Beyond Medicaid: Practical Ways to Get Help Paying for Health Insurance

If you don’t qualify for Medicaid—or you’re worried it’s your only option—you’re not stuck. There are several other ways to get help with health insurance costs, from government programs to employer benefits and nonprofit support.

This guide walks through the main options, how they work, and what to consider so you can decide which paths might fit your situation.

Understanding Your Options for Health Insurance Help

Before diving into specific programs, it helps to know the big picture. Financial help with health insurance generally comes from one (or more) of these sources:

• Federal and state programs (other than Medicaid)
• Employer-based benefits
• Marketplace subsidies and cost-sharing reductions
• Medicare and related assistance programs
• Nonprofit and community resources
• Special programs based on income, age, or health needs

You may be able to combine several of these. For example, someone might use Medicare plus a low-income subsidy, or a marketplace plan plus cost-sharing help and a drug assistance program.

1. Marketplace Subsidies: Help With Premiums and Out-of-Pocket Costs

If you don’t have access to affordable coverage through a job or a public program, the Health Insurance Marketplace (also called the exchange) is often the first place to look.

Premium Tax Credits (Subsidies)

These are income-based discounts that lower your monthly premium for marketplace health plans.

• Available to many people who have low to moderate incomes
• You usually can’t get them if you have affordable, qualifying coverage through an employer or certain other programs
• The amount depends on your household size, estimated yearly income, and the cost of plans in your area

You can choose to:

1. Apply the credit up front to reduce your monthly bill, or
2. Claim it when you file your federal tax return

If your income ends up higher or lower than expected, the final amount is adjusted at tax time.

Cost-Sharing Reductions (CSRs)

Beyond premiums, deductibles and copays can also be hard to afford. That’s where cost-sharing reductions may help.

• Available only with Silver-level marketplace plans
• Can lower your deductible, copays, coinsurance, and out-of-pocket maximums
• Eligibility is based on lower income levels than premium tax credits

These reductions are built directly into the plan if you qualify, so you see the lower costs when comparing options.

2. Employer-Sponsored Health Insurance and Financial Help

If you work for an employer that offers health benefits, that’s often one of the most cost-effective ways to get coverage.

Employer Contributions

Many employers pay a portion of your monthly premium. This is essentially built-in financial help, even if it doesn’t feel like a formal “subsidy.”

• The employer might pay a larger share for employees than for dependents
• Some jobs offer multiple plan levels (e.g., basic vs. premium) with different employer contributions
• Premiums are often taken out of your paycheck before taxes, which lowers your taxable income

Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs)

Some employers also offer accounts to help you pay qualified medical expenses with pre-tax dollars:

• HSA (Health Savings Account)

  • Paired with certain high-deductible health plans
  • Money you and sometimes your employer contribute can be used for eligible expenses
  • Funds can often roll over from year to year

• FSA (Flexible Spending Account)

  • Available with many employer plans
  • You contribute from your paycheck before taxes
  • Often has “use it or lose it” rules, with limited carryover

These accounts don’t lower your premium directly, but they stretch your money for out-of-pocket costs.

COBRA and Employer Extensions

If you leave a job, lose hours, or experience certain life events, you may be able to keep your employer coverage through COBRA or similar state programs.

• You usually pay the full premium (employer + employee share), which can be expensive
• However, some employers or temporary programs may help with part of the cost
• It can be a useful bridge between jobs or during transitions

3. Medicare and Extra Help for Older Adults and People With Disabilities

If you’re 65 or older or have certain qualifying disabilities, you may be eligible for Medicare, which is separate from Medicaid.

Basic Medicare Coverage

Medicare is divided into parts:

• Part A: Hospital insurance (often premium-free if you or a spouse paid Medicare taxes long enough)
• Part B: Medical insurance (monthly premium required)
• Part D: Prescription drug coverage (separate premium)
• Medicare Advantage (Part C): Private plans that bundle Parts A and B, often with drug coverage

Programs That Help With Medicare Costs

There are several forms of financial assistance related to Medicare:

• Medicare Savings Programs (MSPs)

  • Help pay Part B premiums and sometimes other costs
  • Based on income and assets
  • Administered by state agencies (often the same that handle Medicaid, but these programs are distinct)

• Extra Help (Low-Income Subsidy) for Part D

  • Lowers prescription drug premiums, deductibles, and copays within Medicare Part D
  • Aimed at people with limited income and resources

• State Pharmaceutical Assistance Programs (SPAPs)

  • In some states, specific programs help residents pay for prescription drugs
  • Often coordinated with Medicare Part D

4. State and Local Health Insurance Assistance Beyond Medicaid

Many states offer additional programs separate from Medicaid, especially for people who fall in the “gap” where they earn too much for Medicaid but still struggle with costs.

State-Based Premium Assistance Programs

Some states use local funds or special initiatives to:

• Lower premiums for certain marketplace plans
• Provide reinsurance programs that indirectly reduce plan prices in the state
• Offer limited help to specific groups (like small business employees, farmworkers, or early retirees)

These programs differ widely from state to state, so it’s helpful to:

• Check your state insurance department or marketplace
• Ask about “state premium assistance” or “health coverage affordability programs”

High-Risk Pools and Special Coverage Programs

In certain areas, there may be:

• High-risk pools for people who have difficulty finding coverage in the regular market
• Special state plans for individuals with particular medical conditions
• Bridge programs that help people transitioning between Medicaid and marketplace coverage

These are less common than in the past but still exist in some regions.

