Tips for Navigating Medical Care Without Health Insurance

Millions of people in the U.S. live without health insurance, a circumstance that can cause people to weigh the need to see a doctor against the cost. Unfortunately, many people will put off or do without medical care because they can’t afford it, a decision that could jeopardize their health.

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While the Affordable Care Act has boosted the number of Americans with insurance, millions remain uninsured. In 2018, 27.5 million people – more than 8% of the U.S. population – were uninsured, according to the U.S. Census Bureau. Private health insurance covered 67% of Americans. Those without health coverage face the dilemma: Where can I go for medical care without insurance?

The Coverage Gap

In addition to the people who are uninsured, millions are underinsured, according to a survey by the Commonwealth Fund. Among people with health insurance, 29% were underinsured in 2018, compared to 23% in 2014, according to the fund’s Biennial Health Insurance Survey: “People who are ‘underinsured’ have high health plan deductibles and out-of-pocket medical expenses relative to their income and are more likely to struggle paying medical bills or to skip care because of cost.”

The survey found that 41% of underinsured adults reported they delayed needed medical care because of cost. By contrast, 23% of people with adequate insurance coverage said they delayed such treatment. Also, 47% of underinsured adults reported medical bill and debt problems.

Tips for Finding Affordable Medical Care

If you’re uninsured or underinsured, here are eight strategies for finding affordable medical care:

1. Research your eligibility for insurance.

Depending on your situation, you might be eligible to buy individual health insurance coverage from the ACA marketplace or in the individual market, or you might qualify for Medicaid, Medicare or the Children’s Health Insurance Program for your kids, says Kim Buckey, vice president of client services at DirectPath, a company that provides personalized health benefits education and enrollment services to large employers.

CHIP is administered by the U.S. Department of Health and Human Services. It supplies matching funds to states to provide health insurance to families with kids. The purpose of the program is to help provide coverage for uninsured kids in families whose incomes are modest but too high to qualify for Medicaid.

Prices for health care appointments and procedures vary dramatically, with differences of up to 2,000%, says Bill Kampine, co-founder and senior vice president, analytics and innovation, for Healthcare Bluebook. The company’s client base includes municipal and large self-insured employers. It also offers a free online tool that individuals can use to comparison shop for health care services by region.

For example, the tool shows that the price for an abdominal X-ray ranges from $25 to $415 in Nashville, and says the “fair price” is $55 for such a procedure. In addition, it gives the cash prices for such an X-ray at 16 specific health care providers in the area. The price ranges from $72 to $125 at these providers. “Shop around and have a fair price benchmark you’re shooting for,” Kampine says.

3. Agree to a price in writing.

This is a simple but important tip, Kampine says. “It’s a good practice, so there will be no confusion later about the price you agreed to,” he says. Many health care providers –
hospitals and clinics – have forms that show the agreed-upon price. You can also document the price with a letter from the provider’s office or an email.

4. Ask about a cash discount.

When you’re shopping around, always ask for a cash discount. “Many providers will provide a discount if you pay for the entire service at the time of care,” Kampine says. These discounts are typically between 5% and 10%, but could be higher.

If you’re uninsured or underinsured, chances are you won’t have a primary care doctor who knows your health situation, Buckey says. “It’ll be important, then, to keep good records about who you’ve seen for what, what tests you’ve had and what the results were,” she says. You also need to keep track of
what medications you’ve been prescribed and for how long. Keep a list of the pharmacies you’ve used, and be sure to keep records for each family member.
If you don’t have a primary care doctor, it’s important to come to your appointments prepared in order to make the most of your time with the provider, Buckey says. Bring your heath care records and
a list of symptoms that concern you, including when they started and what makes you feel better or worse.

7. Consider community health centers and free clinics.

There are a number of health care providers that provide services at little or no cost to those who are eligible, says April Temple, an associate professor of health sciences at James Madison University in Harrisonburg, Virginia.

For instance, federally funded community health centers offer low-cost medical services on a sliding fee scale. Similarly, there are about 1,400 free clinics nationwide that provide care to the uninsured. Local health departments offer select services including immunizations, testing for
sexually-transmitted diseases and HIV and family planning and contraception.

8. Also, think about urgent care centers.

Nationwide, there’s been a meteoric rise in the use of urgent care centers in recent years. These facilities provide a higher level of care than what’s available at some pharmacy retail clinics, but aren’t equipped to provide emergent care for things like heart attacks and strokes. Urgent care centers can treat a wide array of maladies, including upper respiratory infections, bronchitis, diverticulitis; high blood pressure, food poisoning, sprains, minor fractures and lacerations. An urgent care visit typically costs around $150, according to

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