How to Get Health Insurance Without a Job: Navigating the System

Can You Get Health Insurance Without a Job? 

Yes, if you’re unemployed, you can get health insurance for yourself and your family in several ways. Losing your job, whether due to quitting, getting fired, or being laid off, qualifies as a “life change.” This life change provides you with a Special Enrollment Period (SEP), allowing you special access to a new health insurance plan through the ACA marketplace.

However, this is not your only option. You may also want to consider these other plans: 

• Medicare, Medicaid, and CHIP
• COBRA
• Short-Term and Catastrophic Plans
• Joining a Family Member’s Plan
• Professional and Trade Associations
• Health Sharing Ministries

Determining which option is right for you depends on various factors, such as your dependents, where you live, and income level. Read on to learn how to choose the right health insurance policy for your needs.

How The ACA Changed Everything 

Before the Affordable Care Act (ACA) was enacted in March 2010, almost all healthcare was tied to employment, had unregulated pricing, and was inaccessible to those with preexisting conditions.

The ACA improved on many of these previous issues. Nowadays, low income households can qualify for subsidies to help pay for insurance, even after losing a job. Further, the ACA also provided guaranteed protection for the following categories of care:

• Ambulatory Patient Services: Outpatient care that doesn’t require an overnight stay, such as doctor’s office visits, outpatient surgeries, and diagnostic tests.
• Emergency Services: Treatment for medical conditions that require immediate attention, including ambulance services and emergency room care.
• Hospitalization: Inpatient care and hospital stays, including surgeries, medical treatments, and overnight stays.
• Maternity and Newborn Care: Prenatal care, labor and delivery, and postnatal care for pregnant women and newborns.
• Mental Health and Substance Use Disorder Services: Mental health treatment, counseling, and substance abuse treatment to ensure mental well-being.
• Prescription Drugs: Coverage for necessary prescription medications, ensuring access to essential pharmaceuticals.
• Rehabilitative and Habilitative Services and Devices: Therapy and devices to help patients recover from injuries, disabilities, or chronic conditions, as well as services to help patients develop or maintain skills for daily living.
• Laboratory Services: Diagnostic tests and screenings to aid in medical diagnosis and treatment planning.
• Preventive and Wellness Services and Chronic Disease Management: Services aimed at keeping patients healthy and managing chronic conditions, including vaccinations, screenings, and counseling.
• Pediatric Services, Including Oral and Vision Care: Essential health services for children, including dental and vision care.

How Does Health Insurance Work If You’re Unemployed? 

Don’t panic about finding a new health insurance plan if you’re unemployed. Several short and long term options exist, whether you’re between jobs for a few months or longer. 

Who Is Eligible For Health Insurance When They’re Unemployed? 

Due to the ACA, virtually anyone can access affordable health insurance, even while unemployed. Getting cheap health insurance when you don’t have a job involves several personal factors. Factors may include (but are not limited to):

• Your income
• Your family
• Special health needs
• Where you live
• Your age
• The insurance you had at your last job

What Types of Plans Are Available? 

Plans available across the board include: 

• HMOs: Your health maintenance organization (HMO) coverage limited care to HMO providers; the HMO only covers emergency out-of-network care. 
• PPOs: With Preferred provider organizations (PPOs), you pay less if using in-network providers, but you can use out-of-network providers and pay more—no referral necessary.
• POS: Point-of-service (POS) plans cover in-network providers at a higher rate (lowering your costs) but require a referral for specialists. 
• EPOs: Exclusive Provider Organizations (EPOs) require you only to use in-network healthcare providers and hospitals.

Exploring Healthcare Options Available Without Insurance

Several healthcare coverage options are available to you, even if you don’t have a job-based employer plan. Some are longer-term, while others are temporary while you don’t have a job.  

ACA Marketplace Plans 

What Is This Plan?

The Healthcare Marketplace is an online site that compares available plans, coverages, and prices. The plans are separated into metal levels, with Bronze plans providing less coverage than Gold and Platinum plans.

