If you can’t afford health insurance, you likely have more options than you realize. Depending on your income, household size, and state of residence, you may qualify for free or nearly free coverage through Medicaid, subsidized Marketplace plans, or community health programs that charge based on what you can pay. Even without any coverage at all, legal protections and discount programs exist to keep medical costs from becoming catastrophic.
Check Whether You Qualify for Medicaid
Medicaid is the first place to look. In the 40 states (plus Washington, D.C.) that have expanded Medicaid under the Affordable Care Act, adults with income at or below 138% of the federal poverty level qualify. For 2026, that means a single person earning roughly $22,000 or less per year, or a family of four earning about $45,500 or less. Children are covered at even higher income levels in most states. There are no premiums and minimal out-of-pocket costs.
Eligibility is based on your current monthly income, not last year’s tax return, so a recent job loss or pay cut can make you eligible right away. You can apply at any time of year. There’s no open enrollment window for Medicaid. If your income is too high to qualify outright, some states run “medically needy” programs that let you become eligible by subtracting large medical bills from your income, a process called “spending down.”
Marketplace Plans May Cost Less Than You Think
If your income is between 100% and 400% of the federal poverty level (roughly $15,960 to $63,840 for an individual in 2026), you qualify for premium tax credits that reduce the monthly cost of a Marketplace plan. For many people at the lower end of that range, these credits bring monthly premiums close to zero. You may also qualify for cost-sharing reductions that lower your deductibles and copays if you choose a Silver-tier plan.
If your income is below 100% of the federal poverty level and you live in a state that hasn’t expanded Medicaid, you fall into what’s called the “coverage gap.” You likely won’t qualify for either Medicaid or Marketplace subsidies. In that case, community health centers and hospital financial assistance programs (covered below) become your most important resources.
Open enrollment for Marketplace plans typically runs from November through mid-January each year. But you can enroll outside that window if you experience a qualifying life event: losing existing coverage, getting married or divorced, having a baby, moving to a new ZIP code, turning 26 and aging off a parent’s plan, leaving incarceration, or experiencing a significant income change. You generally have 60 days from the event to sign up.
Catastrophic Plans for Lower Costs
If you’re under 30, you can buy a catastrophic health plan through the Marketplace without any special qualification. These plans have low monthly premiums and very high deductibles, so they function mainly as protection against worst-case scenarios like a serious accident or major illness. They cover three primary care visits per year and preventive services before you hit your deductible.
If you’re over 30, you can still get a catastrophic plan if you qualify for a hardship or affordability exemption. You qualify for the affordability exemption if the cheapest available coverage would cost more than 7.97% of your household income. Hardship exemptions cover situations like homelessness, eviction, bankruptcy, domestic violence, the death of a close family member, or unpaid medical debt. You apply for the exemption through the Marketplace.
Community Health Centers Charge on a Sliding Scale
Federally Qualified Health Centers (FQHCs) are required by law to see patients regardless of their ability to pay. There are nearly 1,400 of these organizations operating at over 15,000 sites across the country, including in rural areas. They provide primary care, dental care, mental health services, and prescriptions.
The fee structure is straightforward. If your income is at or below 100% of the federal poverty level, you receive a full discount and pay only a nominal fee, sometimes as little as $20 to $40 per visit. Between 100% and 200% of the poverty level, you pay on a sliding scale with partial discounts across at least three income-based tiers. Above 200%, you pay the standard fee. You can find your nearest health center through the HRSA website or by searching “community health center near me.”
Many of these centers also participate in the 340B Drug Pricing Program, which allows them to purchase medications at deeply discounted rates and pass those savings to patients. To access 340B pricing, you need to be an established patient of the center, but the documentation requirements are minimal. Even a single visit with a basic health record is enough to qualify.
Hospital Financial Assistance Programs
Every nonprofit hospital in the United States is legally required to maintain a written financial assistance policy, sometimes called charity care. Under Section 501(r) of the tax code, these hospitals must clearly spell out who qualifies for free or discounted care, make that information available to patients, and charge eligible patients no more than what they’d bill an insured person.
The specific income thresholds vary by hospital. Many offer free care to patients earning below 200% of the federal poverty level and discounted care up to 300% or 400%. You typically need to fill out an application and provide proof of income. The key thing to know is that you can apply for financial assistance after receiving care, not just before. If you’ve already received a large hospital bill, contact the hospital’s billing or financial counseling department and ask about their financial assistance policy.
Separately, a federal law called EMTALA requires every hospital with an emergency department to screen and stabilize anyone who arrives with an emergency medical condition, regardless of insurance status or ability to pay. Hospitals cannot demand payment before providing emergency treatment, and they cannot use debt collection tactics in the emergency department. If the hospital can’t provide the specialized care you need, it must transfer you to one that can, and that hospital cannot refuse the transfer. This law does not eliminate the bill, but it guarantees the care comes first.
Short-Term Plans and Their Limits
Short-term health insurance plans are available outside the Marketplace and don’t require income verification or enrollment windows. They’re cheaper than standard plans, but they come with serious limitations. As of September 2024, federal rules cap these plans at an initial term of three months and a maximum coverage period of four months, including renewals. Some states impose even shorter limits or ban them entirely.
These plans are not required to cover preexisting conditions, prescription drugs, maternity care, mental health services, or preventive care. They can deny claims based on your medical history. They’re best understood as a temporary bridge, not a replacement for comprehensive coverage. If you’re between jobs and waiting for employer coverage to start, a short-term plan may make sense. For ongoing needs, a Marketplace plan with subsidies or a community health center will serve you far better.
State Mandates Still Apply in Some Places
The federal tax penalty for not having insurance was reduced to $0 in 2019, but six jurisdictions still enforce their own individual mandates: California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C. If you live in one of these places and go without qualifying coverage, you may owe a penalty on your state tax return. Each state calculates the penalty differently, but exemptions are available for financial hardship and for people whose cheapest available coverage exceeds an affordability threshold. Check your state’s tax authority for the specific numbers.
Prescriptions Without Insurance
Prescription drug costs are one of the biggest concerns for uninsured people. Beyond the 340B program available through community health centers, most major pharmaceutical manufacturers run patient assistance programs that provide medications free or at low cost to people without insurance. These programs typically require an application showing income below 200% to 400% of the federal poverty level.
Discount programs like GoodRx and RxSaver aggregate coupons from pharmacies and pharmacy benefit managers, often cutting the cash price of generic medications by 50% to 80%. These aren’t insurance, but they can make common medications affordable. Walmart, Costco, and several grocery store pharmacies also maintain lists of generic drugs available for $4 to $10 per month without any insurance or coupon needed.