An Open Letter to Anyone Who Might Find Themselves Uninsured

Dear Friend,

If you’ve never been uninsured, I hope you never have to feel what it’s like. It’s not just stressful, it’s terrifying. When you live with a condition like Type 1 diabetes, losing coverage can feel like walking a tightrope without a net. I’ve been there.

With premiums for ACA plans projected to rise by double digits in 2026, enhanced subsidies expiring, and an estimated 7.5 million people expected to lose Medicaid over the next decade, many more will soon be in the same position I once was: uninsured, needing care, and wondering how to stay alive.

I don’t want the lessons I learned the hard way to go to waste. If there’s even a chance you might lose coverage in the coming years, here’s what you can do now to protect yourself.

1. Stockpile and prepare while you’re covered

   Refill your medications as soon as they are eligible.

   This took me a while to learn but has been so helpful. Sometimes, my insulin prescription would be ready for a refill but I still had some left so I would wait until I absolutely needed it before refilling it. I learned that if I refill my prescription as soon as it’s eligible under my insurance plan, even if I still have some insulin left, I can start creating a stockpile in the event that I become uninsured.

   Don’t wait until you’re down to your last dose. If your refill is ready, pick it up right away and use the extra to slowly build a cushion. A few extra days’ supply each month can turn into weeks, or even months, of backup if you lose coverage. You can also express concerns to your doctor about running out and see if they can write a prescription with extra supply for emergencies.

   Schedule your doctor’s appointments for the end of the year now

   At the end of the year, medical providers can get busy because many people have hit their deductible and are seeking care. If you may become uninsured beginning in 2026, schedule appointments with your doctor now for November or December so you can get refills of your prescriptions and be seen by your provider while you still have coverage.

   Ask about 90-day prescriptions

   If you still have coverage, sometimes switching from a 30-day to a 90-day supply (often through mail order) can give you a bigger cushion before you’re uninsured. If you fill this 90-day prescription right at the end of this year, you will have a supply for 3 months into next year when you may be uninsured.

   Get records and test results now

   Download and save your entire medical history, lab results, and prescription list from your provider portal while you still have access. This makes switching doctors or applying for charity care much easier.

   Share

2. Tap every source of low- or no-cost care

   Let your care team know you’re uninsured

   Doctors, nurses, and pharmacists often know workarounds that can help you get care, even when you can’t afford it. For example, they should be able to tell you which local pharmacies have $4 generics or which nonprofits cover certain medications.

   Ask your doctor if they have samples of any medications you take

   Many times, drug companies give samples of medications to medical providers as part of their sales pitch. Doctors are often very open to giving these samples to their patients, especially if they let them know they’re struggling to pay for their prescriptions. If you have a good relationship with your provider and feel comfortable asking for samples (don’t be shy or embarrassed), it is a way to get your medications even if you do not have insurance. Health is more important than pride, so ask.

   Use free clinics

   You can use the National Association of Free and Charitable Clinics navigator tool to find clinics near you that offer free medical care. There are also services like Remote Area Medical that operate pop-up clinics offering medical, dental, and vision care throughout the country. RAM and other clinics depend on charitable donations, and they will need far more resources to meet the increased demand in the future. If you can afford to support them, please consider it. Any amount would be appreciated and will help them help the millions of uninsured and underinsured Americans.

   Enroll in patient assistance programs for lower cost prescriptions

   These programs, like the Lilly Insulin Value Program, help patients with no insurance pay a small fee, for example $35 for insulin, for their prescriptions. These programs are run by the drug companies and are certainly no substitute for just lowering the list price of their drugs and ending the game drug makers and insurers’ pharmacy benefit managers (PBMs) play that keep list prices and out-of-pockets requirements high. However, if you are uninsured and need help, these programs can come in handy for a short period of time.

   Use GoodRx, Cost Plus, and similar cash-price tools

   Even without insurance, you can get steep discounts by showing a free coupon from GoodRx, Cost Plus Drugs, or similar services to the pharmacy.

   Seek out mutual aid

   Mutual aid efforts have increased since the COVID-19 pandemic and have become a powerful way to use community to weather hard situations like being uninsured. You can search for mutual aid networks in your area or for a specific disease or community you are a part of. For example, there are many people engaged in mutual aid for Type 1 diabetics. Mutual aid can help in sharing information about low cost medical care or where to get the cheapest prescriptions when paying out of pocket.

3. Know when the ER is your safety net

   If you run out of a life-sustaining medication or experience a medical emergency, don’t hesitate to go the ER. Under federal law (EMTALA), ERs must evaluate and stabilize you regardless of insurance status. They can provide an emergency supply of essential medication like insulin. They are not a long-term solution, but they can save your life.

We’ve already lost too many people because they could not afford insurance. Alec Smith was 26 when he aged out of his parents’ insurance plan. His monthly insulin cost $1,300 without coverage. He tried to ration it. He didn’t survive. Tragically, there are so many more people with stories like his.

Preparing for gaps in coverage isn’t fair, but it can save your life. While we fight for a system where health care is not a gamble but a guarantee, I hope these strategies help you get through a crisis if you ever find yourself uninsured. And keep in mind, no other developed country puts their people’s health in such unnecessary jeopardy; they cover everybody at far less expense than the U.S. We’ll walk you through how they do it in future posts.

Please share this with anyone who might need it.

The more we prepare and look out for each other, the more lives we can save while building a health care system that cares for everyone.

With solidarity and hope,

Rachel Madley

Disclaimer: This letter is intended to provide general information and resources based on personal experience. It is not medical advice and should not replace consultation with your health care provider.