![](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/0e64e7c660a237adbc4168e80a7a6714a4-healthcare-final.rsquare.w400.jpg\")
<\/p>\n <\/p>\n
My Two Cents<\/a><\/p>\n \n Personal-finance columnist Charlotte Cowles asks the nosy, revealing, sometimes uncomfortable questions about money so you don\u2019t have to.\n <\/p>\n \n Photo-Illustration: by The Cut; Photos: Getty Images\n <\/p>\n When Ashley, 36, was laid off from her job at an advertising agency in Austin over a year ago, she asked how much it would cost to keep her health insurance through COBRA. \u201cThey told me, and I actually laughed,\u201d she said. \u201cIt was $950 a month.\u201d Instead, she opted for the cheapest plan she could find through the Texas health-insurance marketplace. The premiums were about $250 a month, but her deductible was over $7,000. She figured it was the best she could do until she found a new job.<\/p>\n Unfortunately, that\u2019s taken longer than Ashley hoped (like all the uninsured people I spoke to for this story, she requested a pseudonym). \u201cI think the term for me is \u2018underemployed,\u2019\u201d she says. She\u2019s been able to find contract work, but it barely covers her bills and certainly doesn\u2019t offer benefits. Despite interviewing for dozens of full-time jobs, she hasn\u2019t received any offers. And the tax credit that kept her monthly insurance premiums so low (\u201cI mean, \u2018low\u2019 \u2014\u00a0in air quotes,\u201d she says) will expire at the end of the year, pushing her costs up to more than $600 a month. She\u2019s choosing to forgo health insurance instead.<\/p>\n \u201cIt feels like a terrible decision, but I can\u2019t afford to pay that, especially for a plan that doesn\u2019t cover very much,\u201d she says. \u201cIf anything horrible happens, I\u2019m going to have a huge bill. But that would happen anyway, because my deductible is so high. I feel like all I can do is roll the dice and hope I stay healthy.\u201d<\/p>\n Ashley isn\u2019t alone in her predicament. When health-care subsidies expire at the end of the year<\/a>,\u00a0insurance plans offered through the Affordable Care Act marketplace will become too expensive<\/a> for millions of Americans who currently use them. Projections show<\/a> that in Texas alone, 1.04 million people would have to drop their insurance coverage; nationwide, the Congressional Budget Office estimates<\/a> that the number of uninsured people will jump by 3.8 million a year, on average, from 2026 to 2034. \u201cIt\u2019s not looking good,\u201d says Jared Walker, the founder of Dollar For<\/a>, a nonprofit that helps people navigate medical expenses. \u201cWe\u2019re going to have a lot of people choosing between paying a medical bill and putting food on the table or making rent.\u201d<\/p>\n Medical bills are consistently the No. 1 reason<\/a> why Americans file for personal bankruptcy. Health insurance is supposed to prevent that, of course, but as premiums skyrocket, millions of people will find themselves in an impossible position \u2014\u00a0unable to afford to protect themselves against unaffordable medical bills. The costs tumble downstream; when people can\u2019t pay for medical care, they put it off until they have no other choice, and then they wind up in the emergency room with a disastrous bill for something that could have been treated (or prevented) far more cheaply if they\u2019d addressed it sooner. \u201cThere\u2019s a lot of concern from hospitals and providers about people ignoring the signs that they\u2019re sick because they\u2019re worried about the financial burden,\u201d says Allison Sesso, the chief executive of Undue Medical Debt<\/a>, a national nonprofit that works to improve health-care access.<\/p>\n Dhiran, who\u2019s in his 40s and lives in Florida, is one of those people: He was uninsured when he got a serious infection in his foot three years ago. After hoping it would get better on its own for a few days, he wound up in the hospital \u2014 and got a bill for over $250,000. \u201cWe got financial assistance from the hospital, and eventually we reached a settlement,\u201d he says. \u201cIt was less than half of the original bill, in installments.\u201d They had to sell some property to pay it off. Now, his wife works the overnight shift at an Amazon warehouse, primarily for the health benefits.<\/p>\n Going without insurance means living with a constant fear of what could go wrong. \u201cLast winter, right after I lost my job and my health coverage, I got a bout of COVID that really knocked me on my ass,\u201d says Andy, 32, who works in public relations and marketing in North Carolina. \u201cI had a fever of 103.5 and so much anxiety, knowing I couldn\u2019t afford to see a doctor.\u201d He recovered, but he dreads the possibility of it happening again: \u201cIt\u2019s an awful feeling, knowing that there\u2019s no safety net at all.\u201d His current employer is a small business that doesn\u2019t provide health benefits. \u201cI really wish I could find a job that would give me insurance, but until that happens, I don\u2019t know what else to do,\u201d he says.<\/p>\n Realistically, how can you mitigate potential risks if you\u2019re one of the millions of people who\u2019s about to lose access to health insurance (or you already have)? \u201cI hate to say this, but everyone\u2019s going to have to become their own detective and patient advocate,\u201d says Walker. \u201cThere\u2019s no real way to \u2018hack\u2019 health care, but there are negotiation techniques and questions to ask that can get costs lower than they\u2019d be otherwise.\u201d<\/p>\n For starters, Sesso recommends that you research local sources of care before you need them. \u201cTo the degree that you can, figure out where there are discounted or free clinics in your area and seek out preventative care,\u201d she says. Some of them will offer flu vaccines and certain screenings, but prepare yourself for a long wait (these clinics can be booked out for months). She also advises putting whatever money you can spare into an emergency fund \u2014\u00a0a tiresome refrain, she knows, but the closest thing to an insurance policy you can create for yourself. Meanwhile, familiarize yourself with your patients\u2019 rights under your state\u2019s laws, which can vary quite a bit (here\u2019s a good tool for doing so<\/a>).