What are the risks of not having health insurance?
Am I required to have health insurance?
Health insurance may seem costly and confusing, but it can help protect you from large medical bills if you need care. Having insurance can make it easier to pay for health care and help cover costs if you get sick or hurt. You can still get care without health insurance, but you typically have to pay the full cost.
While you may pay monthly fees with insurance, these costs are often much less than paying large medical bills on your own. In some states, you may also have to pay a tax penalty if you don’t have health insurance. Learn more about how health insurance can help protect your finances and your health.
What are the financial impacts of being uninsured?
Even though there's no longer a federal penalty for being uninsured, some states still charge a fee. The amount may depend on your income or be a set fee for each adult.1
While you don’t plan to get sick or hurt, health care costs can still come up — whether from an unexpected illness or accident, or expected care like maternity care or surgery. Depending on which coverage you choose, your plan may help cover unexpected medical costs. Once you’ve met your deductible, some health plans may take care of 60% to 90% of covered expenses, which can add up fast. For example, the average cost for a 3-day hospital stay is $30,000.2
Here’s how average costs may compare for common types of care with and without health insurance.
| Average cost without insurance | Average cost with insurance3 | |
|---|---|---|
| Visit with a primary care provider (PCP) | Up to $6004 | $160 |
| Urgent care | $250 to $5305 | $165 |
| Emergency room (ER) visit | $2,8636 | $1,700 |
Higher risk of debt or medical bankruptcy
Medical bills over $500 can hurt your credit if they go to collections and are unpaid for more than one year. The debt can stay on your credit report for 7 years but is removed once it’s paid.7
More than 62% of uninsured adults under 65 have medical debt, including credit card debt or money owed to family members. Having debt can make it harder to pay other bills or protect savings.8
Medical debt may also affect a mortgage application. Lenders may count monthly payments to a hospital or doctor in your debt-to-income (DTI) ratio. This could lower the loan amount you qualify for.9
About 7% of U.S. residents have catastrophic health care expenses each year. This means their health care costs are more than 40% of their household income after basic needs. Medical bills or illness-related work loss are also linked to about 66% of personal bankruptcies in the U.S.10
No limit on out-of-pocket costs
Without health insurance, there is no limit to the amount you may pay on health care costs. An out-of-pocket limit is one of the ways a health plan protects you from high medical expenses. Your out-of-pocket maximum is the total amount you'll pay no matter how much covered care you get in a plan year.
After you reach your out-of-pocket limit, your plan typically pays 100% of covered health care costs, up to the allowed amount. For example, if your annual out-of-pocket limit is $3,000, once you’ve paid $3,000 for covered care that year — including deductibles, copays and coinsurance — your plan usually covers 100% of eligible services for the rest of your coverage period.
Higher health care rates
Another financial risk of being uninsured is paying higher health care rates than people with insurance. Chargemaster rates matter because uninsured patients may have to pay them in full. These rates are the list prices that hospitals and providers set for every service they bill. Prices can be very different from one hospital to another.11
Chargemaster rates often represent large markups over the cost of care. For example, hospital charges can be about 3.5 to 6.6 times the actual cost of care.11
What are the health impacts of being uninsured?
Adults without health insurance often have less access to recommended care. This includes preventive services for chronic conditions such as diabetes, cancer and cardiovascular disease. They may also receive lower-quality care and have worse health outcomes than adults with insurance.12
Lower likelihood of preventive care
Nearly half of uninsured adults don’t have a regular place to go when they are sick or need medical advice, like a primary care provider (PCP).8 A PCP is typically who you see for preventive care. Most health plans cover eligible preventive care, like vaccines and yearly checkups, when you see a network provider.
Even if you feel healthy, preventive care can help find problems early, before they become more serious. Health insurance can help people get preventive care and use health care services when they need them. This can lead to better health over time.
Delayed treatment
Nearly 40% of uninsured adults report delaying, skipping, or not getting the care or medication they need due to the cost.8
For adults with chronic conditions, not having health insurance can be especially serious. They are 3 to 4 times more likely to delay or skip care because of cost than insured adults with the same conditions. Research shows that getting insurance can improve access to care, increase health care service use and lower mortality.8
How to afford health insurance
Just as you compare prices for everyday purchases, you can look for ways to help manage health care costs.
Having insurance doesn’t mean your health care will be free. You’ll still pay a monthly premium. You may also have copays, other out-of-pocket fees or deductibles to meet before coverage kicks in.
There are different types of health insurance plans to meet different needs. Certain factors can affect your health insurance costs. It’s important to understand what these costs are before selecting a plan.
