If you go to the hospital in an emergency and do not have insurance, the hospital staff legally has to treat you due to theEmergency Medical Treatment and Labor Act(EMTALA). However, you may be turned away if you’re not facing a medical emergency. Life-threatening emergencies or active labor due to childbirth require a hospital to stabilize or transfer you — even if you do not have insurance or another way to pay your medical bills.
If you do not pay your final bill, the hospital may send your bill to a collection agency.Medical debt is the most common collectionreported on consumer credit records. If it adds up, you could deal with a damaged credit score, bankruptcy, or other serious financial problems.
Thankfully, there are ways to navigate big hospital bills and serious debts. Learn more about avoiding hospitals for everyday and non-emergency urgent care, employing medical cost-saving strategies, turning to charity care and other services, and working with lower-cost or free providers.
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What Does It Mean To Be Uninsured?
Being uninsured means you lack government-based or private insurance to help reduce medical care costs. In 2021, 27.5 million non-elderly people were uninsured. The high cost of coverage is the primary reason people say they’re uninsured.
Theimpacts of being uninsured include:
- Going without necessary medical care due to cost
- Facing unaffordable medical bills after seeking care
- Not receiving preventive care
- Not receiving major health condition and chronic disease services
- Problems paying medical bills in the past 12 months.
- More medical debt
Some states penalize those without insurance, including:
- California
- District of Columbia (Washington, D.C.)
- Massachusetts
- New Jersey
- Rhode Island
- Vermont
You’ll generally pay the penalty when you file your state tax return.
How Does Uninsured Medical Treatment Work?
You can still get medical treatment if you’re one of the millions without insurance. However, consider the challenges and possibilities in advance.
Circ*mstances In Which You Can Receive Care Without Insurance
You can receive various medical services without insurance. Instead of showing an insurance card and paying a copay or coinsurance, you’ll do something called “self-pay.” Self-pay often results in lower fees, with a recent study indicating thatuninsured people paying cash pay less than those with insurance.
Some uninsured people may pay less based on income. For example, an institution might offer a billing or service discount if your income is equal to or greater than a certain percentage of the Federal Poverty Guidelines.
Can You Be Denied Medical Coverage For Not Having Insurance?
If you’re experiencing a life-threatening emergency or active labor, the closest hospital will likely treat you or transfer you to another hospital, whether or not you have insurance or can pay. Both state and federal laws require health providers to offer treatment for a critical, debilitating, or life-threatening condition.
But some people try to get routine care — vaccines, a sore knee, etc. — at a hospital without an appointment. A care provider can deny treatment If you’re seeking medical care for a condition, symptom, or illness that is not critical or life-threatening. Hospital emergency rooms often become overburdened with injuries or illnesses a doctor’s office could treat.
What Kind of Care Can You Receive?
Beyond a life-threatening situation, the care and treatment you can receive varies by provider and facility. Some clinics are intentionally designed to offer patients free or sliding-scale preventive and routine care, including vaccines and screening for chronic diseases such as cancer.
Other facilities and physicians may offer chronic disease management and treatment, diagnosis and treatment of illnesses and injuries, and urgent care services. These services may be offered with self-pay or cash discounts, payment plans, or another approach.
Some facilities that focus on elective surgery and care, such as cosmetic surgery, may always charge consistent prices.
Paying for Uninsured Patient Treatment
In a sense, we all pay for uninsured patient treatment. Healthcare providers may shift unpaid debts from uninsured patients to other paying patients. Patients with private or government insurance may pay more, or costs may rise more broadly.
That’s because if you cannot pay your bill, the underlying costs remain. For example, the physician still needs to get paid for time and work. Costs may be paid with subsidies or grants from nonprofit organizations, foundations, and federal or state government.During the COVID-19 pandemic, the federal government helped reimburse providers for caring for infected, uninsured patients.
What Happens If You Cannot Pay?
