Health insurance is expensive.
In addition, many of the tests, treatments, and physicians you need in order to treat and monitor your chronic illness aren’t covered by traditional health insurance.
When you’re chronically ill, you’re likely to struggle keeping a full time job with benefits. If you have your own business, work freelance, work part time, work multiple part-time jobs, or you’re living on SSDI, you can’t get health insurance through your workplace.
It can feel impossible to afford health coverage when you’re on a limited income, regardless of your health status. Struggling with one or more chronic illnesses only makes this worse.
How on earth are you supposed to get affordable health insurance when you’re chronically ill?
Like most young adults, when I left my parents’ house and lost my Medicaid coverage, I couldn’t afford health insurance yet. I only made $13/hr and spent every bit of it on essential living expenses.
Thus, I went uninsured from age 19 to nearly 26. I told myself it didn’t matter because I wouldn’t use health insurance anyway. At first, it was true.
Then I contracted Tick Borne Relapsing Fever, and I had to go to the doctor and ER multiple times, as well as pay for extensive lab work. The medical debt on top of the illness making me bedridden for five months left us in a terrible place financially.
Only 1 1/2 years later, I found myself hospitalized from COVID-19. A few months later, I was slowly getting stronger, but I had $18,000 in medical debt and no idea how to pay for it. I was still too sick to go back to work, and Jonathan’s income had been cut down to almost half because of COVID economic impacts.
We decided we were going to do whatever it took to get health coverage, even though our income was so low and we were on mortgage forbearance just to make ends meet.
It took me months of extensive research to find out how we could get affordable insurance, so today I’m going to share the results of that effort with you.
How to Get Affordable Health Insurance When You’re Chronically Ill
1. Medicaid
The problem with Medicaid lies in that not every state’s Medicaid program covers low income adults. In my state and many others, only low income children, pregnant women, and parents of minor children qualify for coverage. If you’re a parent of dependent children this isn’t a problem, but if you aren’t it poses a problem in many states. In those states, it doesn’t matter how little money you have, if you don’t have dependent children, you can’t get Medicaid.
You can check here to find out if your state covers low income adults. If so, Medicaid is a viable option for affordable health insurance.
Once you have Medicaid, you can search for providers a few different ways.
Your State’s Medicaid Database
Each state has a provider database for their Medicaid program. You can search by county and specialty. Through the South Carolina database, I found a top notch primary care doctor for one of my family members. You’ll be able to find M.D. and D.O. practitioners of all specialities and even chiropractors.
Academy of Nutrition and Dietetics
You can find a nutrition expert through the Academy of Nutrition and Dietetics database. After entering your zip code and pressing the “search” button, you can click on the “Insurance/Payment” option and select “Medicaid” to see nutrition experts in your area that accept Medicaid. This search tool helped me find a Functional Registered Dietitian for one of my family members.
Psychology Today
Psychology Today’s search tool can help you find a therapist that takes Medicaid. After typing in your city or zip code (city will give you more results), click on the “Insurance” filter and select “Medicaid”. You’ll then see all the therapists in your area that accept Medicaid. I found an amazing therapist for one of my family members this way.
2. The Health Insurance Marketplace
The Health Insurance Marketplace is where you buy a standard health insurance plan like Blue Cross Blue Shield.
Low income individuals who don’t qualify for Medicaid in their state are eligible for a Premium Tax Credit.
The amount depends on exactly how low your income is, but if you’re between 100-400% of the federal poverty level, you will qualify for something.
This means you can buy a regular insurance plan on healthcare.gov, but the government will allot a certain amount of money to go towards your monthly payment to dramatically reduce your cost.
For example, Jonathan and I selected a joint plan that would have cost us $750 a month at the regular price, but we qualified for a Premium Tax Credit based on our income that dropped the cost to $95 a month.
You’ll have the option to view and compare all the plans you’re eligible for, before choosing one that works for you. People without many health problems can afford to get a cheaper catastrophic plan with a high deductible. We needed a plan with no deductible, a limited out of pocket maximum, and immediate coverage for health services. Keep that in mind as you compare plans.
Because this is regular health insurance, you can only apply during the open enrollment period each year (typically November 1-December 15 for coverage that begins January 1). You can find the application here.
