When I ask friends whether they’ve ever gone without health insurance, I’m often surprised to find that the answer is “yes.”
“My husband and I made the nail-biting decision to go without health insurance for three weeks when he switched jobs, right after my older daughter was born,” one tells me.
“I didn’t have insurance when I was in college and ended up with a decent ER bill for a kidney stone,” another friend says.
Unfortunately, in the United States’ health care system, it’s common to forego health insurance.
However, this isn’t generally a risk worth taking.
“Our health is unpredictable. You never know if an accident may occur or if a simple ache could turn out to be something more,” says Ciara Zachary, an assistant professor in the department of health policy and management at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. “Having health insurance protects you from facing high medical bills that can threaten your financial security.”
Despite the seeming lack of choice and high cost, there are ways to make health insurance more affordable, so you don’t have to go without. Here’s how.
[READ: How to Shop for Health Insurance Covering Mental Health]
Why You Need Health Insurance If You’re Healthy
Having health care provides several benefits beyond what you may think:
Catastrophic injury or illness
The most obvious reason for health insurance is to protect you against huge medical bills due to a significant health event or accident.
This might be rare, but if it happens, it could be financially devastating.
“Unlike, say, bananas, you have no idea how much health care you might need this coming year,” says Naomi Zewde, assistant professor in the department of health policy and management at the UCLA Fielding School of Public Health. “Medical spending has an uncertain element to it, and that uncertainty can get pretty expensive.”
Preventative care
Recommended vaccines and screenings are covered by insurance and could prevent illnesses that would otherwise end up costing you financially, as well as potentially affecting your long-term health.
“Without health insurance a healthy young person may miss out on regular checkups and screenings, which may identify underlying health concerns that may become harder and more costly to address as one ages,” Zachary says.
This type of care might include:
— Vaccinations
— Mental health screening and treatment
— Testing for sexually transmitted infections
— Screening for some cancers, such as skin cancer screening, and Pap smears/HPV tests for women to detect cervical cancer
“Preventive health services are proven to help people stay healthy in the long term,” says Nina Hill, a research fellow at the Institute for Health Policy and Innovation at the University of Michigan.
Building a rapport with a care team
During routine visits, you can develop a relationship with your primary care doctor and, for women, your OB-GYN, so that you are more likely to discuss any minor medical issues that otherwise have the potential to become major problems.
“You can see a provider that you prefer to build a relationship with instead of relying on urgent care, the ER or a walk-in clinic,” Zachary says.
Emergency rooms often refer you back to your primary care doctor for follow-up anyway.
Lower prices
Medical pricing can be challenging to understand, but usually, doctors and hospitals will negotiate with insurance companies to accept a lower rate than the out-of-pocket charge.
“While you can negotiate on your own, you have much more power negotiating through your insurance, plus it’s less hassle for you,” Zewde says.
[READ: What Is a Health Savings Account?]
What Can Happen If You Don’t Have Health Insurance
If you do end up with high medical bills due to not having insurance, there may be ways to negotiate some debt forgiveness or set up a payment plan.
Even so, this situation isn’t ideal, and you could end up losing much of your savings.
“Medical debt is still a concern for too many people,” Zachary says.
In addition, hospitals have gotten increasingly aggressive about debt collection, according to Zedwe.
Bankruptcy
One way to avoid paying medical debt is to declare bankruptcy, which can dissolve medical debt.
In fact, medical debt accounts for over half of bankruptcies.
“The point of bankruptcy is when you’ve really got some negotiation as an individual consumer; hospitals actually prefer that you pay them what you would have lost in bankruptcy rather than actually file,” Zedwe says.
Unless you have a lot of cash, you often won’t lose much in bankruptcy, as you can keep most of your home equity, some vehicle equity and your retirement savings; still, most people would prefer not to have to go bankrupt for their medical bills.
“Most people just lose the lawyer fee, a couple thousand dollars, but you’ll face lots of stress and hassle,” Zedwe says, in addition to your credit score being negatively affected.
Potential penalties by your state
The federal government previously imposed a tax penalty on people who didn’t have insurance as part of the Affordable Care Act (ACA), to ensure enough young, healthy people bought health insurance to offset utilization by older, sicker people.
“When everyone pays into the insurance pool, we end up paying for each other’s expenses, and the money goes to the member who was the least lucky for that year,” Zedwe says.
Without sufficient revenue, insurance companies may struggle to pay the bills of members who become ill, and may need to increase premiums for everyone.
