What to do if you're still uninsured

Some people won't be covered even after the new law takes effect

Published: September 20, 2013 04:00 PM

The new health care law aims to reduce the number of uninsured Americans significantly, but millions will remain without health insurance, either because they’re excluded from the law’s provisions or, despite the reforms, they still don’t have an affordable source of coverage. Some people who still might not have health insurance are:

  • Undocumented residents.
  • Low-income adults living in states that are not expanding Medicaid to cover everyone in this category.
  • People who can’t find insurance that costs less than 8 percent of their household income.
  • People who choose to pay a penalty rather than purchase health insurance.

If you are uninsured or in danger of becoming insured, here’s what you need to know.

Make one last effort to get insured

Going without health insurance should be a last resort. If you have to pay a bit more than 8 percent of your income to buy it, compare this additional cost to the tens or hundreds of thousands of dollars you might end up owing if you become ill or injured without it. (Did you know that the average three-day hospital stay costs $30,000?)

Use our Health Law Helper, an interactive tool that may help you identify some coverage options that you didn’t know about.

If you haven’t already, visit your state’s Health Insurance Marketplace to look at plans and find out whether you or family members may qualify for financial help with insurance premiums. Healthcare.gov has a link to every state marketplace.

Find lower-cost drugs and medical offices

Go to a community health center. There are more than 8,000 across the country. They provide basic outpatient care—including, in some cases, dental and mental-health services—and they charge according to a person's ability to pay. Find the center nearest you.

Use retail clinics. Most are operated by large national chains (including CVS, Target, and Walgreens) and staffed by nurse practitioners, nurses with advanced training who can prescribe medications. Research has shown that the quality of the routine care they deliver is similar to that of doctor’s offices, but at a lower price. Use them for routine services such as school checkups and immunizations, and for treatment of minor ailments such as ear infections and strep throat. Find a nearby retail clinic.

Ask doctors to cut your bill. No one pays the sticker price for health care except uninsured people who don't have the benefit of the big discounts that public and private insurers obtain for their members. Many doctors will offer a similar discount to uninsured people, but you have to ask. If you can’t pay the whole bill at once, ask about setting up a payment plan.

Comparison shop for prescription drugs. You can easily end up paying more than you need to if you fail to compare prices at more than one pharmacy, or take an expensive brand-name drug when a cheaper generic could work just as well. Our money-saving guides can help you evaluate the options.

Understand how to use hospitals

Use the emergency room only for true emergencies. It’s the only place you should go for a serious medical problem that requires urgent attention, such as a broken bone, a heart attack, or symptoms of a stroke. Even without insurance, the hospital is legally required to stabilize you if it is one that accepts Medicare funds. But the care is not free: the emergency room is among the most expensive places to get care. You will receive a bill afterward and it will probably be a very large one.

Apply for hospital financial assistance. If you must go to the emergency room or into the hospital (preferably in advance in nonemergency situations) check the hospital’s website or ask for its written Financial Assistance Policy, which will include the criteria for assistance and information on how to apply. The new health care law requires every nonprofit hospital to have one. (Not sure whether your hospital is nonprofit or for-profit? Our hospital Ratings include that information. Navigate to your hospital and click on the “general information” tab, which you can see even if you’re not a subscriber.)

If you qualify for financial help (unfortunately, the exact criteria are left up to individual hospitals), in addition to the assistance the nonprofit hospital is not allowed to charge you more than what a typical insurance company would pay for the treatment you got. That’s important, because hospital list prices can be much higher than the discounted prices negotiated by insurers.

Know your hospital billing rights. The new health law says that nonprofit hospitals can’t take “extraordinary” steps to collect bills without first notifying you about their financial assistance policies and giving you an opportunity to apply, if you haven’t already.

The hospital is supposed to send you this information along with your bill, but if it doesn’t, it has four months from that time to notify you, and you have the same four months to apply for help. During that time the hospital can’t take aggressive measures to collect a bill, such as foreclosing or putting a lien on your home, suing you, or reporting you to a credit rating agency. 

Look for disease-specific programs

There are dozens of them but you have to know where to look and, in many cases, follow some very specific rules. The federally financed Breast and Cervical Cancer Treatment Program, for example, will pick up the entire cost of treatment for low-income women. But to qualify in many states, your condition must have been diagnosed at one of the program's approved screening centers. If you received a diagnosis elsewhere, you're not eligible. Find the screening program nearest you. Needymeds.org, a website run by a nonprofit group, lists financial-assistance programs for specific diseases in an easy-to-search format.

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