Medical debt is common. Around 41% of adults have some debt caused by medical or dental bills. Patients unable to pay medical debts may face the following:
- Being sued by a provider
- Bills going to collections
- Lowered credit scores
- Bankruptcy
- Inability to pay other bills, leading to home foreclosures or evictions
If you cannot pay your medical bills and are low-income, you may be able to apply for charity care or financial assistance. You’ll likely be asked to submit an application and proof of your family size, income, and assets to qualify. If approved, depending on your state, your bills could be automatically reduced, and you could be given a payment plan that works with your budget.
How to Reduce the Cost of Medical Care Without Insurance
If you do not have insurance, you can still use several strategies to limit costs and get necessary care. Try one or a combination of the following approaches.
Shop for Providers
Shopping for healthcare providers for routine and preventive care can save you money. You may find a provider who charges less for uninsured or lower-income patients, can work out a payment plan with you, or provides you with a discount for full-price payments.
Preemptively Request a Discount
Call the provider’s clinic before going in for care and ask for the estimated fee. Then, research the cost of the service or procedure in your area and the price insurers pay for the same procedure. Sites like FAIR Health Consumer can help you shop for pricing.
Be sure to explain your financial constraints. Some providers may ask you to fill out paperwork and apply in advance for a discount and provide proof of limited financial resources.
Pay in Advance
Being able to pay in advance can help you cut medical care costs if you’re uninsured. You may be able to set up a payment plan over time or pay in a lump sum for further reductions. In addition to any uninsured or low-income patient discounts, paying in advance could save up to 50% in costs or more.Speak with the billing department to ask about discounts for paying in advance.
Ask About Drug Discounts
Several drug discount plans exist, including numerous prescription discount cards. Your state, a local pharmacy, or another provider may offer these cards. You can use the card at participating pharmacies and save up to 80% on prescriptions, vaccines, and over-the-counter medications.
Drug manufacturers also offer discounts through their websites, including printable coupons, rebates, trial offers, or free samples.
Set Up a Savings Account
Putting aside money every paycheck or monthly can create a rainy-day fund for many uses, including medical care and bills. If you can begin saving money for unexpected health expenses, you can budget for physician visits and avoid late payments and collection fees associated with late medical bill payments.
The Best Places to Get Healthcare Without Insurance
If you do not have health insurance, you can access many lower-cost alternatives to an emergency room — without the wait. Learn more about your choices.
Community Health Centers
Community health centers provide primary healthcare to uninsured people and typically offer lower pricing than other options. The following services are provided on a sliding fee scale based on your income, not based on whether you have insurance:
- Primary care and preventive health services
- Urgent care services
- Dental services
- Pharmacy services
The center may even provide transportation as necessary for your medical care. You can find a center near you using the HRSA website.
State or County Departments of Health
You can access health and wellness clinics depending on your state or county. Many clinics focus on education and preventive care, including immunizations, family planning, and screenings for chronic diseases such as cancer, STIs, and tuberculosis.
For this reason, state or county Department of Health clinics can be a good option if you’re uninsured but want to be more proactive about protecting your health. The clinics will not turn away those who can’t pay, and services are offered on a sliding-scale basis.
Urgent Care and Walk-in Clinics
Urgent care and walk-in clinics offer care at a much lower cost than an emergency room. Physicians and nurse practitioners can treat a wide range of issues, including:
- Cuts, sprains, and minor injuries
- Nausea and vomiting
- Allergies and rashes
- UTIs, sinus infections, coughs, fevers, and other infectious symptoms
Some clinics even offer more advanced care on-site — including x-rays and lab work — and can address fractures.You’ll often know pricing up-front, which is usually a flat-rate fee. However, you may also be asked to pay right away.
Pharmacy Care Clinics
Nurse practitioners and physician assistants often provide care at these clinics within a retail pharmacy. Care includes diagnosing and treating minor injuries, infections, and illnesses like insect stings, digestive issues, and ear and skin infections.