Who Can Get This Plan?

These plans are available to anyone, no matter their employment status. In addition, ACA-compliant plans cannot exclude you due to preexisting conditions, and you can enroll your children in the plan. 

How Much Does It Cost?

High deductible Bronze plans may cost just a few hundred dollars per month but come with higher deductibles and lower cost sharing ratios. Low deductible Gold or Platinum plans feature higher premiums but lower deductibles and more coverage. However, if you’re eligible to sign up for but didn’t enroll in a family member’s employer offered health insurance, you may not qualify for lower, income based Marketplace coverage costs. 

How To Get This Plan

If you’ve recently become unemployed, you qualify for an SEP, which allows you to enroll online through the Marketplace website. Or you can call an insurance agent to inquire about costs and any savings you qualify for. However, note that Marketplace plans start on the 1st of the month, so if you lose your employer’s coverage on the 15th, you may go 15 days without any health insurance coverage.

Pros and Cons 

Pros: 

• Qualify for premium savings based on this year’s income estimate, not last year’s earnings (when you were employed all year) 
• Plans are ACA-compliant and have broad-based coverage 
• You’ll know all premium and out-of-pocket expenses upfront, depending on the plan you choose

Cons: 

• Can be more expensive than your old employer-based plan
• You must choose a Silver plan to qualify for cost-sharing reductions, which may not have the same coverages as a Gold or Platinum plan
• Gaps in coverage can occur if your employer’s plan ends mid-month

Medicare, Medicaid, and CHIP 

What Are These Plans?

These are government plans that offer healthcare for adults over 65 (Medicare), low-income adults (Medicaid), and children (CHIP). Plans vary by state and type, but most offer care within a network. State-based plan services may depend on the plan and where you live.  

Who Can Get This Plan?

Your eligibility is not based on employment status but on age, income, and household size. Medicare is based on age-based eligibility, primarily. Medicaid and CHIP depend on household income levels (set by the state) and other factors such as disability. However, preexisting conditions won’t prevent you from gaining coverage. 

How Much Does It Cost?

Premiums are very low for government programs. For example, Medicaid premiums can be based on a percentage of household income (such as 2%) or as low as $1-$10. Medicare may be as low as $164 per month. Deductibles are also low. 

How To Get This Plan

Filling out a Marketplace application for health insurance coverage automatically lets you know if you or your family qualify for Medicare, Medicaid, or CHIP. If you are eligible, the Marketplace contacts your state agency, which helps you enroll. 

Pros and Cons

Pros: 

• Very affordable with free and low-cost coverage for kids and teens up to age 19, particularly if you have little to no income 
• Comprehensive coverage for primary and preventive care
• Medicare provides several plans, including Original Medicare and Medicare Advantage plans

Cons:

• May be confusing to figure out if you or your dependents qualify for income-based coverage based on your state of residence, particularly if you’ve lost your job and your income is uncertain
• Some plans offer limited networks and coverage
• Only some family members (children) may qualify for coverage 

COBRA 

What Is This Plan?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to stay with your employer’s group health insurance plan, even if you were laid off or quit. If you were laid off or otherwise had your employment terminated, you’re entitled to at least 18 months of continuation coverage, which may extend to 36 months in certain situations. 

Who Can Get This Plan?

You and/or other family members qualify for COBRA if you were all already enrolled in your employer’s health plan, your employer had 20 or more employees, and a few other employer-based restrictions. Keep in mind that you will not qualify if you were fired for gross misconduct.

How Much Does It Cost?

You’ll likely find that COBRA is more expensive than what you paid when employed because your employer probably paid part of your costs. You may be required to pay your plan’s entire premium and possibly even more, up to 102% of the plan’s cost. 

How To Get This Plan

Your employer informs the health plan that you’re unemployed; the plan then sends you an election notice describing how to get COBRA coverage. You have up to 60 days to decide whether you want COBRA.

