What can I do if I can't afford health insurance?

Most people who think they can't afford health insurance qualify for substantial assistance — many for free or near-free coverage — but never apply. Here's the comprehensive list of options based on your specific situation.

Step 1 — Get an accurate read on what you qualify for

Check both:
- Medicaid (income-based, no premium)
- ACA Marketplace subsidies (income-based, lower premiums + cost-sharing reductions)

And:
- Medicare Savings Programs (MSPs) if you're 65+ or disabled
- Extra Help (Low Income Subsidy) for Medicare drug costs
- State-based pharmaceutical assistance programs
- Patient assistance programs for specific medications

Use our [free 60-second subsidy calculator](/aca/subsidy-calculator/) for a starting point, OR call HealthCare.gov at 1-800-318-2596 for personalized screening.

Step 2 — Assess each option in priority order

Option 1 — Medicaid (best if you qualify)

• Free or near-free coverage
• No deductibles or copays in most states
• Covers all essential health benefits + often dental, vision, transportation
• Year-round enrollment (no Open Enrollment restrictions)

Eligibility (varies by state):
- Income at or below 138% of FPL in expansion states (~$21,600/yr single, ~$29,200 family of 2 in 2026)
- Income at or below 100% FPL in non-expansion states for adults without dependent children
- Pregnant women, parents of minor children, disabled individuals, and seniors have higher income limits

Apply through: your state Medicaid office, HealthCare.gov, or 1-800-318-2596

Option 2 — ACA Marketplace with subsidies

If you don't qualify for Medicaid:

• Under 150% FPL: Often $0 monthly premium for benchmark Silver plan + Cost-Sharing Reduction (CSR) drops deductible to $0–$300
• 150–200% FPL: $0–$50/mo Silver with strong CSR
• 200–250% FPL: $50–$200/mo Silver with moderate CSR
• 250–400% FPL: $200–$500/mo Silver depending on age and area; CSR not available
• Above 400% FPL: Through 2025, capped at 8.5% of income; subsidy cliff returns Jan 1, 2026 unless extended

The 150% FPL year-round enrollment rule: If your household income is at or below 150% FPL, you can enroll any month — no Special Enrollment Period required.

Apply at: HealthCare.gov or your state Marketplace

Option 3 — CHIP for children

• Children's Health Insurance Program covers kids in households with income too high for Medicaid but moderate enough to need help
• Income limits vary by state but often up to 200–400% FPL for kids
• Premiums and copays usually $0–$40/month per family
• Apply through Medicaid agency or HealthCare.gov

Option 4 — Medicare with subsidies (for 65+ or disabled)

If you're 65+ or qualify for Medicare via disability:
- Extra Help pays most of your Part D drug costs (premium, deductible, copays) if income under 150% FPL
- Medicare Savings Programs (QMB, SLMB, QI) pay your Part B premium ($202.90/month savings) and sometimes deductibles/copays
- Dual eligibility (Medicare + Medicaid) is the most generous — full Medicaid wraparound for Medicare cost-sharing + extra benefits

Apply through your state Medicaid agency for MSPs and Medicaid; through Social Security (1-800-772-1213) or HealthCare.gov for Extra Help.

Option 5 — Employer coverage IF affordable

If you have access to employer-sponsored coverage:
- The employer typically subsidizes 60–80% of the premium
- Even with the employee share, often cheaper than Marketplace at moderate incomes
- Family glitch fix (2022) means family members can get Marketplace subsidies even if employee can't

Option 6 — COBRA

Usually a last resort because:
- Full premium plus 2% admin fee = often $1,500–$2,500/month for family coverage
- ACA Marketplace with subsidies almost always cheaper if you qualify
- 60-day enrollment window after losing employer coverage

Use COBRA only if:
- You don't qualify for ACA subsidies
- You're mid-treatment and can't disrupt your network
- Short gap between jobs and you'll have employer coverage soon

Step 3 — Reduce specific medical costs even without insurance

If you genuinely have no insurance options:

For prescriptions:
- GoodRx, RxSaver, Blink Health — discount cards work at most pharmacies, often 50–80% off retail
- Patient assistance programs from drug manufacturers — most major pharma companies offer free or reduced-cost meds for income-qualified patients (NeedyMeds.org, RxAssist.org index these)
- Mark Cuban's Cost Plus Drugs — cash prices on generics far below retail
- Walmart $4 generic list — many common generics for $4/month
- Local FQHCs (Federally Qualified Health Centers) — sliding-scale fees for prescriptions filled at their pharmacies

For doctor visits:
- FQHCs (federally qualified health centers) — sliding-scale fees based on income, $0–$50 typical visit cost; HRSA.gov find center
- Free and charitable clinics — listed at NAFCclinics.org; serve uninsured at no charge
- Direct primary care (DPC) — monthly subscription model ($75–$200/mo) for unlimited visits with a single PCP, no insurance
- Telemedicine — Cash-pay telehealth visits often $50–$80; sometimes covered by employer wellness programs

For emergency care:
- Emergency rooms cannot refuse you under EMTALA (federal law) regardless of ability to pay or insurance status
- Hospital financial assistance — most non-profit hospitals have financial assistance policies ("charity care") for uninsured/underinsured patients; ask before discharge
- Negotiate hospital bills — bills can often be reduced 30–60% for cash payment or with financial hardship
- Medical bill negotiation services — companies like CoPatient.com, MedBillsAssist.com

For mental health:
- Open Path Collective — therapists offering reduced-fee sessions ($30–$80) for uninsured
- University training clinics — psychology PhD/PsyD programs often offer low-fee therapy with supervised trainees
- 988 Suicide and Crisis Lifeline — free 24/7
- NAMI HelpLine — free mental health resource navigation, 1-800-950-NAMI

For dental:
- Dental schools — supervised student-provided dental work at 50% retail or less
- Local FQHCs — many include dental services on sliding scale
- DentaQuest and Aspen Dental — low-cost dental clinic chains

For vision:
- VSP Eyes of Hope, EyeCare America — free or reduced eye exams and glasses for income-qualified
- Walmart, Costco vision — low-cost glasses without insurance

Step 4 — Plan for the future

Uninsured is risky. Make a plan to get coverage:

1. Set a calendar reminder for ACA Open Enrollment (Nov 1 each year)
2. Track if you become eligible for an SEP (job change, move, marriage, etc.)
3. Re-check Medicaid eligibility quarterly — if income drops, you may newly qualify
4. Build an HSA when you eventually get HDHP coverage
5. Connect with local enrollment counselors at FQHCs, libraries, senior centers — they can help navigate

Free help applying:
- HealthCare.gov: 1-800-318-2596 (24/7)
- State SHIP (for Medicare): 1-877-839-2675
- Local enrollment counselors: Find at HealthCare.gov "Find Local Help"
- Medicaid hotlines: Search [your state] Medicaid for state-specific number

What to do next: Call (866) 534-1886. We screen you for ALL of the above options — Medicaid, Marketplace subsidies, MSPs, Extra Help, employer coverage, etc. — and help with the application paperwork. Free, no commitment, and we'll tell you honestly if a non-Marketplace path (Medicaid, Medicare, free clinic) is better for your situation than anything we'd sell.