What Happens If You Don't Have Health Insurance in the United States - #MedicalBillerExplains Ep. 7

Millions of people in the United States do not have health insurance. Sometimes this is the result of a divorce, losing a job, or a death in the family. But whatever, the reason we are here to tell you what you need to know about being uninsured. Why might people not have health insurance?

What Happens If You Don't Have Health Insurance in the United States - #MedicalBillerExplains Ep. 7
Photo by Arseny Togulev / Unsplash

Frederick McNulty: Hey everyone. Welcome to the channel. I'm Frederick McNulty, Director of Content at Finestra. In this series, we're asking the most common questions about healthcare in the United States and hearing answers from certified experts.

Amethyst Storey: Hi, I'm Amethyst Storey. I'm a certified professional biller, and I've been in the field for 17 years.

FM: Millions of people in the United States do not have health insurance. Sometimes this is the result of a divorce, losing a job, or a death in the family. But whatever, the reason we are here to tell you what you need to know about being uninsured. Why might people not have health insurance?

AS: People might not have health insurance if they don't have enough money to pay the premiums and they can't qualify for Medicaid. With Medicaid, you have to be under a certain federal poverty level to qualify, and it's based on your state's regulations, which vary by every state.

And there is something called the Affordable Care Act that was put into place several years ago. That makes premiums a little bit more affordable. You should be able to go onto your state's health exchange. In Connecticut, It's Access Health; in different states, it's called something different, but you should be able to go on there. And they do have tax credits now, that make the premiums for people more affordable. So more people can get insurance coverage.

FM: If someone is uninsured, are they still able to access medical care?

AS: Yes. If you're uninsured, you are able to access medical care, but it does put a strain on the system because a lot of people that are uninsured will go to a hospital because they can't be turned away if it's a government funded hospital. So they go there to get the care they need and they receive it. But it puts a strain on the healthcare system - especially if the care is not emergent.

FM: If someone needs care, but they're uninsured and they go to the hospital - what happens to the bill?

AS: If they go to the hospital and they don't have insurance and they need care, they're taken care of in the emergency room, just like any other patient. Registration will come in and get their information, their address, their phone number, and they will be sent a bill at a later date. At which point I would expect them to call; hospitals do have financial paperwork if you don't have insurance, or if you're having a hardship with being able to pay, there are funds that can help you. But in general, they don't tell you about them. You have to ask.

FM: Up to this point, we've mostly been discussing individuals who are uninsured, who themselves need medical care. But what happens if for example, a child is in the household and the child is also uninsured, are they able to access care?

AS: Children can also access care if they're uninsured. However, sometimes children can qualify for health insurance that adults cannot. For example, in the state of Connecticut, children can qualify for Medicaid -even if their adult parents don't qualify. You should always contact social services to look into what options are available for children if there are uninsured children in the household.

FM: Speaking generally, if you're uninsured, will things be more expensive?

AS: Yes, things are usually more expensive if you're uninsured, because what happens when you have insurance and you go to an in-network provider, that provider has a contracted rate. So you're only paying a portion of that contracted rate instead of the full rate. If you're uninsured, you're paying a full self pay rate, which is in general more expensive.

FM: Is the rate that someone who is uninsured and the rate that someone who is out of network are those similar?

AS: No, they actually can be very different. The out of network rate - it's still billed at the same rate. So for example, if you're billing $150 for something it's still billed at $150 to the insurance company, when you have out-of-network benefits, the patient generally has a higher cost share, but they're still going to pay for something. Whereas if you're uninsured, you're gonna be paying the full rate. There is no discount or out of network rate. It's just one flat self-pay rate.

FM: When the affordable care act commonly known as Obamacare passed, there were a lot of controversies surrounding a mandate that every person be insured. Could you speak a little bit about how that impacts people who are uninsured?

AS: People who are uninsured are penalized at the end of the year on their taxes. There is a penalty that they add to your taxes. If you are not insured for all 12 months of the year. And that penalty is prorated by the number of months that you're uninsured.

FM: What advice would you give to someone who's uninsured?

AS: If you're currently uninsured, I would go to social services and look into what your options would be for insurance. You could fill out an application and see what kind of insurance you qualify for. If you don't qualify for Medicaid insurance, you can also go to the exchange website in your state and find out what you qualify for, because due to the ACA, there are tax credits now that can help you afford your insurance premiums.

Even if you end up having a high deductible, it's better to have insurance than not to have insurance to cover you if you ever need care. One of the biggest things that's hard for people that are uninsured is that if there is not a hospital nearby, or if it's a private hospital, they don't have to see you. If you're uninsured and you don't want to go without medical care.