However, a penalty doesn’t solve the fundamental problem of people not having health insurance.
“People want health insurance — the thing holding people back is the cost,” Zedwe says.
The federal penalty was eliminated; however, some states still have their own tax penalties for being uninsured. These include Massachusetts, New Jersey, California and Rhode Island.
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The Best Health Insurance for Healthy People
If you want to have health insurance but aren’t sure it’s worth it if you’re healthy, consider these options.
“Some is better than none,” Hill says. “Comparing these different options allows young people to find the best flexibility, affordability and coverage for their health care needs.”
High-deductible plans
In return for a lower premium, a high-deductible plan means you’ll pay more out of pocket for health care before your insurance kicks in.
If you don’t end up incurring many health care expenses, you’ll save money. However, you should crunch the numbers to ensure it makes sense for you and that you can afford the deductible in a worst-case scenario.
“For high deductible health plans, it’s especially important that young people understand how much it actually costs to see their doctor or therapist, or get important tests done,” Hill says. “Often the tradeoff with a lower monthly premium is higher costs when you actually need care.”
High-deductible plans through an employer are often paired with a health savings account (HSA), in which pre-tax dollars from your paycheck are deposited and can be used to pay medical expenses.
“You should certainly make use of it — it’s basically just a tax-free savings account you can dip into for any medical costs that do come up, plus you’ll still get your other benefits of health insurance,” Zedwe says.
Employer-sponsored plans
Many employers offer high-deductible plans as an option in a tiered system: The less you pay for health care, the higher the deductible you have.
Look at the details to make sure the level of plan you pick makes sense for you, and that any predictable health care services you use are covered.
“If cost is the major driver, you don’t just want to consider the monthly bill or premium — you will want to understand all costs, which may include copayments, coinsurance and the deductible,” Zachary says. “If you are a healthy person with employer-sponsored insurance, see if there is an option to speak with a HR representative or someone from the insurer.”
School-sponsored plans
If you’re still in school, your college or university may have student insurance, affordable plans that may require you to use their on-campus health clinic.
These plans remain affordable because they serve a young population that is not often sick and will only use them for a limited time while in school.
ACA Marketplace insurance
If employee-sponsored health insurance isn’t available or affordable for you, consider using the federalHealth Insurance Marketplace or your state’s insurance marketplace to explore the different options available for purchase.
Unfortunately, the expiration of enhanced tax credits that reduce the plans’ overall costs will make these plans less affordable.
“We are expecting a significant increase in premiums,” Zachary says.
To decide if a Marketplace plan is right for you, use the healthcare.gov tool to compare plans, or contact a free health care navigator:
— On healthcare.gov, click “Find Local Help“
— Check if your state offers health care navigator services
— Ask your doctor or hospital
— Check your local community center or public health office
— Look into nonprofits such as the Healthcare Navigation Project
Catastrophic plans
One health care plan option with very low premiums and a very high deductible is a Marketplace “catastrophic plan,” which is designed to cover you in the case of a serious medical event. You must be under the age of 30 or qualify for certain hardship exemptions to purchase one of these plans.
However, these plans might be too limited.
“These plans are cheap but may not cover the basics, and so people are surprised when they receive higher than expected bills,” Zedwe says. “Even if you are healthy, you should try to purchase a high-quality plan with comprehensive coverage.”
Staying on your parents’ plan
If you’re under 26 years old, consider taking advantage of the opportunity to stay on your parents’ insurance until you’re employed or more financially stable, and can better afford your own coverage.
Some states even have extended coverage: For example, in New Jersey, you can stay on your parents’ plan until you’re 31 if you’re not married and don’t have kids.
Medicaid or CHIP
You can check with your state to see if you qualify for Medicaid insurance, which is available to eligible low-income residents.
In addition, if you’re pregnant or have children, you may qualify for CHIP (Children’s Health Insurance Program), even if you don’t qualify for Medicaid.
To find out more about both programs, go to medicaid.gov and select your state.
Bottom Line
Going without health insurance is a risk you shouldn’t take.
“Even if you are a young, healthy person that doesn’t even get the common cold each winter season, having health insurance can help put your mind at ease,” Zachary says. “Health insurance is the best tool you can use to avoid financial stress due to health care.”
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Protect Your Health and Finances: Do You Need Health Insurance? originally appeared on usnews.com
Update 09/04/25: This story was previously published at an earlier date and has been updated with new information.
