A Guide to Medical Services for the Uninsured

Patient Expert

When you have any sort of health issue and are uninsured or underinsured, it can be challenging to know where to go for affordable health care. In this post, I hope to present a variety of resources which may be useful in obtaining necessary medical care.

Community Health Clinics and Hospitals

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, funds a network of community health clinics and other health centers that provide free or low-cost health care to people who are uninsured or underinsured. You pay what you can afford, based upon your income. Medical services vary from center to center, so it is important to find a center that provides the type of care you need. Health centers, located in most cities and many rural areas, provide:

1. checkups when you're well

2. treatment when you're sick

3. complete care when you're pregnant

4. immunizations and checkups for your children

5. dental care and prescription drugs for your family

6. mental health and substance abuse care if you need it

Find a Health Center near you.

NeedyMeds.org provides a database of Free and Low-cost Clinics.

Public Hospitals and Academic Institutions

Many hospitals provide free or reduced-cost care on a voluntary basis, depending on the mission of the facility. Each hospital is different. Some hospitals are dedicated almost exclusively to serving the medical needs of low-income, uninsured individuals. In addition, hospitals affiliated with academic institutions, although not always considered public institutions, often provide free or reduced-cost care. If you believe a hospital can provide care that you need but cannot afford, contact the patient services department of the hospital to ask about available programs.

Find members of National Association of Public Hospitals and Health Systems (NAPH).

Hill-Burton Facilities

In 1946, Congress passed the Hill-Burton Act, a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility's area. The program stopped providing funds in 1997, but about 200 health care facilities nationwide are still obligated to provide free or reduced-cost care.

Eligibility for free or reduced-cost care under Hill-Burton is based on income. For some services, such as nursing home care, you might qualify if your income is up to two to three times the federal poverty level. You do not need to be a U.S. citizen to qualify for Hill-Burton care, although you do need to have been a resident of the United States for at least three months. To find out if you qualify for Hill-Burton assistance, apply at the admissions or business office of a Hill-Burton facility.

Find a Hill-Burton facility near you.

Government Programs

Additional government programs may be available in your area. Every state has programs to help needy families and individuals with the cost of healthcare. NeedyMeds.org provides a database for government programs including state-sponsored programs, Medicaid websites, SHIP websites, and Federal Poverty Guidelines.

Prescription Assistance Programs

Previously, I wrote a lengthy post which detailed the many prescription programs available for medications commonly used in treating rheumatoid arthritis. Please consult Financial Assistance for Your Rheumatoid Arthritis Medications for more information. Although you should read the entire post and use it as a reference, I will mention RX Outreach as an excellent source of generic medications at reasonable cost for patients with income below 300 percent Federal Poverty Level.

Patient Advocate Foundation

The Patient Advocate Foundation (PAF) offers the National Financial Resources Guidebook for Patients: A State by State Directory of information for patients seeking financial relief for a broad range of needs including housing, utilities, food, transportation to medical treatment, and children's resources. I called PAF in 2006 looking for prescription assistance for an MS-related medication. Although I discovered that they had closed their MS fund, one of their Case Managers conducted extensive research on my behalf and found a local government program which could help me with a $1000 grant for prescription medication. The social worker at the local government office even found a charity organization who was willing to anonymously help me.

Health Insurance Consumer Guides

The Georgetown University Health Policy Institute has written A CONSUMER GUIDE FOR GETTING AND KEEPING HEALTH INSURANCE for each state and the District of Columbia 51 in all. Each guide lets you know in a simple and straightforward format what protections you have, and lack, if you need to find individual health insurance coverage after a major life event like divorce, losing a job, or the company you work for going out of business.

Final words of advice.

Help keep your records complete. Try to obtain your medical care from a select group of health providers so that your records are more complete at each location. Better yet, get copies of your records and keep them with you.

Negotiate fees. Be willing to be your own advocate and negotiate fees with physicians and hospitals. Be straight forward, inform your doctor of your uninsured status, and ask if he/she is willing to lower their fees or allow you to pay on a sliding scale or even a payment plan. If you are uncomfortable talking to your doctor directly, speak with his/his office manager.

Don't give up. Just because you do not have medical insurance doesn't mean that you need to go without necessary medical care. Several pharmacies have walk-in clinics staffed by nurse practitioners and physician assistants who are able to diagnose and treatment common illnesses, minor injuries, and skin conditions. They also offer health screenings and vaccinations. (see MinuteClinic as an example)