In 2010, after a long struggle and many compromises, the United States Congress passed the Affordable Care Act (ACA), commonly known as Obamacare. This legislation was supposed to make health insurance available to all Americans at an affordable price. In theory, it should have ensured that all Americans had the coverage they needed to protect themselves from punishing medical bills.
Yet according to the U.S. Census Bureau, over 27.5 million Americans — roughly 8.5% of the population — had no health insurance for any part of the year 2018. This number included over 77,000 children — more than 1 out of 20 Americans under age 19.
According to the Kaiser Family Foundation (KFF), most uninsured Americans are from low-income families with at least one working adult. The main reason these workers cite for not having coverage is that they can’t afford it despite the subsidies provided by the ACA.
Some of them are caught in the coverage gap provided by uneven expansion of Medicaid from state to state, which leaves many people unable to qualify for either ACA subsidies or Medicaid. Others have fallen victim to the family glitch, which makes people ineligible for subsidies if a family member can get affordable care from an employer. And since the portion of the law that penalized people for going without insurance has been repealed, some people living in states without a state mandate have decided to take their chances without a policy.
If you’re one of the millions of Americans with no coverage, all your health care costs are out-of-pocket costs — and they can be substantial. In a 2015 study by the Johns Hopkins Bloomberg School of Public Health, doctors quoted researchers who called them asked the price of a new patient appointment without insurance an average price of $160 — about $174 in 2020 dollars. That price excludes tests such as blood work.
According to the KFF, 1 in 5 uninsured Americans went without necessary medical care in 2018 because of its cost. To avoid becoming part of this statistic, you need to find lower-cost sources of care your budget can handle.
Places to Get Health Care Without Insurance
The worst possible way to control your health care costs is to avoid going to the doctor. When you put off dealing with small medical problems, they can turn into much bigger, harder-to-deal-with problems. In the long run, you’ll end up paying more both in dollars and in the toll these problems take on your body.
Instead, look for providers who are willing to treat you without health insurance. Many people without insurance rely on the emergency room, but ERs are expensive and often don’t provide the follow-up care you need. For more affordable care, look at community and retail health clinics and other providers that offer either free care or reduced rates.
Subsidized Health Clinics
In both urban and rural neighborhoods across the U.S., health clinics offer affordable medical care to people who need it. These clinics provide such basic care as vaccinations, prenatal care, and general preventive care like checkups and health screenings. If you need more specialized care, such as mental health or substance abuse treatment, these clinics can give you a referral.
Subsidized health clinics fall into two main categories: free (or very low-cost) and sliding-scale. Free clinics are supported by grants, taxes, or charitable donations. Some of them provide care at no cost or a nominal cost to low-income and uninsured patients only. Others are free to all, but they offer only essential services.
Sliding-scale clinics use a different model. They treat everybody, but the amount they charge for care depends on your ability to pay. The highest-income patients pay full price for care, while the lowest-income patients pay little or nothing.
To find a health clinic in your area, consult these resources:
- National Association of Free & Charitable Clinics (NAFC). NAFC is a nonprofit association of clinics that provide “safety-net” health care, including mental health care, to the uninsured or underinsured and others who lack access to care. As of August 2020, it includes more than 1,400 charitable clinics and charitable pharmacies across the U.S. Some are free, and some use a sliding scale. To find a free clinic near you, click “Find a Clinic” on the NAFC website.
- U.S. Health Resources and Services Administration (HRSA). The HRSA funds nearly 1,400 federally qualified health centers, also known as community health centers, across the country. You can find community health centers in every U.S. state, district, and territory. In 2019, these centers had more than 250,000 providers and served nearly 30 million patients. Use the Find a Health Center tool to locate one in your area.
- FreeClinics.com. This website offers one of the most comprehensive lists of free and low-cost clinics on the Internet. It includes both medical and dental clinics, operating on both income-based and sliding-scale models. You can find detailed information and contact information for each clinic, and the user forum provides feedback from people who have received care there. To get started, click your state’s name on FreeClinics.com, then look for the city closest to you.
- Planned Parenthood. One of the best sources for inexpensive reproductive care is Planned Parenthood. Many people know this organization as a controversial provider of abortions. But its clinics also offer a wide variety of other health services, including annual gynecological exams, mammograms, birth control, prenatal care, testing and treatment for sexually transmitted infections (STIs), and routine health care for women and men. Simply enter your zip code on the site to find the health center nearest you.
- NeedyMeds. The main purpose of the NeedyMeds website is to help people afford medications without insurance. However, it also maintains a list of free, low-cost, and sliding-scale clinics by location. You can search for medical, dental, mental health, and substance abuse clinics. The site provides a location and contact info for each clinic along with information about services, eligibility, and fees.
