A Healthcare Survival Guide for the Uninsured

For most consumers, understanding the nuances of the American healthcare system and health insurance is incredibly confusing. And that's putting it lightly.

What makes healthcare so complex? For one, the costs of care vary widely. A McKinsey study notes that about one-quarter of all consumers have been faced with unexpectedly high medical bills. On top of that, it can be difficult to get a straight answer to a basic question like, “What can I expect to pay out of pocket for this procedure?” And even if you do, the answer might make you feel even more anxious, given how expensive some treatments can be — even for those covered by traditional health insurance.

Another concern involves the lack of communication and transparency between consumers, insurance systems, and healthcare providers. People in need of care often feel that they receive only the bare minimum when it comes to customer service, respect, and compassion. They can feel disconnected from and have a lack of trust in their doctors. Beyond that, for the uninsured, those in poverty, family caregivers, and non-English speakers, these problems can often feel magnified.

When people face these barriers to health insurance and healthcare, it puts them, their families, and their communities at risk, especially if they do the following:

• Trust friends and family for advice about medical care. Though people mean well when they do this, it's dangerous. Without the guidance of healthcare professionals, these patients miss out on available healthcare resources and possibly place their trust in flawed information.
• See medical care as only for acute injuries and illnesses. This leaves those with chronic conditions, like diabetes or high blood pressure, at risk.
• Seek emergency healthcare over urgent care. Urgent care is a relatively new concept for people living in America. Consequently, many consumers go to emergency rooms when they could save money by instead visiting local urgent care centers for the care they need.

At Health Karma, our team believes each of these concerns can be addressed. Our goal is to provide people resources through our user-friendly navigation platform to help everyone understand and control their healthcare situations. This empowers every healthcare consumer to make the best decisions for their personal medical needs and plan ahead for anticipated expenses regardless of whether they have insurance.

That said, consumers without health insurance may be surprised to learn all the ways they can still get the care they deserve.

Surviving Without Employer Health Coverage

Not all employers in America offer their full-time or part-time workers the opportunity to receive employer-sponsored health insurance through the company. However, employees can still enroll in individual health insurance plans within and outside of the government-coordinated Health Insurance Marketplace.

Let's start with the latter. The Health Insurance Marketplace connects U.S. citizens and legally present residents — who are not imprisoned and not enrolled in Medicare — to health insurance plans available in their state. In the United States, the Affordable Care Act (ACA) Health Insurance Marketplace was launched in 2013 and designed to help people without employer health coverage find and compare plans.

How does the Health Insurance Marketplace work? An interested consumer can visit HealthCare.gov during the annual open enrollment period or after a qualifying life event like a marriage, the birth of a child, or sudden and unexpected loss of a different insurance plan. Once on the site, the consumer will be directed to the appropriate plans depending on his or her personal data. It’s worth mentioning that the site can also show if someone qualifies for public health insurance programs like Medicaid or the Children's Health Insurance Program (CHIP).

Choosing the Right Health Insurance Plan

The Health Insurance Marketplace can be both a valuable resource and a bit confusing for those who want to make sure they choose the right plans. Some ways to sift through available options include:

• Knowing how much monthly income can go toward paying for medical costs like premiums and out-of-pocket copays and prescription expenses.
• Anticipating any bigger medical expenses that may arise during the coming year, such as a surgical procedure.
• Figuring out if it’s best to go with a higher deductible plan that requires higher out-of-pocket costs but can be an appropriate answer for most healthy individuals.
• Determining if current healthcare providers, like primary care physicians and specialists, are in or out of a plan’s network.
• Weighing the benefits of a restrictive but cheaper HMO plan versus another kind of plan like a PPO.
• Understanding the full scope of a plan’s prescription policies so there are zero payment or exclusion surprises for medications that the plan’s users will need.
• Reviewing who needs to be on the plan. A spouse or a child may be eligible for coverage through a different source.

What If None of the Available Health Insurance Marketplace Plans Work?

In some circumstances, people may not find what they need via the Health Insurance Marketplace or another exchange. But that doesn't mean they don't have any more options. Healthcare consumers can still take advantage of alternative health solutions that aren't insurance but offer affordable routine medical services.

Take Direct Primary Care (DPC) programs. These programs offer a model so patients can pay physicians or practices periodically for defined primary care services. For example, someone could pay a flat monthly or annual fee to gain access to certain preventative, wellness, and chronic care services.

Another option is the Health Karma Virtual Care Membership Plan. This solution works in a similar way to most DPC programs. For a monthly price, members receive unlimited access to quality virtual urgent care, virtual primary care, and virtual behavioral health consultations. Additionally, they enjoy access to special discounts for other healthcare services like dental and vision with top providers.

The bottom line is that although employer health coverage can be great, it isn’t the only option for affordable medical coverage.

Surviving a High-Deductible Health Plan

It’s no secret that the number of people with a high-deductible health plan (HDHP) is on the rise. The National Center for Health Statistics reported that 46% of all people under 65-years-old were enrolled in an HDHP just four years ago. As of 2019, the number had jumped five percentage points to 51%.