Pros and Cons

Pros: 

• Same plan means you don’t have to shop for new plans or providers
• Employer plans may offer better coverage 
• Can be an excellent short-term option when you don’t have a job

Cons: 

• Likely more expensive than other options 
• Dependents are eligible even if you don’t stay enrolled
• You must find another option within 18 months

Short Term and Catastrophic Plans

What Is This Plan?

These plans are typically more affordable but can be confusing. Here is a quick rundown: 

• Catastrophic: You pay most expenses out of pocket, as this insurance primarily insures you against expensive emergency room visits. However, many essential and preventive services are still covered. You can purchase these plans on the ACA Marketplace.
• Short-term insurance: Plans vary by state and primarily cover those with no jobs for a few months. Essential and preventive services are not generally covered. You cannot purchase these plans on the ACA Marketplace, which are not ACA compliant.

Who Can Get This Plan?

Catastrophic plans are only available for those under age 30 or if you have a hardship or affordability exemption and are over age 30. Preventive plans may not cover any treatment of preexisting conditions. 

Short-term plans are available for all ages but may enroll those with or cover treatment of preexisting conditions. Short-term health insurance plans involve medical underwriting that determines coverage, and short-term plan length and types can vary by state.  

How Much Does It Cost?

Catastrophic and short-term plans vary based on coverage and deductibles, but deductibles can be as high as $6,000 for one individual, which means you’ll pay the first $6,000 in medical costs out of pocket. This is fine if you have no healthcare needs all year, but it could become costly if you have to see a physician repeatedly. As a tradeoff, the premium is very low. 

How To Get This Plan

You can find out if you qualify for a catastrophic plan when you apply for a Marketplace plan; you may also need to apply for a hardship exemption. Short-term plans differ by state, and your state’s insurance department will list short-term plans available to you, along with any restrictions.  

Pros and Cons

Pros:

• Relatively lower monthly premiums 
• Insures against worst-case scenario financial disaster due to medical bills
• Short-term plans can cover gaps between employment, or gaps between employment and Marketplace plans

Cons: 

• Very high deductibles and potential out-of-pocket expenses
• Depending on the short-term insurance plan, it may not cover preexisting conditions
• Limited enrollment length or renewals possible

Joining a Family Member’s Plan 

What Is This Plan?

If your spouse has job based insurance, it may be possible to join that plan. If you’re an adult under age 26, you may also be able to join a parent’s job based or ACA-compliant plan if it covers dependents. 

Who Can Get This Plan?

These plans’ coverage will vary depending on the plan, your state, and other factors. However, most family member plans should cover preexisting conditions without medical underwriting as long as the plan is not grandfathered. A grandfathered plan refers to a health insurance policy that was in effect on or before March 23, 2010, when the Affordable Care Act (ACA) was signed into law.

Young adults can even enroll on a parent’s plan, even if that young adult is married to a spouse. However, your spouse and children cannot enroll. Coverage from an employed spouse may include spouses and dependents.

How Much Does It Cost?

An employer-based plan can be far less expensive due to group rates and employer subsidies for the monthly premium. Most job-based plans meet “affordable” coverage standards, meaning it costs less than 9% of your household income. 

How To Get This Plan

Ask your parent or partner to ask their workplace benefits administrator for information, telling the administrator that you lost your job and qualify for a special enrollment period. 

Pros and Cons

Pros: 

• Most plans meet basic coverage standards
• Most plans meet affordability standards 
• As a result of the above, it offers more value

Cons: 

• Limited application, primarily spouses (and their children) and dependents up to age 26
• Not available to dependents’ spouses and families 
• May be more expensive than the cheapest Marketplace options

Professional and Trade Association Plans

What Is This Plan?

Trade associations may offer a range of health insurance coverage, including coverage for medical, vision, and dental services. With professional and trade association plans, members pay in and share costs like a small business. Some plans are tailored to specific needs related to the occupation represented by the union or trade.

Who Can Get This Plan?

You must be a member of the organization, which will set out any requirements and restrictions. The plans are usually limited geographically and legal in limited states. However, they may partner with more extensive healthcare plans or Medicare Advantage plans to provide more extensive coverage.