Retail Health Clinics
Many large retail chains across the country, including drugstores, supermarkets, and big-box stores like Walmart, now maintain in-house health clinics. According to Harvard Health Publishing, these clinics are usually staffed by nurse practitioners or physician assistants rather than doctors, which helps keep their costs down. Most of them can provide care like:
- Physical examinations
- Health screenings for work or school
- Drawing blood for tests like blood sugar or cholesterol
- Treating common illnesses such as colds and flu, rashes, sinus infections, urinary tract infections, or pink eye
- Treating minor injuries like strains, sprains, cuts, and burns
You can walk into one of these clinics at any time and receive care after a short wait without needing to make an appointment. They’re open for longer hours than most doctors’ offices — typically 7am to 7pm seven days per week — making them a convenient choice for people who work full time. And because they’re in retail stores, you can visit one while running other errands.
However, the main advantage retail clinics offer for the uninsured is cost. These clinics typically charge a fixed price for each service, and they provide pricing information upfront. For instance, Walmart Care Clinics charge $59 to $99 for an office visit, $39 to $246 for immunizations, and $4 to $95 for lab tests. Ateev Mehrotra, a researcher and associate professor of health care policy at Harvard Medical School, told Harvard Health Publishing that retail clinics typically charge 30% to 40% less for care than a doctor’s office and 80% less than the emergency room.
Both Mehrotra’s research and a 2016 Rand Institute report found that for minor problems, retail health clinics provide care on a par with most doctors’ offices and better than most emergency rooms. However, one thing retail clinics can’t give you is an ongoing relationship with a provider who knows all the details about your health. It’s harder for a provider to spot the signs of a serious problem if they don’t know all about your ongoing health conditions and medications.
To minimize these problems when visiting a retail health clinic, give the provider as much information as you can. Tell them about all your ongoing health problems, and bring a list of all the medications you’re taking.
According to the 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers by the Drug Channels Institute, in 2019, there were around 1,950 retail clinics in the U.S. The primary retail chains that provide them are CVS, Walgreens, Kroger, Target, Walmart, and Rite Aid. However, not all stores have clinics, so check out the stores’ websites to find clinic locations near you.
Direct Primary Care
Most doctors rely on health insurance for the bulk of their earnings. They charge fees the average patient can’t afford to pay out of pocket, counting on the health plan to cover them. This fee-for-service model gives doctors an incentive to see as many patients in a day as they can instead of spending plenty of time with each patient. They also have an incentive to perform as many tests and other services as possible, even if the patient doesn’t really need them.
Direct primary care (DPC), also known as concierge medicine, uses a different payment model. You pay your doctor a flat monthly fee in exchange for as many office visits as you want. DPC doctors have fewer patients and spend more time with each one. As a DPC patient, you have more access to your doctor and don’t have to wait months for an appointment.
Estimates of DPC fees vary. A 2018 Stat article says they range from $50 to $200 per month, while a 2017 NBC News segment puts the cost at only $25 to $85 per month. Either way, the fee is far less than the unsubsidized cost of insurance, which eHealth says averaged $456 a month for a single person in 2020.
The downside is that your monthly DPC retainer doesn’t cover as many types of care as a full health insurance plan. According to NBC News, most DPC plans include basic lab tests, and some cover medications. However, if you need other types of care, such as surgery, a hospital stay, a specialist visit, or an in-office procedure — even if it’s done by your primary care provider — you must pay either with insurance or out of pocket.
To find a DPC physician in your area, visit the Direct Primary Care Coalition. Its Frontier Mapper feature shows the locations of DPC practices across the country. They’re most common near large cities, especially on the East Coast.
Another way to see a doctor without insurance is to connect online. Telemedicine allows you to have a virtual visit with your doctor through videoconferencing or ask a quick question via text rather than coming into the office. According to KFF and Stat, the practice saw a big boost during the COVID-19 pandemic of 2020 because it allows patients and doctors to meet without exposing each other to germs.
A telemedicine appointment can cost much less than seeing a doctor in person. A 2017 study in Health Affairs found that the average doctor visit in the U.S. cost $146, and the average ER visit cost $1,734. By contrast, the average cost to consult a doctor by telemedicine was just $79.
However, according to research by GoodRx, it’s possible to consult a doctor virtually about many conditions for much less than that. According to April 2020 data in the GoodRx Telehealth Marketplace, the lowest available prices for various health concerns included:
- General health starting at $19 through K Health
- Anxiety starting at $9 through Galileo
- Birth control (including a prescription) starting at $10 through HeyDoctor by GoodRx
- Erectile dysfunction starting at $30 through HeyDoctor by GoodRx
- COVID-19 consultation and diagnostic tests for free through many providers
If you have a different health concern, you can compare prices for several telemedicine companies through the GoodRx Telehealth Marketplace. You can also ask your current primary care provider, if you have one, whether they offer telemedicine visits and how much they cost.