While these clinics take insurance, the out-of-pocket rate to treat your condition is generally a low, flat fee you can pay with cash, check, or credit card. Many pharmacy clinics may be open late and on weekends and offer virtual or in-person appointments.
Teaching Hospitals
More than 1,000 academic medical centers and teaching hospitals exist nationwide. These hospitals aim to care for the uninsured and other tasks, including research and training future medical professionals. These clinics rely on residents (doctors in training) and their instructors to help provide primary, preventive care, trauma, and urgent care.Costs could be free or based on a sliding scale, which may ask you to offer proof of financial need.
Employer Sponsored Welfare Programs
Most people in the U.S. get health insurance through employer-sponsored welfare programs that include workplace benefits. If your employer offers these programs, it can include health insurance coverage for preventive care, doctor visits, and hospital stays.
However, not all employers offer health insurance coverage, and you may still need to pay all or a portion of your premiums. You may also be responsible for a deductible, copays, and coinsurance.
The National Association of Free & Charitable Clinics
This network of 1400 free and charitable clinics provides services specifically for uninsured and underinsured people in the U.S. Clinics can provide medical care and diagnosis using imaging and labs. Services may be offered at traditional medical facilities, churches, mobile clinics, or via telehealth.
Care may be free or very low cost, such as $10 per visit. However, it can be challenging to locate a nearby clinic and visit during open hours, which may be limited. Use NAFC’s Find a Clinic tool to find one.
What Low Cost Insurance Options Are Available?
Health insurance typically features out-of-pocket maximums that can prevent healthcare costs from spiraling out of control, along with free preventive care.
Some of the lowest-cost insurance is provided by employers, who help cover your monthly premium. But other low-cost insurance options are available that can help reduce the costs of emergency and routine care.
ACA Marketplace Plans
ACA Marketplace plans must include the10 essential health benefits, including emergency department access, hospital stays, and scores of free preventive services. Pricing depends on your age, location, plan types, and how the costs are split between you and the insurer.
AverageACA Marketplace monthly premiumsrange between $323-$841 depending on the state or $456 nationally. However, you can reduce premium costs by qualifying for a tax subsidy. Or you can choose a plan with a higher deductible or minimum you must meet before the plan’s cost coverage kicks in.
Medicaid
If you apply for health insurance through your state or federal health marketplace, you’ll determine whether you or your family members qualify for your state’s Medicaid or Children’s Health Insurance Program (CHIP) programs.
Each state’s Medicaid plan is slightly different, with different eligibility rules and services. But overall, the program’s services will help you access medical services at free and reduced costs. Like traditional insurance, you’ll receive a Medicaid card. However, not all providers accept Medicaid, and you must renew coverage yearly.
Putting It All Together
Visiting a hospital without insurance poses financial and healthcare challenges. While the EMTALA guarantees care for life-threatening emergencies, routine, and non-emergency services can lead to overwhelming medical bills. However, strategies such as seeking lower-cost providers, requesting discounts, and exploring drug discount plans can mitigate costs. Moreover, low-cost insurance like ACA Marketplace plans and Medicaid can provide vital coverage for the uninsured.
Frequently Asked Questions
Are certain states more forgiving or accommodating for uninsured individuals seeking hospital care?
States with laws designed to reduce uninsured and/or low-income patients’ hospital costs include California, Colorado, Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, Rhode Island, New York, and Washington. Other states may take other steps, such as offering state-run assistance programs or only requiring nonprofit or publicly funded hospitals to provide financial assistance.
How does the hospital determine the price of treatments for uninsured patients?
Hospitals assess in advance whether a patient is likely to pay for treatment expenses based on whether the patient is uninsured or likely to qualify for a hospital’s financial assistance. Financial assistance reduces the treatment’s bill, but the treatment’s cost stays the same. The hospital budgets for varying amounts of financial assistance, depending on the hospital’s geographic location, mission, financial condition, and other factors.
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