In this faltering economy, most of us have had to do some scrimping and belt-tightening, but health care is one area where it really doesn't pay to cut back. Unfortunately, for many Americans, life without health insurance isn't just a concern, it's a frightening reality: 42.8 million people under the age of 65 are uninsured, according to the National Center for Health Statistics. Even when you don't have coverage, though, it's critical to keep up with checkups, screenings, and prescriptions — not only for your well-being (and your family's) but also for the health of your pocketbook: If you wind up sick or in the hospital because of a condition you ignored, you could find yourself buried in medical bills. (In fact, medical debt is a top cause of bankruptcy in the United States.) Luckily, you can still get the care you need if you're uninsured. Here's how.
Reduced payments
Here's something most people don't realize: "If you ask them, many doctors will accept less than the asking price for their services," says Richard Schoor, M.D., a urologist in Smithtown, NY. That's because whatever you offer to pay is likely to be more than the contracted insurance or Medicare rate they'd receive. Your doctor may be willing to cut you a deal and nail down a reasonable payment plan. Another option — if you can manage it — is paying cash up front. "This is a vastly underused method that works out better for patients and doctors," says John Di Saia, M.D., a surgeon in Orange County, CA. The benefit for your doctor is that she's paid immediately. (It can take months or even a full year before doctors get reimbursed by insurance companies.) The advantage for you is that prepaying motivates doctors to slash their fees. For five years now, 36-year-old Heather Loftiss, an uninsured mom in Houston, has paid cash for her family's medical expenses. "I work this way with all our doctors, including my husband's back surgeon and my kids' pediatrician," she says. By prepaying her obstetrician and the hospital where she delivered her second child, she estimates she saved $4,000. Her advice: "Talk directly to your doctor, because they are always willing to make better deals." If you're seeing a new doctor, speak to the receptionist before you visit and ask if they offer cash discounts.
Mini-clinics
Conveniently located in chain stores such as CVS and Wal-Mart, these walk-in health centers epitomize "one-stop shopping." Hundreds of these clinics exist across the country, staffed seven days a week by registered nurse practitioners and physician's assistants who can treat and prescribe medications for everyday sicknesses such as sinus infections, pinkeye, and tick bites. Some mini-clinics also provide preventive screenings (for diabetes, high blood pressure, and cholesterol, among other conditions) and vaccines. Prices for services vary depending on the clinic and your ailment; treatment for a bladder infection, for instance, will cost you a flat fee of $69 at CVS's MinuteClinic. To locate a clinic near you, visit minuteclinic.com (CVS), takecarehealth.com (Walgreens), or walmart.com/clinics (Wal-Mart).
Community health centers (CHCs)
Not to be confused with "free clinics" (which are not always overseen by the government, meaning their quality of care is not held to a regulated standard), these federally run centers provide primary and preventive health and dental services to everyone from infants to the elderly. Costs for services, which range from routine exams and prescriptions to immunizations and prenatal care, are based on a sliding scale (meaning what you pay depends on your income) and are among the lowest around. Of the 18 million people who regularly use these health centers, 39 percent are uninsured. Tien Teng, 28, of Oakland, CA, went to a CHC for her annual gynecological exams when she was in between jobs and didn't have insurance. "Because I was unemployed, I wasn't asked to pay a dime," she says. President Lyndon Johnson opened the centers in the late 1960s in response to the vast number of Americans slipping into financial crisis; not surprisingly, CHCs are now seeing a surge of new patients, so much so that you should make an appointment before stopping by your local center. (If you walk in, you're likely to face a long wait.) Find your closest CHC at find ahealthcenter.hrsa.gov.
Planned Parenthood
For many women, Planned Parenthood was the place to go for medical care, birth control, and information when they first became sexually active. Today, the organization still provides top-notch family-planning services to young women, but it also offers a wide breadth of gynecological care, such as routine pap tests, breast exams, STD testing, and menopausal help to women of all ages, at low fees. Patients are charged on a sliding scale based on their income and the health center's public funds. (Some Planned Parenthood centers receive more donations and state funding than others, which can affect how much you're charged.) When you call to schedule an appointment, explain your financial situation and that you're uninsured. You should be able to get a good estimate of what you'll be asked to pay. Search plannedparenthood.org for a location near you.
TelaDoc Medical Services
TelaDoc is a 24-hour telephone medical service that, for a small fee, connects you with a physician who can diagnose minor ailments such as sore throats and migraines and then call in a prescription for you. The program, which is available for adults and children 10 years and older, isn't meant to replace a primary-care physician (you still need to see one for regular screenings and more serious conditions), but it's a convenient and cost-effective alternative when you recognize from experience that your child has another ear infection and you really just need someone to confirm it and write a prescription. Your first step is to become a member, which requires filling out standard medical forms — the whole process can be done online and takes roughly 15 minutes. To speak with a physician, you either dial a toll-free number or go online, where your name is automatically placed into a queue. You'll hear back within about three hours from a doctor who will review your online medical file and ask questions about your (or your child's) symptoms. Once a diagnosis is made, you'll be able to pick up a prescription at your local drugstore. Each telephone consult costs $35; you'll also be charged a small monthly membership fee ($2.85 for individuals; $4.60 for families, plus a $10 registration fee per each person in your plan). For more information, visit teladoc.com or call 800-835-2362.
The National Breast and Cervical Cancer Early Detection Program
When you're concerned about basic health care, cancer screenings may seem like expensive "extras," but you shouldn't skip them: The earlier cancer is detected, the greater your odds of beating it. This government-run program offers free and low-cost screening tests for breast and cervical cancer to uninsured or low-income women. Since 1991, the program has diagnosed 35,090 breast cancer and 2,161 invasive cervical cancer cases, saving thousands of women's lives. To determine whether you qualify for a screening, the organization will ask you about the size of your family as well as your total household income, which has to be at or below 250 percent of the federal poverty level. (An annual income of $22,207 for a family of four is considered poverty level, so if your family makes $55,517 — which is 250 percent of $22,207 — or less, you can take advantage of the services.) Depending on where you live, screenings are performed either at a private or a community health center. Find out more by calling the Centers for Disease Control and Prevention at 800-232-4636 or logging on to cdc.gov/cancer/nbccedp.
Get covered for less
How to find an affordable insurance plan.
Join a club. You may pay lower rates if you sign up for a plan through a professional group or your school alumni association. Your local Rotary Club or Chamber of Commerce should be able to lead you to a group suited for you. But if the rate seems too good to be true, do your homework. Call your state insurance department and check to see if the plans your group is offering are legit or if there are any registered complaints about them.
Pick a high-deductible plan. You'll pay out of pocket for your first $2,000 (or so, depending on your policy) worth of medical expenses, but such plans often charge much lower monthly premiums than those with lower deductibles. Search for these plans at ehealthinsurance.com.
Consider catastrophic health insurance. Best if you're young, healthy, and don't need regular care, these high-deductible plans cover emergency care such as hospitalization, X-rays, and surgery costs — but not routine physician visits. Find one at gohealthinsurance.com or medhealthinsurance.com.
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