A while ago, a friend sent me a photo via KakaoTalk. It was a bill from a visit to the emergency room, and as soon as I saw the numbers, I couldn't help but exclaim, "Wow!"

He mentioned that his insurance had briefly lapsed while he was switching jobs. Unfortunately, he got sick during that short gap. It's more common than you might think to have such bad luck.

Hearing that reminded me of a program in San Francisco for situations like this. It's called Healthy San Francisco, or Healthy SF for short.

First, let me clarify something. Healthy SF is not insurance. The official notice clearly states that it is not health insurance.

Instead, it is a healthcare access program run by the city's health department. It allows uninsured residents to receive regular basic care at designated clinics. Therefore, it does not count as meeting the requirements for health insurance coverage.

The eligibility criteria are surprisingly simple. You must live in San Francisco, be at least 18 years old, and not have health insurance.

Additionally, you should not qualify for public insurance programs like Medi-Cal or Medicare, and your household income must be at or below 500% of the federal poverty line.

When I first saw the 500% figure, I thought I had misread it. The threshold is surprisingly high, so even those with middle-class incomes might qualify.

And here's a really important point: when applying, you are not required to provide proof of citizenship or residency. Regardless of immigration status, employment, or pre-existing conditions, residents can access this program.

There's a reason why this program is being talked about again. California has frozen new enrollments for full-scope Medi-Cal for undocumented adults (19 years and older) starting January 1, 2026.

Those who are already enrolled can maintain their coverage as long as they renew on time. However, for new applicants, the door is effectively closed.

According to a report by Mission Local, the number of Healthy SF enrollees has increased by 39% since January 2026. Just looking at the numbers shows where the demand is shifting. It might be wise to act quickly, as clinic wait times could increase.

So, how much does it cost? There is a participation fee that varies by income level, paid quarterly.

For those at or below 100% of the poverty line, the fee is $0. For 101-200%, it's $60 per quarter, and for 201-300%, it's $150.

For 301-400%, the fee is $300 per quarter, and for 401-500%, it's $450. This is calculated per person, so if there are multiple family members, each one is assessed separately.

In addition to the participation fee, there is also a Point of Service fee that you pay when receiving care. The amount varies depending on your income and which clinic you choose. Most services at city health department clinics are $0 for those at or below 100% of the poverty line.

Once enrolled, you will select a primary clinic known as a Medical Home. You will receive your regular care there, and if needed, you will be referred to specialists or hospitals within that network.

Many people overlook an important detail here. Benefits only apply to care received within San Francisco, and hospital costs are only covered if they are at a hospital within your Medical Home network.

This means that if you get sick while visiting another city, this program won't cover it. Basic services like dental or vision care are also not included. You will need to look for separate community clinics for those services.

Additionally, you must reapply every 12 months. If you forget, your coverage will be terminated, so be sure to set a reminder on your calendar.

You can check your eligibility, upload documents, and make an appointment through the HSF participant portal. Having proof of residency and income ready will make the process much smoother.

The first thing I told my friend was to check his Medi-Cal eligibility. If he qualifies for that, he won't be eligible for Healthy SF.

The order of application is important. Those who qualify for public insurance should pursue that first, and only if they are ineligible should they consider Healthy SF.

Be sure to discuss with your doctor or pharmacist what treatments you will receive and whether you can continue any medications you are currently taking. Each clinic may operate a little differently.

Personally, I find it reassuring that such a program exists. Fewer people should have to suffer from illness simply because they lack insurance, as this ultimately leads to a healthier community.

Of course, it's not perfect. Since it's a program funded by the city budget, clinics have pointed out that they receive less than the actual cost of care.

However, for those who have gaps in their insurance, this is far better than having nothing at all. If I were in that situation, I would immediately check the portal as soon as my coverage lapsed.

If you know someone who is struggling without insurance, please share this article with them. It's much less daunting to know about options in advance than to search for help after getting sick.