Staying Healthy When Your Job Doesn’t Provide Health Insurance | Part 1

If you’re one of the 27.6 million people in the United States without health insurance, then you know it can be tricky to stay on top of health concerns. Many part-time, freelance, and contract workers don’t get health benefits as part of their employment, while others may be worried about the potential of losing their job and long-term coverage in one fell swoop. 

Should you get insurance? If so, how do you find affordable plans? What if you’re relatively healthy—is it better to skip the expense?

Dive into each of these situations below to find out how to get the care you need when your job doesn’t provide health insurance.

Should your employer provide insurance?

The Affordable Care Act requires employers with 50 or more full-time workers to provide health care coverage to full-time employees—anyone who works 30 hours or more a week, or 130 hours or more a month. The employer’s plan should meet "minimum value" coverage and affordability standards; for instance, the plan should provide substantial coverage of physician services and at least 60% of the total allowed cost of benefits.

A smaller organization might not be able to offer health care benefits, but if your employer has enough full-time workers to meet the criteria above, you may be entitled to health insurance. Ask a human resources representative for details about what your organization can provide.

The Health Insurance Marketplace

If your job doesn’t provide a plan, your next step is to check out the Health Insurance Marketplace at healthcare.gov. The site is designed to be a one-stop shop for health plan comparison and advice.

The Marketplace can be confusing, so let’s run through some fast facts:

• The enrollment period, a time when you can compare and pick a plan, generally starts in the fall of the calendar year before coverage begins. You can enroll in the fall of 2023 for coverage in 2024, for instance.
• There’s a deadline for enrollment each year (this year, the deadline is December 15 for coverage that starts January 1, 2024).
• What if you miss the deadline? You won’t be able to enroll in the regular Marketplace, but you might qualify for a Special Enrollment Period, which lets you apply for insurance at any time.

The Special Enrollment Period is offered to people who have experienced recent major life changes, such as losing a job, getting married, having a baby, changing residences, etc. The Marketplace defines "recent" as the past 60 days, so act quickly and see what other changes may qualify here.

Pro tip: You can appeal a decision within 90 days from the date of your Eligibility Notice if the Marketplace denies coverage or a Special Enrollment Period. There are no guarantees, but it may be worth a shot depending on your situation.

It is possible to buy private health insurance outside of the Marketplace. You can visit sites like eHealth or go to the websites of individual providers. Plans tend to be pricier this way, so run a cost comparison and make sure you know what each plan covers.

Medicaid and other income-sensitive options

Jobs without coverage usually don’t come with huge salaries. Managing your money on a limited income takes some planning, but it doesn’t mean you have to go without insurance.

You might qualify for Medicaid, the low-income health insurance program. Medicaid offers affordable and sometimes free services from qualifying health care providers. You can enroll year-round, and there is no deadline to apply. The income guidelines for Medicaid are slightly different for each state, so look up your state on Medicaid’s website to find out if you qualify. 

Here’s where you have to crunch some numbers: Medicaid eligibility is based on how your income compares to the federal poverty level. Let’s say you make an annual income of $12,000 (for individuals). This is about 100% of the federal poverty level for an individual. If you earn less than this annual amount, you’ll most likely qualify for Medicaid if your state has expanded Medicaid coverage. If you earn more, you might still be eligible for premium tax credits, which save you money on a Marketplace plan.

The application process is paperwork-heavy, so get your important documents together. Depending on the state in which you are applying, gather relevant documents like proof of identity (a birth certificate or Social Security card), proof of income, proof of address, etc. If you have children, you may be able to get them low-cost health coverage through the Children’s Health Insurance Program (CHIP). Like Medicaid, CHIP takes applications all year so you don’t have to meet the Marketplace deadline.

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Ready for Part 2 of this series, Staying Healthy When Your Job Doesn’t Provide Health Insurance? We cover topics like dental and vision care, preparing for medical emergencies, and what to know if you decide to stay uninsured.