I have a neurological disorder that is slowly taking my ability to use my legs away. I am trying to keep my self insured and afford the prescriptions/ physical therapy/ doctor appointments and procedures. I work for a school and I am not offered health insurance. I currently am now making too much money to be able to afford my insurance. If I stop seeing the doctor and going to physical therapy my muscles will tighten faster and I will lose the use of my legs sooner. How can I afford insurance and still work and earn a living?


The key to working and getting affordable health insurance, with serious medical conditions is cost assistance and taking all available tax deductions. Specifically you would want:

  • A Silver plan on the Health Insurance Marketplace so you can qualify for cost sharing reduction subsidies and advanced tax credits. Bronze plans may be cheaper, but the cost sharing reduction is more valuable than tax credits for someone who needs serious medical help.
  • An HSA with the maximum amount be contributed every year (to lower taxable income, MAGI, and increase cost assistance).
  • Consider self employment of some form. Self-employed people have more options for tax deductions (including medical premiums).
  • Consider cutting back hours (if that is an option).
  • In all aim to keep your income below 250% of the Federal Poverty Level as that is going to qualify you for cost sharing reduction subsidies and greater tax credits. If you can keep income below 138% FPL and your state expanded Medicaid, even better, you'll qualify for Medicaid and can still work.

We know none of the above suggestions are "easy", but hopefully some of these will help!

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