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Latest Health Hurdle: Buying Insurance Without A Bank Account

Millions of people who rely on check-cashing stores, like this one in New York City, could run into trouble buying health insurance.
Millions of people who rely on check-cashing stores, like this one in New York City, could run into trouble buying health insurance.

When movie stars become unbankable, they're no longer a slam dunk at the box office. When investments become unbankable, they're relegated to the Wall Street's junk pile. For ordinary Americans deemed unbankablethose who don't have a traditional checking or savings account — it can be hard to simply pay bills.

And that absence of a bank account is about to become a big problem for those who also lack health coverage — and for the health insurance companies trying to sell them coverage. After all, how do you sell a product to a customer who has no easy way to pay you?

One in five households in the U.S. have only a tenuous relationship with a traditional bank. Many of 51 million adults in these households rely on check-cashing stores and money lenders, according to the Federal Deposit Insurance Corporation.

The federal health law requires most Americans to carry health insurance starting next January. The presents a particular problem for those households. Most health plans accept a credit card for the first month's premium payment and then require customers to pay monthly with a check or an electronic funds transfer from a checking account.

Those options won't work for the so-called unbankables looking to purchase health coverage with federal subsidies through online insurance marketplaces, says Dan Schuyler, a director at Leavitt Partners, a firm that is advising private insurers and states on how to comply with the law. "You don't want to take these millions of unbankable people through the entire enrollment process and then at the end of line say, 'OK, the only way you can pay for your share of the premium is with a bank account number,' " he says.

The consequences could be severe. When your cable gets turned off, you miss The Walking Dead or Pawn Stars. But starting next year, if your insurance is canceled, you'll be breaking federal law and liable for any medical bills.

Researchers who study consumer financial behavior say people have their reasons for spurning banks. New immigrants, for example, may have distrusted the banks in their home country and brought that skepticism with them to the U.S. And for many people of modest means, overdrafts and fees charged by traditional banks can upend the financial balance in their household.

"The bank account is extremely stressful when you don't have a job that's reliable," says Tran, a 25 year-old community organizer and Ivy League graduate who lives south of San Francisco.

Her current employer doesn't offer her health benefits, and she was turned down, she says, when she applied for health coverage on her own. Tran hopes to get hired to a full-time position and asked that we use just her last name so it didn't give her bosses a bad impression.

Tran says when she took her new job and no longer had direct deposit, Bank of America began charging her, up to $12 a month. "I was not happy with the charges," she says.

Consumers who will be required to purchase health coverage will need payment options that are simple, easy and affordable, say consumer advocates and health care experts.

"I think there is a dawning awareness that this is a large problem," says Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service. Until last year, Haile was wrestling with this problem on behalf of the state of Tennessee, where he served as director of the Insurance Exchange Planning Initiative. "We raised these issues with the federal government well over a year ago and in a series of about four or five letters." Haile said he didn't get much of a response then.

Indeed, neither the Affordable Care Act, nor any other federal health laws, require health insurers to accept all forms of payment, such as credit cards or the cash-loaded, prepaid debit cards that many people without bank accounts often rely on.

Federal officials are wary of doing anything to discourage insurance companies from selling plans on the exchanges, say current and former state health officers who have pressed the federal Department of Health and Human Services for a ruling.

One of the largest players on the new exchanges is likely to be WellPoint, a Blue Cross and Blue Shield licensee. In an email, a WellPoint spokesperson says the company is "evaluating expanded payment options to members." Other insurers, including Cigna and UnitedHealthcare, are urging state officials in planning documents to allow companies to set their own payment policies.

Federal health officials issued a letter in April stating that all health plans selling coverage in the federally run insurance marketplaces in 28 states will have to accept payments in ways that don't discriminate against their customers, but didn't prescribe what those payments should be.

Varney is a reporter with our partner Kaiser Health News, a nonprofit news service.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Sarah Varney