I Can’t Afford Health Insurance and Don't Qualify for Medicaid
If you can't afford insurance or get Medicaid, you might qualify for government help to get cheaper rates, or you can look into state health care programs or community health centers.
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The average cost for a Silver plan is $175 per month after discounts that are based on your income. If you make too much to get these discounts, you might be able to save on your monthly rate with a cheaper plan type, such as a high-deductible or Catastrophic health plan.
Affordable Care Act (ACA) subsidies
If you make too much to get Medicaid, see if you can get Affordable Care Act (ACA) subsidies.
Subsidies are discounts tied to your income. The less you make, the more you'll save on your health insurance from HealthCare.gov or a state marketplace.
You can only get subsidies if you shop on HealthCare.gov or your state's health insurance marketplace. If you buy a plan directly from an insurance company, you won't get discounts based on how much you make.
You can get an ACA subsidy if you earn between roughly $15,960 and $63,840 per year as a single person or between $33,000 and $132,000 as a family of four.
As you fill out an application on HealthCare.gov, you'll be asked for your income and household size. If you can get a discount, you'll have the choice of paying a lower rate each month. You can also choose to get your subsidies at the end of the year as a tax credit.
You can't use a subsidy to help pay for workplace coverage, Medicaid, Catastrophic plans or short-term health insurance.
Cost-sharing reductions (CSRs)
Cost-sharing reductions are a kind of discount that makes your costs cheaper when you get medical care.
For example, cost-sharing reductions can make it cheaper to get a prescription filled or go to the doctor. Cost-sharing reductions make getting care more affordable by lowering your medical bill.
You need to earn between about $15,960 and $39,900 as an individual or roughly $33,000 and $82,500 for a family of four to get cost-sharing reductions. In addition, you can only get cost-sharing reductions if you have a Silver health plan.
High-deductible plan options
High-deductible health plans are much cheaper than normal medical insurance.
However, you'll have to pay a large amount for your medical care yourself before your insurance starts paying toward most of your bills. This is called your deductible.
By law, a high-deductible health plan must have a deductible of $1,700 or more for an individual plan or $3,400 or more for a family plan. However, many plans have significantly higher deductibles.
If you have a high deductible health plan, you can put pre-tax money into a special account that can only be used for medical costs, called a health savings account (HSA). HSAs can be a great way to save for medical expenses so they don't impact your day-to-day finances as much.
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Other health insurance options
If you don't qualify for ACA subsidies, you may be able to take advantage of other cheap alternatives. These plans typically cost less than regular health insurance. But they often have less coverage, higher deductibles or other drawbacks.
It's a good idea to weigh all the costs you'll have to pay with a plan before you buy. That's because a plan with a low monthly rate may leave you with thousands of dollars in costs that you're responsible for when you visit the doctor.
Catastrophic health plans offer bare-bones coverage for a very cheap monthly rate. You have to pay a $10,600 deductible before a Catastrophic health plan will start covering most non-preventive services.
That makes a Catastrophic health plan a poor choice for most people. However, Catastrophic insurance might make sense if you're in good health and you have enough money in savings to easily cover your deductible.
You can only buy a Catastrophic health plan if you're under 30 or you qualify for a special hardship exemption.
Short-term health insurance plans typically cost less than regular health insurance but the coverage isn't as good.
You can usually buy a short-term health plan for about $250 per month. That's much cheaper than a Silver health plan, which costs $752 per month on average.
Keep in mind, short-term health plans don't cover as much as regular health insurance because they don't have to cover the same essential services as a marketplace plan. For example, short-term health plans might not cover maternity or psychiatric care.
Short-term plans can also reject you or charge you a higher rate based on a preexisting condition, and many plans cap your annual benefits.
Short-term health plans may have very high deductibles compared to ACA plans. It's usually a better idea to buy a plan through HealthCare.gov or your state's health exchange when possible.
However, short-term health insurance can make sense if you need temporary coverage and you have a limited budget.
You may be able to get Medicare if you have permanent kidney failure (end-stage renal disease), Lou Gehrig's disease (ALS) or if you've been on Social Security Disability Insurance (SSDI) for at least two years.
Otherwise, you'll automatically qualify for Medicare when you turn 65.
In most states, you can stay on your parent's health insurance until age 26. In addition, some states let you keep your parent's coverage into your late twenties or early thirties.
Currently eight states let you stay on your parent's health insurance after you turn 26. A further 17 states let you keep your parent's coverage past 26 if you have a disability that qualifies you.
A Basic Health Program works to help bridge the gap between Medicaid and a subsidized ACA health plan.
Currently, only Minnesota, New York and Oregon have Basic Health Programs. In Minnesota and Oregon, you can qualify for coverage if you make between $22,025 and $31,920 for a single person or between $45,540 and $66,000 for a family of four.
In New York, the limit is higher. You can make between $22,025 and $39,900 for an individual or between $45,540 and $82,500 for a family of four.
If you can't afford health insurance but can't get Medicaid, consider getting your health care from a health center.
Health centers don't sell insurance, but they do provide medical care for people with low incomes. The cost depends on how much you make; you'll typically pay less if you make less.
You can get multiple kinds of care at a health center, including regular doctor care, eye exams, dental care and more. You can find a health center in your area by using the Find a Health Center tool from the Health Resources & Services Administration.
Tips for saving on health insurance
You might be able to save on your monthly health insurance rates by comparing quotes from different companies, picking a plan with a high deductible and choosing an HMO plan.
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You can save hundreds of dollars or more per month without sacrificing coverage by switching to a cheaper plan.