<\/p>\n If you\u2019re sick or need to talk to a doctor, your first step could be to pay out of pocket for an online consultation, says Walker. \u201cI have done this many times when I was uninsured. Services like Sesame<\/a> allow you to pay $35 to visit with a doctor on Zoom, which can be incredibly useful.\u201d A few years ago, he had a painful lump on his neck, but a trip to urgent care wasn\u2019t in the cards \u2014 without insurance, it would cost him hundreds. \u201cI just wanted to talk to a doctor to make sure I wasn\u2019t going to die. I went on Sesame, it was $35, and the doctor was like, \u2018Oh, you have a swollen lymph node. It\u2019ll go away in four or five days.\u2019\u201d<\/p>\n A Zoom appointment won\u2019t cut it for more serious problems, obviously. If you need a procedure and you\u2019re not sure what it will cost out of pocket, you can call in advance and request what\u2019s known as a good-faith estimate<\/a>. Make sure to do so at least three days before your appointment and get it in writing. Then, if your medical bill is significantly higher than the estimate, you may be able to dispute it under the No Surprises Act<\/a> or certain state laws. At the very least, it enables you to compare costs between different providers.<\/p>\n For medications, Walker recommends GoodPill<\/a>, a nonprofit that helps uninsured patients fill their prescriptions at lower costs. Other websites like GoodRx do the same, although primarily through coupon programs and price-comparison tools.<\/p>\n If you\u2019re in a position where you do need medical attention urgently, be open with your doctor about your situation. \u201cIncreasingly, I have seen that having an honest conversation with your provider about what you can afford is better than not talking about it at all,\u201d says Sesso. Sure, medical billing is not part of any health-care worker\u2019s training. \u201cBut more doctors are recognizing that they have to be equipped for these questions. They might be able to give advice to patients about follow-up care that\u2019s more affordable, even if it\u2019s not the best.\u201d<\/p>\n If the worst happens, and you wind up with a big bill \u2014 or a series of bills for an ongoing condition \u2014 do not pay anything right away, and, whatever you do, don\u2019t put it in a credit card. \u201cOnce it goes on a credit card, it becomes consumer debt, which is regulated differently from medical debt and has much higher interest rates,\u201d says Sesso.<\/p>\n Instead, take your time and don\u2019t panic. \u201cFor the most part, you have a year before any medical bills can start to affect your credit score,\u201d says Walker. (Right before Biden left office, his administration finalized a rule<\/a> that blocked medical debt from affecting people\u2019s credit scores, but a federal court has since blocked it<\/a> \u2014\u00a0bad news for the approximately 15 million Americans<\/a> whose credit reports are still being dragged down by $49 billion worth of medical debt.)<\/p>\n To prevent becoming one of them, start by requesting an itemized bill, says Walker. \u201cSometimes even just asking for it will get it reduced, because the billing department might catch errors before they send it to you,\u201d he says. \u201cResearch has found that 80 percent of medical bills have errors in them. And I also know patients who have successfully used ChatGPT or Claude to check all the CPT codes on their bills and catch errors themselves.\u201d<\/p>\n From there, see if you\u2019re a candidate for charity care, a bill-reduction service that most hospitals offer depending on your income level, household size, and bill amount. (Dollar For\u2019s website<\/a> has a tool that allows you to check your eligibility.) If you don\u2019t qualify, your next step is to see if the hospital or provider will reduce your bill if you can offer cash up front \u2014\u00a0a back-door settlement, if you will. \u201cI just did this and saved a bunch of money,\u201d says Walker. \u201cYou have to call and ask for the cash pay rate. Sometimes even if you have insurance, the cash pay rate is lower than what they\u2019d charge your insurance, which you\u2019d still have to pay if you haven\u2019t met your deductible. It can be wild how different the price is.\u201d The problem, of course, is that you still have to be able to pay it. \u201cIt only works if you have some cash on hand,\u201d he says.<\/p>\n If that doesn\u2019t work, you have two more options: One is to ask for a payment plan, which most providers will offer, although the installments might be higher than you like. \u201cYou often hear about people getting on these magical payment plans where they pay $10 a month toward a bill for hundreds of thousands of dollars, and they just keep paying it for the rest of their life,\u201d says Walker. \u201cFrom what I\u2019ve seen, that doesn\u2019t really happen very often. And even when it does, sometimes a hospital will still send your bill to collections because the outstanding amount is so high.\u201d<\/p>\n That brings us to your second option: Wait until your bill gets sold to a collector, at which point you may be able to negotiate an even lower settlement fee (here\u2019s a script to use<\/a>). For a more detailed guide to dealing with medical bills you can\u2019t afford, see here<\/a>.<\/p>\n Finally, remember that we should not have to live this way \u2014\u00a0there has to be a better solution. \u201cIt\u2019s ridiculous,\u201d says Sesso. \u201cSo don\u2019t do it in silence. Call your elected official. Talk about the fact that this is what\u2019s happening to you. We cannot go on like this.\u201d<\/p>\n Email your money conundrums to\u00a0mytwocents@nymag.com<\/a> (and read our submission terms here<\/a>.)<\/p>\n