Medicaid is an important source of healthcare for millions of low-income Americans, but not for everybody. Typically, those factors establish who is eligible for Medicaid, and in many cases, how much the recipient is expected to pay. Though you might not qualify for Medicaid, you probably don’t know what affordable health coverage options are available to you. Luckily there are a few other options available to people who cannot get Medicaid to get the health care that they need.

In this article, we will dive into the different types of health insurance for the not Medicaid eligible, including health insurance through the Affordable Care Act (ACA) Marketplace, employer-sponsored health insurance, and short-term health insurance for example. We will also discuss eligibility for these insurance plans, coverage options, and how to apply for these insurance plans.

Why You May Not Qualify for Medicaid?

Medicaid is a program of healthcare for poor people and their families. But not everyone is entitled to the program. There are several reasons why someone might not qualify for Medicaid:

1- Income Level: If someone makes too much money, Medicaid eligibility is based on money and you may not be able to get Medicaid coverage. Depending on the state, the income thresholds vary and those making more than the threshold tend to be ineligible.

2- Citizenship and Immigration Status: As a general rule, Medicaid is available only for U.S. citizens, or legal resident persons. You might not qualify for Medicaid if you are not a U.S. citizen or you are not lawful to be in the United States.

3- Age: Children are covered by Medicaid, pregnant women, parents, elders, and people with disabilities. But children or a qualifying disability makes you eligible in some states, even if you’re an adult without children and a qualifying disability in other states if the state has not expanded Medicaid under the Affordable Care Act.

4- State-Specific Guidelines: To maximize the impact of the CDC’s actions, Medicaid for the Cancer Prevention Initiative should be administered across states independently, and each state has the freedom to set their own eligibility rules. The Affordable Care Act (ACA) has expanded Medicaid in some states to include more low-income people; others haven’t. If you have low income and live in a state that hasn’t expanded Medicaid, you might not be able to get coverage.

So if you don’t qualify for Medicaid, it’s good to know that there aren’t many other options for keeping you from seeing a doctor.

Types of Insurance for Those Who Don’t Qualify for Medicaid

And if you’re searching for insurance for those who don’t qualify for Medicaid, you’ve got options, based on your situation. Below are some of the most common types of insurance individuals can get who don’t qualify for Medicaid.

1. Affordable Care Act (ACA) Marketplace Plans best fit your needs.

For people who do not qualify for Medicaid, one of the most common ones is to file an application for health insurance in the ACA Marketplace. A health insurance marketplace was set up by the Affordable Care Act where you can buy a policy that fits you and your budget. Everyone who doesn’t qualify for Medicaid or other government-sponsored programs can buy these.

ACA marketplace plans are available in four levels: Finally, there are bronze, silver, gold, and platinum. Coverage levels are based on coverage level and cost-sharing provided (how much are you going to pay out of pocket for healthcare services).

• By far the cheapest plans are bronze plans, but they have the highest out-of-pocket costs.
• Silver plans have a mix of premium and out-of-pocket costs that might work for you if you don’t want to pay high premiums.
• If you expect to use a lot of medical care, Gold and Platinum plans have higher premiums, but lower out-of-pocket costs, and are best.

2. Subsidized Marketplace Plans

The ACA Marketplace helps reduce the cost of your ACA Marketplace plan if your income is below a certain threshold. Premium tax credits these subsidies for individuals and families who earn between 100 percent and 400 percent of the federal poverty level (FPL). The idea behind these credits is that people who may not meet eligibility for Medicaid but cannot pay for insurance out of pocket should be able to afford it more easily.

In addition to your premium tax credits, you may also be eligible for cost-sharing reductions (CSRs) to lower the out-of-pocket cost of your medical services. If you’re thinking of applying to an ACA plan, you should look into these options and see if you may qualify for some financial assistance.

3. Employer-Sponsored Insurance

But for people who don’t meet the requirements for Medicaid, another option is employer-sponsored insurance. Health insurance is typically provided through most employers as a benefit for full-time employees, but a few also offer coverage for part-time workers and dependents.

