincible and bad things can’t or won’t happen to us. But none of us knows what will happen tomorrow, much less in the distant future.
Even if it seems like you don’t need health insurance today, buying a plan on the marketplace or from your employer’s health insurance company during open enrollment is the smart thing to do. Having a plan not only protects your physical health, it also helps to protect your financial health.