5. Financial Help From Nonprofits, Hospitals, and Community Organizations

Beyond government and employer programs, community resources can provide critical help—especially with medical bills and specific treatments.

Hospital Financial Assistance (Charity Care)

Many nonprofit hospitals have financial assistance policies for patients who can’t afford their bills, regardless of whether they have Medicaid.

You may qualify for:

• Reduced charges based on income
• Interest-free payment plans
• Partial or full forgiveness of certain bills

To use this help, you usually need to:

1. Ask the hospital’s billing or financial counseling department about financial assistance or charity care
2. Provide basic income and household information

This doesn’t replace health insurance, but it can significantly reduce what you owe if you receive hospital care.

Disease-Specific and Medication Assistance Programs

If you have a particular condition (such as cancer, diabetes, or a rare disease), there may be:

• Nonprofit organizations that help with premiums, copays, or travel for care
• Manufacturer assistance programs that lower the cost of brand-name medications for people without adequate coverage

Eligibility commonly depends on income limits, insurance status, and specific treatment types.

Community Health Centers and Sliding-Scale Clinics

Community health centers and some private clinics offer sliding-fee scales based on income.

• You might pay reduced fees for primary care, mental health visits, dental care, or prenatal services
• These centers may also have staff who help you apply for insurance, including marketplace plans and Medicare or Medicaid if you qualify

Again, this is not full insurance, but it can lower day-to-day care costs and help you stay connected to providers.

6. Short-Term, Supplemental, and Alternative Coverage Options

Some consumers consider short-term or limited-benefit health plans, especially when they’re in transition or feel priced out of traditional coverage. These options require careful attention.

Short-Term Health Insurance

Short-term plans:

• Usually have lower monthly premiums
• Often have high deductibles and significant coverage limits
• May exclude pre-existing conditions or key benefits like maternity care, mental health services, or prescriptions
• Do not qualify for marketplace subsidies

They can help with unexpected major medical events, but they are not a complete substitute for comprehensive coverage. Reading the fine print is essential.

Supplemental Policies

Some people add supplemental coverage to help with specific situations:

• Accident insurance
• Critical illness insurance
• Hospital indemnity plans

These policies usually pay fixed amounts when certain events occur. They are not primary insurance but can help with out-of-pocket costs if used alongside a standard health plan.

7. Comparing Major Paths to Health Insurance Help

Below is a simplified overview to help you see how some of these options differ.

8. How to Figure Out Which Help You Can Get

The number of options can feel overwhelming. A simple step-by-step approach can make things clearer.

Step 1: Clarify Your Situation

Ask yourself:

• Do I have access to employer coverage (through my job or a family member’s job)?
• What is my estimated yearly household income?
• What is my age, and do I have any disability that might qualify me for Medicare?
• Am I already using any public program (like Medicare, veterans’ health benefits, or tribal health services)?

This will quickly narrow down which paths to explore.

Step 2: Check Your Core Eligibility

• If you’re 65+ or have certain disabilities → Learn about Medicare and its savings programs
• If you’re under 65 and not eligible for Medicare → Look at employer coverage first if available, then the Marketplace
• If your income is lower but you don’t qualify for Medicaid → Check for marketplace subsidies and state-specific programs

Step 3: Layer On Additional Help

Once you know your main coverage source, consider:

• Can I qualify for cost-sharing reductions with a Silver marketplace plan?
• Does my employer offer an HSA or FSA?
• Am I eligible for Extra Help with Medicare drug costs or a Medicare Savings Program?
• Could I get support from hospitals, nonprofits, or disease-specific foundations for certain expenses?

Step 4: Get Free, Neutral Guidance

If you’re unsure, you can seek help from:

• Licensed health insurance agents or brokers (who can explain options and plan details)
• State health insurance assistance programs that advise Medicare beneficiaries
• Local community health centers or nonprofit advocacy groups that help with applications and appeals

These resources can help you compare real numbers, not just general descriptions.

9. Key Takeaways: Help Exists Beyond Medicaid

You can absolutely get help with health insurance costs even if you do not qualify for Medicaid. The main alternatives include:

• Marketplace financial assistance: Premium tax credits and cost-sharing reductions
• Employer-based support: Employer contributions, HSAs, FSAs, and sometimes temporary continuation coverage
• Medicare-related help: Programs that reduce premiums and prescription costs
• State and local initiatives: Premium assistance, special coverage options, and prescription support
• Community and nonprofit resources: Hospital financial assistance, sliding-scale clinics, and disease-specific aid
• Supplemental options: Short-term or limited plans, used carefully and with full understanding of their limits

The best approach is usually to start with your main coverage option (employer, marketplace, or Medicare), then look for additional programs that can lower your premiums and out-of-pocket costs.

If you take the time to explore what’s available in your state and for your income level, you may find significantly more help than you expect—even without Medicaid.