Paul Sanchez
For many people, insurance is unaffordable, and in 2021, 8.3% of Americans (approximately 27.2 million people) had no health insurance. However, there are ways to get medical support even without insurance. Hospital emergency rooms are required to provide treatment regardless of insurance or ability to pay, and urgent care centers can provide more moderate treatments at a lower cost than emergency rooms. Additionally, community health centers and walk-in clinics can provide basic medical care, such as vaccinations, often on an income-based sliding scale. People may also qualify for government-sponsored insurance, such as Medicare or Medicaid, or coverage through the Health Insurance Marketplace.
| Characteristics | Values |
|---|---|
| Medicare eligibility | Younger than 65 years with a disability and have received Social Security Disability Insurance (SSDI) for at least 24 months |
| Individuals of all ages who have end-stage renal disease (permanent kidney failure in need of dialysis or a transplant) | |
| Medicaid eligibility | U.S. citizens with a household income below a certain level |
| Charity care eligibility | Depends on a person's income and assets |
| Affordable healthcare options | Walk-in clinics, urgent care centers, community health centers, local pharmacies, teaching hospitals |
| Other options | Health Insurance Marketplace, Medicare, Social Security, Supplemental Security Income, Affordable Care Act, CHIP or SCHIP programs, Medicaid |
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What You'll Learn
Medicaid and Medicare eligibility and enrolment
Medicaid is a joint federal and state program that provides health coverage to Americans with limited income and resources. The eligibility rules differ among states, but generally, individuals must meet their state's rules for income and resources and be a resident of the state. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. Some states have expanded their Medicaid programs to cover other adults below a certain income level.
Medicaid eligibility for individuals aged 65 and older or those with blindness or a disability is determined using the income methodologies of the SSI program administered by the Social Security Administration. Certain Medicaid eligibility groups do not require a determination of income by the Medicaid agency; coverage may be based on enrollment in another program, such as SSI.
To enroll in Medicaid, individuals can visit HealthCare.gov to create a Marketplace account and complete an application. If the application shows that the applicant may qualify for Medicaid, the Marketplace will forward the application to the applicant's state for a final eligibility decision.
Medicare is federal health insurance for anyone aged 65 and older and some people under 65 with certain disabilities or conditions, such as End-Stage Renal Disease. Most people get Part A (Hospital Insurance) for free, but some must pay a premium. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits.
Individuals who are eligible for Medicaid and Medicare are covered for both optional and mandatory categories. Medicare Part B (Medical Insurance) helps cover medical services like doctors' services, outpatient care, and other services that Part A doesn't cover. Medicare Part C is a Medicare Advantage Plan offered by private companies approved by Medicare, and Part D assists with prescription drug costs. Medicare eligibility and enrollment are handled by the Social Security Administration, which can be contacted at 1-800-772-1213.
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Charity and community clinics
The San Francisco Free Clinic (SFFC) is another example of a charitable clinic. Founded in 1993 by two family physicians, the SFFC provides free medical care to those without health insurance and also serves as a training ground for future primary care providers. Similarly, the Virginia Health Care Foundation supports over 60 free and charitable clinics and over 200 community health centre locations across Virginia, offering care to low-income and uninsured residents.
Charity care, also known as financial assistance, is defined by the Internal Revenue Service (IRS) as "free or discounted health services provided to persons who meet the organisation's eligibility criteria for financial assistance and are unable to pay for all or a portion of the services." Federal law requires that nonprofit hospitals, which account for 58% of community hospitals, provide some level of charity care to maintain their tax-exempt status. Hospitals establish their own charity care policies, which vary in eligibility criteria, application procedures, and levels of care provided.
In addition to free and charitable clinics, some community health centres offer low-cost healthcare services on a sliding scale based on income. These centres are located in both urban and rural areas and are another valuable resource for those without insurance. Furthermore, some states have expanded their Medicaid programs to cover all people below certain income levels, regardless of other eligibility criteria.
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Walk-in and urgent care centres
If you are uninsured and need medical attention, you can visit a walk-in or urgent care centre. These centres are designed to offer patients affordable and accessible care, even if they lack insurance. They are a convenient alternative to the ER for minor illnesses and injuries, and often have shorter wait times. Services offered include diagnosis, treatment, lab tests, X-rays, vaccinations, physical exams and more.
It is important to note that you will have to pay for your visit and treatment out of pocket if you don’t have insurance, and there may be additional fees for diagnostic tests, X-rays, or other services. A typical urgent care visit without insurance costs around $100 to $125 on average, but this can vary depending on the facility and your specific treatment plan. Some centres offer self-pay options and payment plans to help make treatment more affordable. It is always a good idea to contact the clinic beforehand to get an estimate of the cost and discuss payment options.