How Much Does It Cost?

Plan costs vary widely with “a la carte” pricing based on how you put together your plan and its comprehensiveness. The cost may also depend on whether you are currently working for the group.

How To Get This Plan

Review your professional memberships or association memberships and call to ask if health coverage is offered even if you’re currently unemployed. If so, carefully review options, exclusions, and pricing (monthly and out-of-pocket estimates). 

Pros and Cons

Pros:

• Can assemble your own plan (preventive, medical cost sharing, virtual, vision, dental, accidental, etc.)
• Plans can be tailored to the needs of your trade, profession, or other association
• Plans may be inexpensive if you choose virtual-only care 
• Sometimes available to individuals who worked within the organization and retired

Cons: 

• Minimal availability by location and profession
• May not be available at all in some states 
• Limited benefits, or may only connect you to a licensed insurance agent

Health Sharing Ministries

What Is This Plan?

A health care sharing ministry (HCSM) plan allows those with a similar religious affiliation to share costs. Members submit bills to their plan after treatment, but there is often no payment guarantee. These plans aren’t actual insurance, don’t comply with ACA requirements, and may not be regulated by your state. 

Who Can Get This Plan?

HCSMs may require abstaining from extramarital sex, drugs, and alcohol. But depending on the plan, it may not have criteria for age, weight, health history, or geographic location. You may be able to add family members, as well. However, you might pay more if you have a preexisting condition.  

How Much Does It Cost?

Premiums can be as low as $90/month, with high annual deductibles ranging from $1,000 to $5000. Coverage or “cost-sharing” starts at a specific amount per incident, such as $1,000 or $2,500. There may be limits on illnesses, such as $100,000 per illness. 

How To Get This Plan

Around 107 HCSMs are U.S. Health and Human Services certified. You can find an HCSM near you and apply online in most cases. You will then be directed to your “share amount” to pay, similar to a premium in traditional health insurance, which may change in the future. 

Pros and Cons

Pros: 

• HCSMs offer very inexpensive monthly health insurance costs for membership. 
• HCSMs may also offer spiritual support, including individual or community prayer. 
• Some plans may offer telehealth and discounts on dental or vision services.

Cons: 

• Your state’s Department of Insurance does not regulate HCSMs
• Many states have taken action against HCSMs for fraudulent or deceptive practices
• Limited application the vast majority of HCSMs are for Christians only

What Is The Safest Option Available To Unemployed People?

Losing job based coverage qualifies you for a Special Enrollment Period for the Marketplace or your spouse or parent’s job-based coverage if that coverage is offered to dependents and spouses. 

If you’re not earning or receiving unemployment compensation, apply for Medicaid, CHIP, and other cost-saving insurance through the Marketplace. You’ll be asked to predict your income, which includes unemployment pay and some retirement withdrawals, but may qualify for reduced healthcare costs. 

Any ACA-compliant plan is the safest bet; you’ll be more sure of your out-of-pocket costs and coverage for essential and preventive benefits. You won’t be excluded due to a preexisting condition. 

Putting It All Together 

If you’ve quit, been fired, or just laid off, you can be confident that you have health insurance coverage options. Maintaining coverage may seem expensive, but doing so can help avoid devastating financial losses if you’re injured or hospitalized while uninsured. When researching your options, be sure to compare the following: 

• Start dates: When does the coverage kick in, and does it leave you without insurance for a period?
• Costs: Does a low premium or cost-sharing expense cover potentially high out-of-pocket costs or low lifetime limits
• Coverage: Does the plan meet ACA requirements? Are there exclusions you’re not comfortable with?

However, don’t wait to act. Some plans have deadline requirements to meet for qualification. The Special Enrollment period requires action within 30 to 60 days after losing job-based coverage, depending on whether you’re trying to access your spouse’s plan, COBRA, or the ACA. With fast, decisive action, you can stay protected and keep costs down until you find your next job.