A high-deductible health plan (HDHP) usually has a lower monthly premium but higher costs when you get care. It can help protect you from very high or unexpected medical bills, such as hospital stays, surgeries or complex treatment.
HDHPs may be a good fit for someone who’s in good health and typically only sees their doctor for preventive care. HDHPs typically cover preventive care services, such as an annual wellness exam, vaccines, and tests and screenings for certain health conditions.
Catastrophic health plans also have low monthly premiums and high deductibles. They help protect you from the costs of major illness or injury. They also cover the same essential health benefits as other ACA Marketplace plans, including no-cost preventive services. You may qualify for a catastrophic plan if you’re:
- Under 30
- Over 30 and don’t qualify for Marketplace savings
- Eligible for a hardship or affordability exemption
These plans may not be available everywhere.
A health savings account (HSA) lets you set aside money for eligible health care costs. To open one, you must be enrolled in an HDHP.
The IRS sets HSA contribution limits each year, so knowing the limit can help you make the most of your account. Once your HSA is set up, you can add money and use it for eligible expenses, including copays, some treatments, menstrual products and more.
Short-term health plans can help fill brief gaps in coverage13. This coverage may help until you find a longer-term option. Also called short-term medical, temporary health or short term, limited duration health insurance, these plans may start quickly and last from one month to nearly 12 months in some states.
TriTerm Medical is another short-term health insurance option that can last nearly 36 months over 3 terms.14 Available in some states, it offers coverage for a longer period of time than many traditional short-term health plans.
There are also supplemental plans, like fixed benefit health insurance, that complements your existing health coverage to help pay for out-of-pocket costs.15 With a fixed benefit plan, sometimes called fixed indemnity or fee for service insurance, you get a fixed amount (or benefit) for covered health care expenses. For example, you could get a benefit to help cover prescription drug copays or apply a benefit payment toward your other health plan’s deductible.
To save money, compare plans with fewer benefits, higher deductibles or lower in-network costs.
Medicaid offers low-cost or no-cost health coverage for people who qualify. It often covers children, pregnant women, older adults, people with disabilities and eligible adults with low incomes. Because each state manages its own program, eligibility rules may vary.
What are health care options without insurance?
If you don’t have insurance, you may still have options. These may include direct primary care, community health centers, self-pay rates, telehealth and payment plans. They may help lower costs or let you pay over time.
There are also subscription services that offer online therapy and counseling without insurance for one monthly payment. Another option includes dental savings memberships that provide access to discounts on qualified dental services, no copays, deductibles, annual limits or maximums.
With these options, costs, services and availability can vary. Before choosing, check what’s included, what it costs and if there are any fees, interest or limits.
Direct primary care (DPC) is a membership that helps cover some primary care services. Costs vary by office. Many memberships cost about $50 to $100 per person each month. You may also pay a one-time enrollment fee.16
What’s included depends on the practice. You may still need health insurance for care outside basic primary care, such as specialty care, hospital care, urgent care or surgery. DPC is not available everywhere, and memberships may not have the same protections as health insurance.16
Community health centers (CHCs) serve more than 32 million patients. Located in underserved rural or urban areas, they offer medical, behavioral and support services regardless of ability to pay.17 CHCs are nonprofits that use a sliding fee scale, which adjusts costs based on income and family size.18
Due to funding challenges, many CHCs are understaffed, resulting in longer wait times, decreased hours of operation and reduced appointment availability.19
Without insurance, a basic primary care visit often costs $150 to $300. These visits average about $171 in major U.S. cities. To lower costs, ask about self-pay discounts.20
Extra services can raise the cost, including:20
- Physical exam and standard labs: $300 to $400
- Bloodwork: $200 to $500
- Vaccines: $20 to $50 per dose
- X-ray: $100 to $1,000
- Minor procedures: $150 to $400
Telemedicine may cost less for non-emergencies, such as minor illness, infections or mental health check-ins. Some care still requires in-person visits, including hands-on exams, vaccines, lab work, X-rays, surgery or physical therapy. Without an in-person exam, diagnosis may be harder, which can lead to gaps in care.
People without internet, a mobile device or a private space may have trouble using telehealth. A phone backup plan can help if technology problems happen.21, 22
Some providers offer payment plans or medical credit options that let you pay bills over time. Some plans are interest-free. Others use deferred interest, which can add interest later if you don’t pay the full balance by the deadline.23
Before choosing an option:23
- Make sure the option covers the care you need. Some cover only certain services, such as elective, dental, vision or hearing care.
- Confirm your provider or hospital accepts the payment option
- Check when interest starts, if the rate changes and if a 0% offer uses deferred interest
- Review credit check requirements, payment due dates and any late, administrative or processing fees
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