If you get a plan through healthcare.gov with a Premium Tax Credit, your best bet when searching for providers is to login to your health insurance account like you’re about to pay your monthly payment, but use their “search for a provider” tool.
3. Christian Health Sharing
Unlike regular health insurance, Christian Health Sharing doesn’t cover anything regarding health maintenance. It’s intended to be a source of coverage for unexpected health problems and pregnancy/delivery.
How it works is every month, you send your payment to the individual you’re assigned to that month.
If a new and unexpected medical need occurs, you submit your need, and once your need is approved you add the bills you need help paying. Then, the organization reimburses you for your medical bills by having other members send their monthly payments to you.
When I did a deep dive into comparing Christian Health Sharing plans, I found most of them to be cost prohibitive.
However, Samaritan’s Health Sharing is affordable (especially for young adults and large families) and accepts bills from alternative and complementary providers.
Before Jonathan and I got regular health insurance and only he had health insurance through his work, I got Samaritan’s Classic for myself.
For a single young adult under age 30, it costs $177 per month.
Single adults age 30+ pay $263.
Married couples without children pay $511.
Families with 1-5 children pay $596.
Families with 6+ children pay $682.
Per new medical need, you only have to pay $400 of your medical bills out of pocket and Samaritan’s will reimburse you for the rest.
Samaritan’s doesn’t take new medical needs for preexisting conditions. However, you can submit those as a special prayer need for members to donate toward voluntarily.
Or, if you have a new medical need that is not a preexisting condition, but the new issue exacerbated a preexisting condition as a result, they may provide coverage.
For example, Samaritan’s is covering the need I submitted for multiple viral infections, including the doctor visits and lab tests. As part of that need, they’re also covering my functional neurology treatment for POTS, because the multiple viral infections caused a POTS relapse, when prior to the new issue my POTS was a lot more stable.
4. Medical Credit Cards
A huge caveat to Samaritan’s Health Sharing is that you have to pay your medical bills up front and they provide reimbursement approximately two months after you submit the bills.
That means you have to have some way to pay your bills initially. For many people on a limited income – chronically ill or not – this cannot come from your checking account.
Medical credit cards like Care Credit and Advance Care solve this issue. They’re also helpful if you’re uninsured, so you can break down your healthcare costs more manageably by the month.
My functional neurologist takes Care Credit, and my immunology specialist takes Advance Care.
Advance Care is essentially a Discover credit card, so you should be able to use it anywhere you’d use a regular credit card.
5. In-House Payment Plans
Some alternative and complementary practices offer in-house payment plans or memberships to break down the cost of your visits and treatment into manageable monthly payments. If all else fails and you’re uninsured, definitely ask any potential providers whether they offer this option. It’s a lifesaver!
6. Use Your Tax Refund to Pay for Lab Work
If you have to order lab work yourself, it’s highly unlikely your insurance plan will cover it or reimburse you, if you’re insured at all.
Since lab work can be so cost prohibitive, Jonathan and I use part or all of our tax refund every year to pay for lab testing we can’t afford otherwise.
It’s definitely not a glamorous option, but being low income and/or chronically ill has few glamorous moments anyway.
7. Handling Medical Debt
If you’re chronically ill and you’ve struggled to afford health insurance, medical debt almost always comes with the package.
The first thing you can and should do is apply for a bill reduction from your hospital system and state. I can’t provide a link because every hospital and state is different, but you’ll be able to find the best way for you to apply with a quick Google search. Doing this brought my debt after hospitalization with COVID from $18,000 down to $3500.
The second thing you absolutely should do is put the rest of your debt that’s left on an interest-free payment plan. Every health network is different, but in my area our biggest networks are Atrium Health and Novant Health. Atrium offers an interest-free payment plan through Access One and Novant offers one through Clear Balance. This will keep your medical debt from affecting your credit history, and it makes it feasible to pay off little by little.
If all else fails and your medical debt ends up in collections, you can contact the collections agency and set up a monthly payment plan. This won’t take the debt off your credit history, but it will gradually reduce the impact as you pay it down.
If you have the means to pay it off at any point, always call and ask the minimum the collections agency will settle for, so you don’t have to pay the full amount. They’ll almost always negotiate.
