In These Fields, You’re Less Likely to Have Health Insurance Than the Jobless

“Having a job doesn’t guarantee coverage anymore,” said Neal K. Shah, CEO of CareYaya Health Technologies and chairman of Counterforce Health, a platform that helps fight health insurance claim denials. “Industries with strong unions and full-time higher-wage people, like teachers or engineers, negotiate good benefits.” 

On the other hand, Shah said, industries that rely on part-time, seasonal, or contract workers often find legal ways to avoid providing benefits like health insurance.

What Drives These Disparities?

The Affordable Care Act (ACA) has made it easier for many people in the U.S. to obtain health insurance, but it still has gaps that can make it challenging for some workers to access care.  

For instance, small businesses with fewer than 50 full-time employees are exempt from the employer mandate—meaning they don’t have to provide health benefits to workers and their dependents. Large businesses—50 or more employees—only have to provide coverage for 95% of full-time equivalent employees, defined as those working 30 hours or more, on average, each week. Even then, they can pay a penalty to avoid offering health care.  

Under the ACA’s measurement rules, an employer can average hours over a set period (often up to 12 months). That means someone who racks up many hours in certain seasons might not qualify as full-time if their average dips below 30 hours/week across the measurement period.

Given these rules, temporary, part-time, and low-wage workers tend to rely more heavily on public insurance, such as Medicaid or subsidized ACA marketplace plans.

Different Industries, Different Incentives

Some jobs come with extra challenges in getting health insurance, especially for seasonal or contract workers at small businesses—like farm workers, said Alexandra Sossa, CEO of the Farmworker and Landscaper Advocacy Project (FLAP).    

“Income and hours fluctuate so coverage is hard to keep, and language and immigration-related fears make enrollment intimidating, especially in rural areas with limited providers and transportation,” Sossa said.

On the opposite end of the spectrum, large corporations, particularly in competitive industries like architecture and engineering, require highly specialized workforces—and often have to offer comprehensive health benefits to compete for talent. 

They’re also better-positioned to do so, said Dr. Christy Lane, co-founder of Flora Fertility and visiting professor at Stanford University School of Medicine.

“Because they employ thousands of people, they can participate in group insurance models where premiums are based on the overall health risk of the group rather than each individual,” Lane said. “With such large pools, the risk is spread widely, which drives down the cost per employee.”

How to Find Health Insurance When Your Job Doesn’t Offer It

If your employer doesn’t provide health care plans for you or your dependents, you still have options:

• Visit Healthcare.gov and try enrolling for health insurance. “In many cases, you will qualify for Medicaid or steeply subsidized health insurance coverage,” said Jack Glasker, managing partner at Affordable Healthcare Solutions, a private insurance brokerage in Westfield, New Jersey. 
• Stay on top of enrollment requirements if and when you receive public or subsidized coverage.
• Consider high-deductible health care plans (HDHPs) or even catastrophic health insurance. Both plan types offer lower monthly premiums, but deductibles, copays, and out-of-pocket maximums tend to be higher. Still, they might be a better option than going without coverage entirely.