I'm nearly broke. Do I still have to buy health insurance?

No. But you might be eligible for Medicaid, and there's financial help for others, too

Published: October 06, 2013 08:30 AM

Q. I’m practically broke. Do I still have to buy health insurance?
A. No. But in many states you’ll now be eligible for Medicaid, so you can get insurance without having to buy it. That includes states that, as part of the new health care law, agreed to expand this federal health insurance program for people with very low incomes. See this map to figure out whether your state is expanding Medicaid.

Under the new rules, the new cutoffs for qualifying for Medicaid are $15,282 for a singleton, $20,628 for a couple, and $31,322 for a family of four. If you’re in this situation, you’ll be glad to know that there’s no asset test. You can have a house, a car, savings, even a retirement account; it’s only your income that matters. Read more about how you can get help paying for health insurance.

Health reform countdown: Today is day 14 of our 100-day Health Reform Countdown. We're getting ready for Jan. 1, 2014, when the new health law takes full effect. See the previous posts in the series. And for more information, use our Health Law Helper. Answer a few simple questions about where you live, your income, and how you get insurance now, and it gives  advice tailored to your situation.

But in the states that are not expanding Medicaid, people below the poverty line who don’t qualify for existing Medicaid programs (for specific groups like low-income disabled people and pregnant women) still won’t have a source for affordable coverage. Why? Because back in 2012 the Supreme Court decided that it should be up to the states to decide whether or not to expand Medicaid to cover all residents below a certain income level. (In the original law, that was required of all states.) And many states, mostly in the South, are not doing it. Those people are out of luck.

Now, no matter who you are and where you get insurance, you won’t have to pay a fine if you don’t buy it because your premiums would eat up more than 8 percent of your household income, or if you earn so little that you don’t have to file an income tax return.

But you should think twice about skipping buying coverage, even if technically you don’t have to. Here’s why: The average three-day hospital stay costs $30,000, and so does having a baby. And a standard course of breast-cancer treatment can easily top $100,000. And you might be surprised how affordable the plans are turning out to be. See our earlier post "Good News On Health Insurance Premiums."

—Nancy Metcalf

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