Living without health insurance means weighing each decision to see the doctor against the potential cost. Being conservative in your medical care isn’t inherently bad, but for many, this means forgoing necessary care and putting their health at risk.
The Affordable Care Act has proved effective in increasing the number of insured Americans, but 13.2 percent of Americans remain uninsured, according to the latest data from the Department of Health and Human Services. If you’re one of the millions lacking coverage, you could also be one of the many going without preventive care, skipping prescriptions or not going to the doctor when you’re sick. If your health demands care regardless of cost, you could also find yourself with unmanageable medical debt.
The Coverage ‘Gap’
The uninsured are largely lower-income Americans, many residing in states that didn’t expand Medicaid. In these states, many people make too much to qualify for the public insurance, but not enough to receive subsidies from plans purchased on the ACA marketplaces. The 2012 Supreme Court ruling that determined Medicaid expansion was optional for states created this “gap,” and those who fall into it simply can’t afford coverage.
According to the Kaiser Family Foundation, 61 percent of uninsured adults say the cost of coverage and/or unemployment are why they go without insurance. That cost comes down to about $4,823 in annual employee costs under employer-sponsored coverage, according to the foundation. For those without a job or no health insurance options through their employer, the costs are much higher.
Where to Turn for Medical Care
Uninsured Americans may have a tougher time finding affordable care than those with a health plan, but that doesn’t mean they don’t have options.
1. If you haven’t already, check Medicaid eligibility.
Medicaid eligibility is largely determined by your income and household size and depends on where you live. It is geared toward the lowest earners and the disabled. Each state differs in how it manages its Medicaid program and eligibility, but if you reside in a state where Medicaid was expanded, you could qualify if you are a single-person household making less than $16,243. The income cutoff for a family of four is currently $33,465.
If you have children and earn too much for Medicaid, they may be eligible for coverage under the Children’s Health Insurance Program, or CHIP. Like Medicaid, CHIP coverage specifics vary by state.
You don’t have to wait for open enrollment or a qualifying event to apply for Medicaid. Simply visit your state’s Medicaid website or get started on Healthcare.gov.
2. Seek cash-only medical providers.
Some medical providers don’t accept insurance at all. They may be called cash-only clinics, direct primary care or concierge-based medicine. Opting to deal with cash-paying patients means these doctors get money without having to go through the bureaucracy of insurance claims and contracts. Some offer monthly payment plans to keep them on a retainer, while others operate similarly to other clinics. One key difference: They’re not paying for the administrative costs of managing insurance relationships and can sometimes pass these savings on to you.
3. Don’t write off community health clinics.
Community clinics get a bad rap, despite offering sliding fee scales and services specifically for the uninsured. But research in the American Journal of Preventive Medicine shows these cost-friendly clinics perform as well, if not better, than private-practice clinics. Also, the ACA is contributing $11 billion over five years toward the expansion of these clinics, allowing them to add more than 43,000 staff nationwide, treat an estimated 5 million additional patients each year and create clinics in medically underserved locations, according to the Department of Health and Human Services.
4. Compare prices and be a savvy health care consumer.
Even insured Americans are carrying a heavier cost burden in the current health care environment, and there are many tools and options to assist all health care consumers in making smart, financially savvy decisions. Some Web tools, such as OkCopay and the Healthcare Bluebook, make price comparison easier. Paired with review and scoring systems such as the U.S. News Best Hospitals or Healthgrades, you can be smart about choosing a doctor who offers quality care without breaking the bank.
5. Negotiate medical bills after the fact.
If you’ve taken steps to save money on the front end, make sure to be equally cautious dealing with medical costs after the fact. Physicians and hospitals often offer discounts for customers who pay in cash. You can also negotiate medical bills down to a lower balance and work out payment plans if the total due is too much to handle.
It may be tempting to go without health care entirely when you are without health insurance, but you don’t have to sacrifice your health to save. Putting forth the effort to find and use the resources available can translate into both a healthier body and bottom line.
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5 Tips for Navigating Medical Care Without Health Insurance originally appeared on usnews.com
