Unemployed And Uninsured: The Gamble Of Going Without Health Insurance To Save Money

Sixty percent of Americans under age 65 — that’s about 164.7 million people — receive their health insurance through their employer, according to a Kaiser Family Foundation analysis. That means losing a job can feel like a one-two punch: the loss of both income and health insurance. 

Then comes the choice. Even with the loss of a paycheck, do you find a way to stay protected through traditional health insurance with its high monthly premiums, large deductibles and out-of-pocket costs? Or do you save money, take a chance and skip traditional coverage?

Marcos Bello faced that choice last year. After being laid off in 2025, Bello found himself with just days of employer-sponsored coverage left and a decision to make about how or whether to insure himself next. 

To cut costs and bridge the gap after a layoff, Bello and some other Americans are turning to non-traditional health care options like short-term health care plans, direct primary care and health care sharing ministries. These plans can offer short-term savings, but experts warn they may leave consumers exposed to denied claims, coverage gaps and significant financial risk if serious illness or injury strikes. 

In 2023, more than 25 million people below age 65 were uninsured, according to the KFF. Of those people who make the conscious choice to go without insurance, the group is often younger, relatively healthy individuals, says Michael Botta, president of Sesame, a health care marketplace.

“I would never tell somebody you should go without health insurance because a backstop in case of emergency is really important,” says Botta. “Bad things happen. Emergencies happen. When you’re young and healthy, you feel pretty indestructible, but one wrong move can be financially and medically devastating.”

Even so, some Americans are choosing savings over security. 

Choosing to go uninsured

2025 was a brutal year for workers, with layoffs surpassing more than 1.2 million and health insurance premiums continuing to climb. Against that backdrop, Bello made the calculated decision to go without traditional health insurance after his layoff. 

Although Bello was only given 10 days of coverage after the layoff, it wasn’t an impulsive choice. The 33-year-old performed a cost–benefit analysis, weighing the price of insurance against the risks of going without it. A key part of his research included uncovering alternative ways to access care, like community clinics and cash pay. (More on those later).

“I was a little more cautious. I wasn’t trying to be out skiing or doing anything dangerous. I was conscious even in the gym,” Bello says. Still, he describes his choice as liberating. “I really felt empowered just knowing all of a sudden, my monthly and quarterly outlay for my medication and health care just got cheaper immediately.”

Health care coverage comparisons

Going without traditional health insurance is a big decision. We’ve put together a chart summarizing some of the most common health care alternatives and lower-cost insurance options — including typical costs, enrollment periods and more. 

Declining COBRA coverage

The Consolidated Omnibus Budget Reconciliation Act, known as COBRA, allows workers to temporarily keep the same insurance they had while working.

Bello had been down the COBRA road before, first signing up for the program after a 2022 layoff and prompted by a late-night emergency room visit for a severe allergic reaction. Concerned about going without coverage, he enrolled before the 60-day window ended. Soon, the cost became hard for him to stomach.

“Before the separation, I was paying $250 every other week out of my pre-tax paycheck, something you don’t really feel as an individual,” he says. “What my employer was covering is now on me. Now I need to pay $1,000 a month.”

When Bello experienced layoff number two in 2025, the memory of the late-night emergency room visit lingered, but the $1,000-a-month COBRA bill loomed larger. One thing he was sure of: He wasn’t signing up for COBRA again.

COBRA can make sense for people with chronic conditions who need continuity of care. However, according to an analysis by the Commonwealth Fund, only about 9% of laid-off workers enroll in COBRA coverage. The biggest reason they skip it is the cost. 

With COBRA, you won’t find subsidies or financial assistance like you can with Affordable Care Act (ACA) marketplace plans. Monthly premiums can also be up to six times higher than what people were paying when employed. On average, that can range from $400 to $700 per person, and even more for families. 

“There’s real sticker shock,” says John Hargraves, managing director of data strategy and analytics at the Healthcare Cost Institute. “You’re suddenly paying the full premium yourself. There’s no employer subsidy anymore. On top of that, there’s usually a [2%] administrative fee. So that’s increasing the premium that the person is going to pay.”

Turning to medical cost-sharing plans

Going without traditional health insurance doesn’t necessarily mean going without any kind of coverage. Medical cost-sharing plans, while not health insurance, are an alternative way for people to pay their medical bills.

Also known as health care sharing ministries (HCSMs) or health care sharing plans, members contribute monthly to a pool to help pay each other’s eligible medical expenses. Depending on the plan, your monthly cost could be as low as $100 a month or less. 

For Kirby Wilson, health care sharing ministries have been a godsend. When the 41-year-old single woman was laid off from her airline job in 2024 and 2025, she was shocked that COBRA would cost $738 a month. Fortunately, she worked part-time for a company that offers HCSM plans and only has to pay $138 for discounted care — a huge relief for her budget.

“If I were basing this on what I could afford, health care wasn’t something that I was going to be able to get,” she says. 

While medical cost-sharing plans can offer value for some people, experts say there are real risks. According to the Commonwealth Fund, in 2023, the plans had more than $230 million in unpaid claims. That’s because some plans have strict rules that disallow reimbursement for various types of care, including substance use disorders, preexisting conditions and preventative care. 

“They’re often cheaper than insurance. But one of the reasons they’re cheaper is that there’s no guarantee that they have to pay your bills,” says Botta. “They can say to you, ‘The pool is out of money. There’s not enough money left to pay for expenses this year.’ Or they could say it was your lifestyle that caused that injury, or that there is no contract. There is no obligation for them, ultimately, to pay your bills.”   

Utilizing short-term health or fixed indemnity plans

If you’re in between jobs or only need basic coverage for a short period of time, short-term plans can be a lifeline. While available in only 36 states as of writing, these plans are typically sold for terms of one to six months, though some insurers offer longer periods, according to the KFF.  

