Before deciding to go uninsured for a year, The Prepared Patient understands the costs, protections, and options that could change their mind.
As Americans prepare to choose health insurance for 2027, some are asking a question they never expected to face: Can we afford to keep our coverage? Premium increases are adding pressure to budgets already stretched by housing, food, and other essentials. For families who rarely visit a doctor, going without insurance may begin to look like a manageable gamble.
The concern is most acute this year. An August 2026 a KFF analysis found that insurers proposed a median 15% premium increase for 2027 Affordable Care Act Marketplace plans. Proposed increases do not tell any one household what it will pay, but they help explain why people are weighing difficult options.
As a physician, I encourage people facing this choice to consider the full consequences before they cancel a policy. Here are the questions I would ask.
What could one unexpected diagnosis cost?
Consider a generally healthy adult who develops appendicitis, breaks a hip, or receives a new cancer diagnosis. Emergency surgery may be followed by imaging, consultations, rehabilitation, prescriptions, and repeat visits. Without coverage, bills from multiple clinicians and facilities can add up quickly. Costs vary widely and may be impossible to predict in advance.
A health emergency doesn't give you time to “shop” for care. Finding prices during a health crisis is nearly impossible and impractical.
An ACA-compliant health plan limits annual out-of-pocket spending on covered, in-network benefits. For 2027, Marketplace plans may have an out-of-pocket limit as high as $12,000 for one person or $24,000 for a family. Some plans have lower limits. Premiums, excluded services, and many out-of-network charges fall outside those limits. An uninsured person has no comparable insurance-based ceiling.
Will the emergency department care for you?
Choosing the emergency department for your care, especially routine care, is not a good plan. In fact, it could be very costly.
Federal law generally requires hospitals with Medicare-participating emergency departments to screen patients for an emergency medical condition and provide stabilizing treatment or an appropriate transfer, regardless of insurance or ability to pay. That protection is essential, especially during a crisis.
It does not erase the bill. It also doesn't guarantee access to every specialist, prescription, rehabilitation program, or follow-up appointment after discharge. Routine and ongoing care can be much harder to arrange and pay for when you are uninsured.
Could you sign up after you get sick?
Usually, a new diagnosis alone doesn't create a special opportunity to buy a Marketplace plan. Most people enroll during open enrollment or after a qualifying life event, such as losing other coverage, moving, getting married, or having a new child. If you voluntarily drop insurance, don't assume you can immediately restore it when you need treatment.
For 2027 coverage, HealthCare.gov enrollment generally runs November 1, 2026, through January 15, 2027. December 15 is the important deadline for coverage starting January 1. State Marketplace schedules may differ. Verify the dates that apply to your state.
Have you checked every option for financial assistance?
Before going uninsured, apply through HealthCare.gov or your state Marketplace. Premium tax credits may be available depending on your household and income. Federal enhanced tax credits ended after 2025, but many eligible households still qualify for standard assistance. Medicaid and the Children’s Health Insurance Program may offer another route, and you can check eligibility throughout the year.
Compare a lower-premium Bronze plan with Silver plans, especially if you qualify for additional reductions in deductibles and copayments. Those extra savings generally require enrolling in a Silver plan. Ask whether a Catastrophic plan is available and whether you meet its eligibility rules. If your employer offers coverage, understand how that affects your options.
You can consider a high-deductible health plan (HDHP). But be aware that coverage doesn't kick in until you have paid a high amount out of pocket. These plans generally have lower monthly premiums than traditional health insurance and require you to pay more of your medical expenses before insurance begins covering costs.
For 2027, an HSA-qualified HDHP generally must have a minimum annual deductible of $1,750 for an individual or $3,500 for a family, with maximum annual out-of-pocket costs of $8,700 and $17,400, respectively (excluding premiums). These limits increase in 2026. A major benefit is the ability to contribute to a tax-advantaged Health Savings Account (HSA), with 2027 contribution limits of $4,500 for individuals and $9,000 for families, provided eligibility requirements are met. This benefits those who can afford to set aside some of their income for these accounts. Under rules introduced in 2026, qualifying Bronze and Catastrophic Marketplace plans also became HSA-compatible, even if they do not meet the usual HDHP deductible and out-of-pocket requirements. HDHPs protect against major medical expenses, offer access to negotiated insurance rates, and generally cover qualifying preventive care without requiring you to meet the deductible.
The biggest downside to HDHPs is financial exposure: routine doctor visits, prescriptions, diagnostic tests, and unexpected medical needs can generate substantial upfront costs. Those with chronic conditions, frequent medical needs, or limited savings may find these plans financially challenging (can be catastrophic). However, compared with going completely uninsured, an HDHP can provide valuable protection against potentially devastating medical bills.
What if you ultimately remain uninsured?
Protect your access to care as much as possible. Locate a community health center or primary care practice that offers sliding-scale fees. Ask the price of nonemergency care before scheduling. Uninsured or self-pay patients can generally request a good-faith estimate for planned services. Ask hospitals about financial assistance programs, which may reduce costs for eligible patients.
There is no federal tax penalty for being uninsured, although certain states impose their own requirements. Check your state rules. Above all, seek emergency care promptly when it is medically necessary. Cost worries should never delay evaluation of a possible life-threatening emergency.
Make the decision with real numbers
Write down three figures: the annual premium for the least expensive suitable coverage, the amount you could comfortably pay toward unexpected medical bills, and the financial consequences of a major illness or injury. Then examine what you would lose in preventive care, regular treatment, and access to trusted clinicians.
In The Prepared Patient, I emphasize planning before a health crisis forces urgent decisions. If your family is reconsidering coverage this fall, start by finding out exactly what your options would cost and what they would protect.
What information would make it easier to decide whether a health insurance plan is worth the price?
About the author Terry Adirim, MD, MPH, is a physician and the author of The Prepared Patient: Your Guide to Surviving the Health Care System (Johns Hopkins University Press, 2026).
The Prepared Patient: Your Guide to Surviving the Health Care System is available at Amazon https://bit.ly/4nCWoDv
Other helpful resources
KFF, How Much and Why ACA Marketplace Premiums Are Going Up in 2027 | HealthCare.gov, When Can You Get Health Insurance? | CMS, Emergency Room Rights Under EMTALA | CMS, Medical Bill Rights When Not Using Insurance | HealthCare.gov, No Health Coverage and State Fees