In addition to walk-in and urgent care centres, there are other options for uninsured patients. These include telemedicine services, retail clinics, community health centres, and free clinics. Telemedicine services allow patients to connect with a doctor via video or phone call, and are often more affordable than in-person visits. Charity care is another option, where medical care is provided for free or at reduced rates based on a person's income and assets.
It is important to remember that if you are experiencing a life-threatening emergency, such as chest pain, severe bleeding, or difficulty breathing, you should go to the ER immediately, as walk-in and urgent care centres are not equipped to handle these types of emergencies.
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Payment plans and financial aid
Some states have charity care laws that require hospitals to provide free or discounted care to patients who meet certain requirements, often based on income. For example, Washington State requires hospitals to offer free care to patients with family incomes below 100% of the federal poverty level (FPL) and discounted care to those with incomes up to 200% of the FPL. New Jersey and Massachusetts have the same income threshold for free care eligibility.
Even if a hospital is for-profit or private, they may have a financial assistance policy that can help pay your medical bills. Ask your hospital about their policy, including eligibility requirements and how to apply. You can also ask for a copy of their financial assistance policy upfront, which they are required to provide by law, along with eligibility criteria and how to apply for help.
If you are already receiving coverage from Medicaid, Medicare, ACA Marketplace, or other insurance, additional programs may provide further support. For example, there are four Medicare Savings Programs that may be able to help with Part A and Part B premiums, deductibles, coinsurance, and copayments.
If you are struggling with medical debt, you may be able to get help with a debt management plan. This involves a payment schedule that a credit counsellor develops based on your situation. Your money is deposited into an account with the credit counselling organisation, which then pays your debt. This can help you secure lower interest rates and get certain fees waived.
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Local health departments and federal government support
Local Health Department Support:
- Medicaid: This is a form of public health insurance offered by states. Eligibility is based on income, age, and health status. Each state's Medicaid program may have different names and coverage levels. For example, Maryland has the Maryland Children's Health Insurance Program (MCHP), which provides full health benefits for children under 19 and pregnant women meeting income guidelines.
- State-based Marketplaces: Since 2013, all states have offered affordable health insurance options through Health Insurance Marketplaces. Some states have set up their own Marketplaces, while others use the Federally-facilitated Marketplace (FFM). These Marketplaces allow individuals to compare coverage options, enroll, and access lower costs based on their income.
- Charity Care: Some states provide "charity care," which is free or reduced-rate medical care. Eligibility is typically based on income and assets. Individuals can apply through their doctor or hospital or check with the National Association of Free & Charitable Clinics to find a clinic in their area.
- Community Health Centers: These nonprofit health centers provide basic medical care, such as vaccinations, and may offer services based on an individual's financial situation.
- Social Services Agencies: Local social services agencies can provide direct assistance and referrals to local health centers and organizations that may be able to help with medical bills.
Federal Government Support:
- Medicare: This is a federal insurance program available to individuals under 65 with disabilities who have received Social Security Disability Insurance (SSDI) for at least 24 months. It also covers individuals of all ages with end-stage renal disease. Enrollees pay part of the costs through deductibles and small monthly premiums for non-hospital coverage.
- Affordable Care Act (ACA) Marketplace: The ACA allows many young adults to remain on their parents' health insurance plans until age 26. The ACA Marketplace also provides access to affordable health insurance options.
- Medicare Savings Programs (MSP): There are four MSPs that help with Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.
- Supplemental Security Income (SSI): Children may be eligible for some disability benefits through SSI.
- Federal Grant Funding: The Centers for Medicare & Medicaid Services (CMS) provide grants to organizations serving as Navigators in FFM states. These Navigators help consumers prepare applications, establish eligibility, and enroll in coverage through the Marketplaces. They also assist in finding affordable coverage options.
- Federal Guidelines for Emergencies: Hospitals must treat individuals regardless of insurance status in emergency situations, as defined by federal guidelines.
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Frequently asked questions
If you have no insurance, there are still options for receiving medical support. You can look into whether you qualify for Medicaid or Medicare, or whether you can access charity or community clinics, which may provide free or reduced-rate healthcare. You can also access a Health Insurance Marketplace to find affordable healthcare.
Medicaid is a type of health insurance for people with low incomes. Eligibility is determined by each state and is income and disability-based.
Medicare is a federal insurance program available to those younger than 65 with a disability who have received Social Security Disability Insurance (SSDI) for at least 24 months, and individuals of all ages with end-stage renal disease. Medicare enrollees pay part of the costs through deductibles and small monthly premiums for non-hospital coverage.
The Health Insurance Marketplace is a way to find quality health coverage. It allows you to review lower costs based on your income, compare your coverage options, and enroll.
Charity care is medical care that is free or has reduced rates, provided by charity or community clinics. Eligibility depends on income and assets, and fees may be set on an income-based sliding scale.
