Why You Need Health Insurance

You’ve probably heard people say that everyone should have health insurance. But if you haven’t needed much in the way of medical care in the past, the reasons why you need health insurance might not be obvious.

Access to care is limited if you can’t pay

Without health insurance, you might find that you simply can’t get the health care that you need. In the United States, the Emergency Medical Treatment and Labor Act (EMTALA) requires nearly all emergency departments to screen and stabilize all patients, regardless of their ability to pay or whether they have health insurance.

But beyond that, medical facilities and professionals can refuse to provide care if the patient is unable to pay for it. This could leave you in a real bind if you need anything other than stabilization in an emergency room. Being diagnosed with cancer and then finding out that you can’t get treatment because you don’t have a way to pay for it would be an awful addition to an already stressful situation.

Medical bills can be financially devastating

Even if you’re able to access treatment, the cost of it can be devastating without health insurance. You might find yourself paying off medical debt for years — maybe even the rest of your life.
According to HealthCare.gov, the average cost of a three-day hospital stay is $30,000. If you need care for a serious condition like cancer or MS, your medical bills could easily be hundreds of thousands of dollars.

Modern health insurance comes with an annual cap on out-of-pocket costs. The cap will vary depending on the plan you pick, and in general, a plan with a higher out-of-pocket cap will tend to have lower monthly premiums. But there’s a federal limit on how high the out-of-pocket cap can be. So a health insurance policy will prevent a scenario in which you owe tens of thousands or hundreds of thousands of dollars in medical bills.

Health plans negotiate rates with your medical providers

Another benefit of health insurance is that the health plan negotiates discounted prices with medical providers who are in the plan’s network. So even if you haven’t met your deductible yet (meaning you have to pay for the service yourself), you’ll still pay less for your care than you would if you were uninsured and had to pay the full amount the provider bills. As long as you use an in-network provider, they have to write off any part of their bill that’s above the amount the health plan negotiated with them.

Having health insurance is obviously beneficial if you end up needing a lot of medical care. But the negotiated pricing discounts are beneficial even if you only need minor care now and then, since you won’t have to pay the full amount that the provider bills.

Free preventive care

Almost all health insurance policies will cover a wide range of preventive care without any cost to the enrollee. This includes screening services like mammograms, colonoscopies, and PAP tests, routine vaccines, blood pressure and cholesterol testing, female contraception, and more.

Free preventive care benefits are provided by all non-grandfathered major medical plans with effective dates after the Affordable Care Act was signed into law in 2010. Even if you’re healthy and rarely use medical care, you could save quite a bit of money by taking advantage of the free preventive care. Without health insurance, things like mammograms and certain types of contraception could easily cost hundreds of dollars, and a screening colonoscopy could cost thousands.

Anyone can end up needing medical care

Even if you’re healthy and never need medical care, there’s no guarantee that will continue to be the case. Serious injuries can happen to anyone. And even healthy people can develop significant medical conditions seemingly out-of-the-blue. Things like autoimmune diseases and cancer can strike at any age, and some people diagnosed with these conditions were previously 100% healthy. You’re only healthy until you’re not, and you just never know when that might be.
You can’t wait until you get sick to enroll.

Regardless of whether you have access to an employer’s health plan or need to purchase your own coverage, enrollment windows are limited. Employers set their own enrollment windows, which usually only last for a few weeks each year. If you need to buy your own health insurance, the enrollment window runs from November 1 to January 15 in most states.

Outside of the annual open enrollment period, you can only sign up for coverage if you have a qualifying life event. That includes things like losing other coverage or having a baby, but it does not include getting sick or injured.
This is why it’s so important to maintain coverage year-round, even when you’re healthy, so that it’s there when you need it.

How to get health insurance

If you don’t have access to health insurance from an employer, Medicare, or Medicaid, you can buy your own health insurance through the Marketplace (exchange) in your state. This will either be HealthCare.gov or a state-run platform, depending on where you live.

The Marketplace provides income-based subsidies that extend to fairly high incomes, so you might be surprised to see how affordable the coverage can be — possibly even free. And all of the plans cover the full range of essential health benefits, including inpatient and outpatient care, prescription drugs, maternity care, mental health care, and more.

As mentioned above, enrollment windows are limited, but you can sign up during open enrollment, or during a special enrollment period if you have a qualifying life event. The same enrollment windows are used even if you want to apply for coverage outside the Marketplace (ie, buying it directly from an insurance company), and subsidies aren’t available outside the Marketplace.

If you’re eligible for Medicaid, you can sign up anytime. In most states, Medicaid is free for eligible enrollees, and the out-of-pocket costs are very low. Eligibility rules vary from one state to another, but if your income is low and you don’t have health insurance, check with your state’s Medicaid office to see if you might be eligible. Also keep in mind that eligible income limits are quite a bit higher if you’re pregnant, so Medicaid might be available to you while you’re pregnant even if you’re not normally eligible.