Middle-class shoppers struggle to stay insured. They’ve weathered years of price hikes and shrinking insurance choices with no help. Faced with more price increases for next year, they’re mulling options outside insurance or skipping coverage entirely—a decision that could lead to a fine for remaining uninsured and huge bills if an emergency hits.
The sign-up period for 2018 coverage closes on Dec. 15 in most states, meaning shoppers have only a few more days to find something that squeezes into their budgets.
The ACA helped chop the U.S. uninsured population 41% to 28.8 million people earlier this year from 48.6 million in 2010, when it became law, according to the latest government figures.
The law expanded Medicaid coverage for the poor and created health insurance marketplaces where people can use income-based tax credits to buy a single or family individual insurance plan if they don’t get coverage through work. Those subsidies cover part or all of the bill, capping insurance costs at a percentage of income for those who are eligible. That shields recipients from price hikes of 20% or more that have hit many markets.
But that help stops abruptly for people making four times the federal poverty level or more—around $48,000 for an individual and more than $98,000 for a family of four.
Of the roughly 15 million people who bought ACA-compliant individual insurance for this year, nearly 7 million had no tax credit help, according to the Kaiser Family Foundation.
Meanwhile, the uninsured rate among adults who make too much to qualify for help buying coverage jumped to 5% this year from 2% in 2016, according to The Commonwealth Fund.
Brokers and healthcare researchers expect that to climb again, especially for people with income levels close to the cutoff for federal help.
These customers can face monthly bills that climb past $2,000 for a family plan and then a big deductible before most coverage starts. Plus fewer markets this year have insurance that comes with a health savings account, which lets people save for medical expenses before taxes. Those accounts are popular with individual insurance shoppers who don’t get tax credit help, said St. Louis broker Emily Bremer.
Leslie Glogau said some of her customers in the Orlando area are considering short-term, limited-benefits plans that are cheaper than ACA-compliant coverage but can leave them vulnerable to big medical bills. Such plans also won’t stave off the uninsured penalty, which can amount to a few thousand dollars depending on income.
Insurance shoppers won’t be fined if they can’t find an affordable option in their market. But going uninsured would still leave them exposed to huge medical bills.
Alternatives include joining a medical cost-sharing ministry for next year. These ministries are not insurance, but they allow people to band together to share expenses, often by making monthly payments. They can be cheaper than regular coverage, and belonging to one allows customers to escape the ACA penalty for remaining uninsured.
Such arrangements usually come with restrictions or qualifications. For instance, participants may not be allowed to use tobacco, and there might be limits on help for medical conditions that existed before the customer signed up.
