Survival Update

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Surviving Without Health Insurance: Good Luck With That

Without putting too fine a political point on it, former President Barack Obama pushed through his signature 2014 Affordable Care Act by making promises that have proved to be untrue. One example is that the new plans did not allow patients to keep their doctors after Obama’s repeated statements assuring the contrary.

The very name is a lie as millions of Americans find they do not earn enough money to pay for an ACA health insurance plan. These people earn too much money to qualify for low-income Medicare.

Welcome to my world and that of many fellow Baby Boomers. We have become unwilling victims of an ill-advised scheme that sought to socialize health insurance in the United States.

As of January 2019, according to Vox, the number of American without health insurance has gone up, up, up:

“The country’s uninsured rate has steadily ticked upward since 2016, rising from a low of 10.9 percent in late 2016 to 13.7 percent — a four-year high.”

Hardest hit have been younger Americans as well as people with lower income. Even though employment is at an all-time high, the U.S. uninsured rate continues to climb.

This may be due to the fact that many employers take advantage of the legal loophole that allows them to deny health insurance coverage to employees who work fewer than 32 hours a week. These cost-conscious companies are trimming expensive insurance benefits by hiring more part-time laborers.

Rather than go down, health insurance premiums (the monthly fee for coverage) have risen since the advent of ACA.

Generally speaking, younger people pay less for the same coverage as their elders. Insurance actuarial tables are used to determine the likelihood of medical need. Statistically, older folks need more medical attention than their juniors.

Before ACA, young people could get by with a catastrophic care plan which featured a high deductible and low premiums. (The deductible is the amount of money the insured person has to pay before the plan benefits kick in.)

Under ACA, all major medical plans effectively became catastrophic care plans with high deductibles and even higher out-of-pocket limits (the maximum amount the plan holder will ever pay in a plan year) – but with high premiums to boot.

The Trump administration has helped a bit. Effective January 1, 2019, the federal tax penalty on refunds due was repealed.

Major medical insurance is a must for people who need comprehensive benefits, want a policy that complies with the Affordable Care Act (ACA), and is guaranteed despite a spotty health history or pre-existing medical conditions.

As of 2019, the average health insurance premium for Americans aged 21 to 24 was $200 per month, according to The Street. Bump that monthly cost one dollar for 25-year-olds.

Check out the true costs of ACA in 2019 for Americans over age 25:


26 – $205

30 – $227

35 – $244

45 – $289

50 – $357

55 – $446

60 – $543

64 – $600

You read that right: the year before Medicare eligibility (age 65), a major medical health insurance plan costs, on average, $600/month for a single person.

This is why I don’t have health insurance. I simply don’t earn enough money to pay for it – but I bring in too much money to qualify for low-income Medicaid. And, as previously mentioned, I’m not alone.

My basic strategy is to stay healthy by eating a well-balanced diet and exercising regularly. I pay for annual check-ups, dental, and vision doctors as a “self-pay” – the industry term for “uninsured.”

But I don’t kid myself: like so many others, I am one accident away from financial destitution.

Sure, there are a few options open to people like me: short-term medical insurance and zero-deductible/fixed indemnity insurance plans can be more affordable to meet daily healthcare needs. These one-year plans feature lower premiums and more (read: higher) deductible choices.

Hospital indemnity insurance helps pay hospital, surgical and critical illness-related expenses. Benefits are paid as fixed-dollar reimbursements for covered medical expenses at specific durations. However, some states require you to have purchased a major medical policy before you can enroll in a hospital indemnity plan as supplemental coverage.

In the Medicaid expansion states – Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington and West Virginia – income determines eligibility.

Residents of these states may receive Medicaid benefits if their household income is below 133 percent of the Federal Poverty Level. A person living alone with no minor dependents may earn no more than $16,146.20 annually for Medicaid eligibility.

The ACA itself deemed that 2018 health insurance plans were ‘unaffordable’ when the lowest-cost exchange or marketplace plan available cost more than 8.05 percent of the person’s household income.

The message I’m getting from my federal government is, basically, “Drop dead.” Without a robust health insurance plan, the odds of that happening have gone ‘way up. Just sayin’.