For example, a Silver plan from UnitedHealthcare costs $819 per month, on average. In contrast, a Silver plan from Ambetter for the same person is $701 per month, on average. That's a difference of $118 per month, or $1,416 per year, for the same level of coverage.
Keep in mind, plan availability and cost depend on where you live. It's also important to factor in customer satisfaction when choosing your health insurance company.
With that said, companies that charge higher rates don't always offer better service. For example, Kaiser Permanente has both cheap average rates and high levels of customer satisfaction.
Choose a plan with a higher deductible
A higher deductible generally means a cheaper monthly rate. That's because you're willing to pay more when you get care, which saves the insurance company money.
It's important to have enough money in your savings account to easily cover your plan's deductible. That way, if something major happens, you won't struggle to afford your medical care. Don't choose a plan with a high deductible unless you can reasonably afford to pay it.
Unlike with car and home insurance policies, you can't just raise your health insurance deductible. You have to look for a plan with a higher deductible. Once you buy that plan, the deductible is set until the next time you can shop for a plan, which is usually open enrollment.
Switch from a PPO to an HMO
Switching from a PPO to an HMO can save you hundreds of dollars per year or more.
Consider enrolling in an HMO if you don't mind trading flexibility for cheaper monthly rates. The average 40-year-old will pay $696 per month for an HMO plan, on average, compared to $836 per month for a PPO plan. That's a savings of $140 per month, on average.
- HMOs (health maintenance organizations) restrict you to a network of doctors. You also need to go through your primary care doctor to see a specialist.
- PPOs (preferred providers organizations) offer more freedom compared to an HMO because they don't require a referral to see a specialist. Also, you can see out-of-network doctors with a PPO, although you'll pay more to do so.
Frequently asked questions
What should I do if I can't afford health insurance?
If you can't afford health insurance, first check if you can get Medicaid. You can get Medicaid in most states if you make less than about $22,025 per year as a single person or less than $45,540 per year as a family of four. If you make too much to get Medicaid, you may be able to get discounts on health insurance from HealthCare.gov or your state marketplace. If you can't afford to buy a plan even with discounts, consider a Catastrophic plan, short-term health insurance or getting medical care from health centers.
What's the income limit for Medicaid?
In most states, you have to make less than around $22,025 per year as an individual or less than $45,540 per year as a family of four to get Medicaid. In some cases, you might be able to make more and still get Medicaid. For example, the income limit for pregnant women is usually higher. Check your state's laws to find out how to qualify for Medicaid in your specific situation.
What is an alternative to Medicaid?
If you can't get Medicaid or marketplace discounts on health insurance, look for community health centers. You can get medical care from a health center, and the cost is scaled to your income. If you live in Minnesota, New York or Oregon, you can also look into your state's Basic Health Program, which is meant to help people who make too much for Medicaid.
Methodology and sources
Health insurance rate data for 2026 is from the Centers for Medicare & Medicaid Services (CMS) website. ValuePenguin used the CMS public use files (PUFs) to find average rates for different plan tiers, geographic locations and family sizes.
Rates
Rates are based on a 40-year-old with a Silver plan, unless otherwise noted. Your costs and plan options will vary; plans aren't always available in all parts of a state or county.
Subsidies
Rates after subsidies are estimates for a 40-year-old with a Benchmark Silver plan and are based on how subsidies were structured before 2021. Prices are calculated using KFF's rates for full-price Benchmark plans, federal poverty levels (FPLs), IRS rules about premium tax credits and Congressional reports about expanded tax credits. The total cost in the state uses calculated rates by income, which are weighted using CMS data on the incomes of those who purchased plans during last year's open enrollment. The median was used for each income range. Unknown incomes were excluded from the calculations. Incomes of 100% of the federal poverty line and 500% of the federal poverty line were assumed for enrollees who earn less than 100% FPL and more than 500% FPL, respectively.
Short-term health insurance rates
Rates are for a 40-year-old man in Austin, Texas, with averages calculated from four insurers across three coverage levels.
Minimal coverage
- $7,500-$10,000 deductible
- $1 million policy maximum
Moderate coverage
- $5,000 deductible
- $1 million policy maximum
Good coverage
- $2,500 deductible
- $1 million policy maximum
If an insurer offered multiple policies that fit a coverage category, the rates were averaged.
Other sources
Other sources include Congress.gov, HealthCare.gov, the Internal Revenue Service, Medicaid.gov, Medicare.gov, the U.S. Department of Health and Human Services, the U.S. Health Resources & Services Administration, the U.S. Department of Labor and various state websites.
About the Author
Senior Writer
Cate Deventer is a Senior Writer who specializes in health insurance, Medicare, auto and home insurance. She's been a licensed insurance agent since 2011.
She started her insurance career working as a customer service agent for State Farm. She later moved to an independent agency, where she worked with several insurance companies and hundreds of clients. She quoted policies, filed claims and answered insurance questions. In 2021, she pivoted her career and began writing about insurance for Bankrate. She moved to ValuePenguin in 2023 and began writing about health insurance and Medicare.
Cate has a passion for helping readers choose insurance to fit their needs. She enjoys knowing that her research and knowledge help people choose insurance products that make a positive difference in their lives.
How insurance helped Cate
Cate used her health insurance knowledge to navigate a surgery in 2023. Understanding how her policy worked let her focus on recovery instead of worrying about bills.
Expertise
- Health insurance
- Medicare & Medicaid
- Auto insurance
- Home insurance
- Life insurance
Credentials
- Licensed Life, Accident & Health Insurance Agent
- Licensed Property & Casualty Insurance Agent
Referenced by
- CBS
- NBC
- Wall Street Journal
Education
- BA, Theatre, Purdue University
- BA, English, Indiana University
Editorial note: The content of this article is based on the author's opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.