What’s the attraction to HDHPs? The answer is fairly straightforward: Low monthly premiums. Consumers on HDHPs pay less per month. However, they have to pay higher deductibles and will be expected to deal with high out-of-pocket limits. A Kaiser Family Foundation survey explained that about one-fourth of people on an HDHP had annual deductibles of no less than $2,000. Reporting from Insure.com showed that the deductible for a single plan could hit a $4,000 ceiling.

In other words, HDHPs may sound good up front but can put a greater financial burden on consumers in the event of a costly medical procedure. Additionally, about 40% of people on HDHPs decide to skip or postpone medical care according to Insure.com.

So does that mean an HDHP isn’t a valid health insurance answer? No. Consumers who are healthy or those with savings “cushions” who rarely go to the doctor for anything other than routine screenings can be a good fit for HDHPs. For those deciding when to choose a high-deductible health plan, the following steps can make the decision easier:

• Research. Know the HDHP plan inside and out, including what’s covered.
• Track. Keep track of your spending against your annual deductible and out-of-pocket maximum and time procedures correctly.
• Supplement. Take advantage of alternative health solutions such as the Health Karma Virtual Care Membership Plan for minor healthcare issues to reduce out-of-pocket costs.
• Evaluate. For medication, check out HealthKarmaRx coupons before running a prescription through the HDHP insurance plan.
• Save. Set up a personal tax-advantaged health savings account (HSA) to cover out-of-pocket medical costs and pay for qualified medical expenses, including deductibles.

Of course, some consumers find themselves in a position where even an HDHP may not work or they end up uninsured. Even without insurance, though, medical care can be more accessible than many people assume.

Surviving While Uninsured

As of 2020, more than 31 million people living in the United States were uninsured, per a National Health Interview Survey (NHIS). Why? There are several reasons. Many people assume they can't afford health insurance, so they never look into it. Others believe they can go without. And some, like immigrants, don’t qualify for any of the health insurance plans offered in America.

Which immigrant groups DO qualify for ACA health insurance marketplace coverage?

• Humanitarian immigrants
• Lawful temporary or permanent residents
• Non-immigrant status holders (e.g., those with worker visas and student visas)

Undocumented or unauthorized immigrants who fall outside these categories cannot apply for public benefits or marketplace-based health insurance. That said, the Health Karma team believes that everyone living in a nation deserves to have access to affordable quality healthcare because it makes the country stronger. People who avoid seeking treatment because they're uninsured suffer needlessly because they too often have limited access to healthcare. The net result is that people who immigrate to America may not have the quality of life they deserve because they lack immediate and preventative medical care.

So what can immigrants and other uninsured consumers do to maintain their health despite roadblocks to joining traditional insurance plans?

• Use alternative health solutions like DPC Programs or the Health Karma Virtual Care Membership Plan. Alternative health solutions provide a bridge to unrestricted healthcare services. While not insurance, they enable a route to basic medical treatment.
• Find lower-cost medications. Medications for chronic and acute illness treatment can be costly. Uninsured folks can save by opting for generic prescription drugs versus name-brand versions when applicable. They can also use tools like Health KarmaRX to find the lowest possible price for prescriptions and accessing saving coupons.
• Take advantage of discount programs. Discount programs for dental, vision and other healthcare needs provide a great way to combat costs if you’re uninsured. For example, with a dental discount program, you can save 20–50% on most dental procedures within a specific network of providers.

Being uninsured can be scary. But it doesn’t have to keep you from receiving quality healthcare.

Where Telehealth Comes into the Mix

During the pandemic, telehealth use skyrocketed by 154% according to the Centers for Disease Control and Prevention (CDC). Two years later, it has become so common that telemedicine subscription plans designed to compete with insurance plans have emerged. These plans operate on a monthly (or annual) payment DPC model.

As so many consumers and providers have discovered, telehealth offers accessibility without sacrificing quality. It also makes complying with healthcare less difficult for those with busy schedules. And it doesn’t matter if someone is uninsured, underinsured, or unable to qualify for insurance — everyone can find a virtual plan to address at least some medical needs.

Telemedicine has the potential to fill a gap in the patient-provider relationship. Providers can stay in touch with the people under their care and patients can expect to pay less than they might for an in-person, in-office visit.

What questions can consumers interested in finding a telehealth solution ask to find the right solution for their or their family’s needs?

• How does the plan deal with prescriptions? Are they covered, or will the patient have to find another way to afford medications, such as using Health KarmaRX?
• What type of portal or system does the virtual care model use? Is it easy to navigate? Does it provide 24/7 accessibility?
• Are there any “hidden” fees for the patient, such as unmentioned deductibles or copays?
• Is virtual urgent care included along with virtual primary care? How long does it typically take to get appointments for the various types of care the plan offers?
• Are annual wellness visits and basic lab tests included with membership?
• Is there a virtual mental and behavioral health component? How does it work and does it offer access to a network of licensed therapists?

Breaking Down Barriers to Health Insurance With Health Karma

Navigating healthcare can seem overwhelming. But it’s doable. Health Karma is ready to partner with individuals interested in getting the most affordable medical care, insured or not, and has the healthcare resources and tools to make the process easier. Click here to learn more about Health Karma Virtual Care solution today.