The cost depends on factors like where you live, your age and other criteria, and plans can start around $100 a month. But in exchange for those lower premiums, you have less comprehensive coverage and fewer consumer protections, including the inability to renew coverage when the policy ends. 

Similarly, fixed-indemnity or hospital insurance plans are cheaper than traditional insurance, with premiums as low as $25 a month. Intended as supplemental insurance, they pay a set amount for out-of-pocket expenses, such as a hospital stay or surgery. A 2021 Commonwealth Fund report warned that these plans are being sold to consumers as comprehensive coverage when they only offer limited benefits. 

“The challenge is, there’s no guarantee it’s going to pay the entirety of the bills that you receive,” says Botta. “A hospital stay, unfortunately, is far more expensive than people often realize, at least the sticker price is when you get a bill.”

For 47-year-old Sunny Lee, the allure of indemnity plans was the low premiums and no deductible. Lee signed up in 2024 after she became unemployed, but quickly ran into the plan’s limits. A breast biopsy and specialist visits weren’t covered because they were classified as pre-existing conditions. The plan also didn’t cover a routine colonoscopy, resulting in approximately $700 in out-of-pocket costs. She ultimately decided to switch to a medical cost-sharing plan.

“I learned in a very hard way that fixed indemnity [plans] don’t necessarily work the way that you imagine or you expect,” Lee says. “You really need to read through all of the policy.”  

Accessing community clinics or direct primary care

For people without insurance, community health centers and direct primary care can cover many everyday health needs without breaking the bank.  

After his second layoff, Bello identified community health centers in his area that provided primary care and preventive services, regardless of insurance status. Community clinics typically offer low-cost care on a sliding scale based on your family size and income. Some people can receive care at no charge if they can’t afford to pay.

“I had no question marks about where I can get care,” Bello says. “I had no question marks about what my medication is going to cost or if I’m going to get my medication. All of those things went away.”

Bello’s extensive research also included direct primary care practices. For a fee of $100 a month or less, DPCs give you unlimited access to a primary care provider. 

“It is a way for you to pay a reliable amount every month for continuity of care,” says Botta. “You can see a DPC doctor and get care for regular, routine things.” Depending on the practice, that may include basic lab work, telehealth visits, mental health care and more. In addition to the membership fee, you will have to pay out of pocket for these services, though the DPC clinic may offer wholesale pricing. 

Still, DPCs have limitations. Clinics are not available in all areas. Additionally, specialty medicine and certain procedures are typically not covered. 

“The challenge is that there isn’t a network,” says Botta. “Also, if a DPC doctor says, ‘l feel a lump on you,’ that DPC membership isn’t going to pay for a biopsy, an MRI, or a specialist visit. You have to navigate the rest of the health care system on your own.”

Using payment assistance programs and cash pay options

Rising medical bills are an ongoing concern for Americans. For those without insurance, the financial worries are even greater. The good news is that medical costs are not as fixed as they seem.

“They [providers] might offer you payment plans or might offer you access cards,” says Itzak Cohen, CEO and co-founder of PayZen, a health care company that uses AI to make medical bills more affordable for patients and providers. “They might offer you financial assistance. The problem is that there’s so much cynicism and fear and, quite frankly, anger from patients around paying medical bills that the first response is to just ignore it. But ignoring it is not going to make the problem go away.”

Bello found that being upfront about being uninsured made a difference, especially at pharmacies. “Once I clarified I was paying cash, the pharmacist applied a coupon and the same medication was more affordable, versus my old insurance.”

For labwork, imaging, dentistry and some basic procedures, Bello called ahead and asked for self-pay pricing. “In several cases, paying cash was cheaper than insured rates,” he says. Bello also requested financial assistance and sliding-scale fees. “I asked hospitals and providers about charity care and income-based programs. Eligibility thresholds were higher than I expected, including for some mental health practices.”

Still, cash pay may only go so far, especially if your finances are tight after a layoff. 

“Insurance is really for the more catastrophic events,” says Hargraves. “The typical cost of a hospitalization is tens of thousands of dollars. Sure, cash pay works for all the low-cost, highly used services, but it’s not really going to work for those less common, very high-cost services.”

Living with the ramifications of going without health insurance 

Whether it’s a health care ministry or a fixed indemnity plan, the bulk of these strategies have one thing in common: They offer lower monthly expenses but also carry risk. 

“It may be an economical choice based on the upfront price. But in terms of the protection it gives you, the value is just not there,” says Sarah Collins, senior scholar for the Commonwealth Fund. “You may get some of your costs covered, but it’s not going to cover you for the big risk that health care can present to people, such as unexpected illness and unexpected accidents.”

The real dangers with these alternatives are being uninsured and delaying care, says Kirat Kharode, CEO of HealCo, a firm that helps employers lower costs by providing access to direct care. 

“People need to understand that they didn’t just pick up something that they thought was the full, catastrophic, best version of whatever [insurance] they had before,” he says. “And now they’re thinking that they have the same thing because they picked up a [health care] ministry option or something like that.”

Karode also warns of the risk of getting trapped in debt, especially during periods of unemployment and reduced income. “It’s balancing the decision and walking with awareness.”  

Bello went seven months without traditional health insurance coverage before landing a job in September 2025… one with employer-sponsored insurance. Looking back, he understands the risk he took. However, Bello says the key is understanding your options and deciding how much uncertainty you can live with.

“I think it’s all about the question marks,” he says. “It’s your responsibility to say, ‘How many of these question marks can I erase from my life and keep moving forward?’ I navigated almost a year without having to pay for expensive [health] care. I made it through. I’m alive.”