Over the last decade the answer to the question of what happens if I don't have health insurance has changed many times. Prior to the passage of the Affordable Care Act, many people didn't give near as much thought to this question. Especially if they were young and relatively healthy. But when the landmark legislation was passed, words like personal mandate and ACA Compliant were introduced into the vernacular of Texans and it changed everything. Texans may not have wanted to pay for health insurance, but suddenly it was going to cost you money if you went uninsured. This all changed once again with law changes in Washington DC during 2018. Given the back and forth, let's take a look at exactly what does happen if you don't have health insurance in 2019.
Those Without Health Insurance Are No Longer Penalized Financially
After full implementation of the the Affordable Care Act (ACA), there was a penalty system put in place for those that did not have health insurance. In the first few years of the ACA, this penalty was fairly benign from a pocketbook stand point as the fine paid was small. But by 2017, the fine had grown to a point that many people went looking for options rather than just giving the government money. The penalty was put in place to force everyone in to the risk pool in an attempt to moderate premiums since all pre-existing conditions were covered without recourse. This all changed in 2018 as the laws were changed once again.
For calendar year 2019, the tax penalty has been eliminated for individuals who choose to go without health insurance. This means that unlike years past, there is no need to scramble and find a policy or qualified sharing plan to avoid the penalty. But there are still ramifications to continuing on without health insurance.
Can I See A Regular Doctor Without Health Insurance?
Yes! Of course you can see a regular doctor without health insurance. Many doctor's offices are not set up well to handle a cash pay patient. However, there is a viable cash pay market place due to many individuals not having visits covered by a health insurance plan. Many health share plans do not provide preventive type visits to their members. As such, those Texans are quite comfortable paying cash for a visit to their primary care physician and have found it to be quite cost effective. The one place where this can become problematic is for specialist type care. The cost to see a specialist, along with testing, can be quite expensive. So factor that into the cost effective equation.
Can I Be Denied Help At The Hospital If I Don't Have Health Insurance?
This is where the ability to get things done can become much more difficult. If you show up at the Emergency Room with a life threatening situation and no health insurance, you will receive care. It may bankrupt you, but you will receive care. If you are headed in for longer term care like cancer treatments, the process can become a bit sticky. Not having insurance and needing cancer treatments that may cost $200,000 puts you in a tough situation. That's why we recommend things like Catastrophic Health Insurance to allow you to combat those scenarios. Using insurance that only kicks in when things get big like Cancer is a different way to think, but can be very cost effective.
How Can I Afford My Prescriptions Without Health Insurance?
Pharmacy benefits may be one of the trickiest things to navigate when looking at working outside our current health insurance system in Texas. If you don't have health insurance, there are a couple of different paths that you can take. But realize that none of them will include high dollar treatments without you paying out of pocket. Insurance For Texans does have the ability to get you pharmacy benefits on a limited basis as one of those paths we discussed. It's a bit unusual, but possible. We typically recommend folks leverage things like Good Rx and comparison shop between pharmacies. In many cases, especially for generic prescriptions, the cost is so low on a Good Rx coupon that paying for a benefit service doesn't make sense. Your final alternative would be to leverage services that provide prescriptions to those who qualify from an income standpoint.
Anything Else To Consider?
Many Texans would rather go uninsured rather than buy coverage on the ACA Exchange. We get it. But our job is to make sure you understand the risks involved with that from a financial standpoint. We can not prevent you from having an accident, getting cancer, or anything health related. However, we can help you make sure that you are not sunk forever if something happens. Talk to one of our agents today about how to evaluate your options. Click the picture below to find out what you can do outside of the Exchange and an employer.