If you can’t qualify for Medicaid, employer-sponsored insurance can be a better option for most than buying an individual health plan from the ACA Marketplace, since it usually provides more comprehensive coverage for less than what you’d have to pay for an individual health plan. Employer sponsorship often subsidizes the premiums of employer-sponsored insurance.

You can contact your HR department or your employer’s benefits coordinator to find out if you qualify for employer-sponsored insurance. If your employer provides health coverage, you will be able to join in open enrollment or at an open enrollment upon meeting a qualifying life event, such as a change in marital status or getting a child.

4. Short-Term Health Insurance

If you don’t qualify for Medicaid but need short-term coverage you can get short-term health insurance. They offer base health coverage for a short time, from a few months to maybe up to a year. Cheap plans for a year or two are, of course, cheaper than ACA marketplace plans, but they don’t usually provide the same level of coverage and they might not have all the benefits, like covering pre-existing conditions or preventive care.

It’s a great option, however, for short-term health insurance, if you’re looking for temporary coverage during a gap in health insurance, such as when you’re changing jobs or waiting for ACA Marketplace coverage to start. But do note that nevertheless, you should read up on the terms of the policy to be sure it addresses your healthcare needs.

5. Health Sharing Ministries

Health-sharing ministries assist their members in sharing medical expenses. Not to be confused with health insurance, these could serve as a factor for people who do not qualify for Medicaid. For the most part, health-sharing ministries are faith-driven and members pay a monthly share that covers each other’s health care costs.

Some health-sharing ministries are cheaper than traditional health insurance, but they can have limited coverage choices and don’t typically cover something like maternity or mental health care. And if you’re determined to explore this path, be sure to read through the terms and conditions so you’re clear on what is covered, and what isn’t covered.

6. State-Specific Programs

Federal options are offered, as are some state options that can cover individuals who don’t qualify for Medicaid. They are designed to help low to moderate-income residents obtain affordable health insurance.

For instance, some of these states that cleared the way to expand Medicaid under the ACA also give financial help to individuals close to or just over the Medicaid eligibility threshold. These programs may also fill the health insurance gap between Medicaid and full-price insurance enabling lower-cost options.

Contact a local health insurance broker to learn more or go to your state’s Medicaid website to find out if there are state-specific programs available in your area.

How to Apply for Insurance If You Don’t Qualify for Medicaid

If you don’t qualify for Medicaid and are interested in finding insurance, here are the steps you can take to apply for coverage:

1- Check Your Eligibility for ACA Marketplace Plans: Check to see if you qualify for an ACA plan by visiting the Health Insurance Marketplace website (HealthCare.gov). You can apply during the open enrollment period or if you experience a qualifying life event, such as losing job-based coverage or getting married.

2- Look for Employer-Sponsored Coverage: If you’re employed then you should ask your employer if they can offer health insurance. Open enrollment periods for health insurance are provided by many employers, so be sure to find out the details of your employer’s plan.

3- Consider Short-Term Health Plans: Research short-term health insurance coverage if you need temporary coverage. These plans are offered by many insurance companies so you should compare plans to see which one suits you.

4- Explore State-Specific Programs: If you live in a state with extra programs for low-income residents, you can check if you are eligible for subsidized insurance by exploring those programs first.

5- Consult an Insurance Broker: If you don’t know what to do, ask your insurance broker. With them, you can work to help you choose the right type of insurance and help you complete the application.

Conclusion

If you don’t qualify for Medicaid, however, you still have options that will help you get affordable health insurance. Whether you are buying from ACA Marketplace plans, employer-sponsored insurance, short-term health insurance, or state-specific programs, you have many options for a plan that fits your needs and budget.

Knowing your options, doing research on the different plans available, and asking for help when you need it are all ways you can make informed decisions about your health insurance and know you’ll have access to the care you need.