Free Health Screenings
For many types of diseases and chronic conditions, early diagnosis is crucial. Catching a disease early can stop it from turning into a more serious condition that’s far more expensive to treat.
One way to do that is through health screenings. They can help diagnose a wide variety of problems early, including diabetes, high blood pressure, high cholesterol, osteoporosis, STDs, certain types of cancer, and mental health problems such as depression.
Many organizations offer free health screenings to patients. These include hospitals, community health fairs, senior centers, government agencies, nonprofit organizations, pharmacies like CVS, and warehouse stores like Costco. Some health screenings are free to anyone who wants them. Others are only for people with low incomes, people with specific medical conditions, or people without health insurance.
There are several ways to find free and low-cost health screenings in your area. Places to call include:
- Health Departments. Call your city, county, or state health department to ask about health fairs or free screenings coming up. You can find your state health department through the Centers for Disease Control and Prevention (CDC) site.
- Local Organizations. Contact local hospitals, pharmacies, and senior centers to ask if they have any free health screenings coming up. Your Area Agency on Aging is also a good resource. You can find its contact information through the government’s Eldercare Locator.
- Health Associations. If you’re seeking screening for a specific disease, try contacting a national or local health organization that focuses on that disease. Examples include the American Cancer Society and the American Diabetes Association.
In 1946, Congress passed a law that gave grants and loans to health care facilities, including hospitals and nursing homes, in return for a promise to provide services to people who couldn’t afford to pay. Although Congress stopped funding this program in 1997, there are still around 130 health care facilities nationwide bound by this agreement. These facilities are known as Hill-Burton hospitals.
To receive free care at a Hill-Burton hospital, you must have an income at or below the current federal poverty guidelines set by the Department of Health and Human Services. However, at some facilities, you can get care at a reduced cost if your income is as much as twice the poverty level. To get free or low-cost care, you must apply at the hospital’s admissions or business office either before or after receiving care. You may have to provide proof of your income or other personal details to be eligible for treatment.
As of 2020, there are Hill-Burton facilities in 36 U.S. states and in all U.S. territories except Puerto Rico. You can find the facility nearest you on the HRSA website.
Urgent Care Centers
If you have a health problem that’s not life-threatening but still needs immediate attention, an urgent care center can almost always provide cheaper and faster service than a hospital ER. These facilities aren’t open 24/7 like emergency rooms. But most are open seven days per week, usually from 7am or 8am until around 8pm or 9pm, according to health care technology company Solv. They can treat problems like severe pain, infections requiring antibiotics, minor illnesses such as the flu or mild to moderate asthma, and minor injuries like sprains, strains, cuts, burns, and most broken bones.
Unlike ERs, urgent care centers treat patients on a first-come, first-served basis. That means if you’re not in immediate danger, you can usually get quicker treatment there than in the emergency room. According to a 2017 CDC study cited by The Conversation, the average wait time at a hospital ER is around 40 minutes, and millions of patients each year must wait two hours or more for treatment. By contrast, the Urgent Care Association of America reports that 94% of patients at urgent care centers wait less than 30 minutes to see a doctor.
Another perk of urgent care centers is that many stock drugs they can dispense directly to patients. If you come in with an infection, you can leave with an antibiotic instead of a prescription for an antibiotic you must pay a pharmacy to fill.
While emergency rooms must treat all patients regardless of their ability to pay, urgent care centers require payment at the time of your visit. However, the fees they charge are typically much lower than the ER’s. For example, the health insurance company Medica estimates that treatment for an earache would cost around $245 at an urgent care center compared to $1,000 in the emergency room. For a urinary tract infection, the estimated cost would be $259 at urgent care versus $1,592 at the ER.
To find an urgent care center near you, simply do an Internet search on “urgent care center near me.” The search engine will pop up a list of nearby centers with their locations and links to their websites. You can also check the websites of the largest urgent care chains, such as Concentra, American Family Care, and MedExpress.
Hospital Emergency Rooms
Many people without insurance rely on hospital emergency rooms as their main source of care since they know they can get treatment there even if they can’t pay. However, that won’t stop the hospital from sending you a bill — and it’s likely to be a big one. A study by the Health Care Cost Institute found that an ER visit’s average cost 2017 was $1,389. That was the price for emergency care only, not including additional treatments such as blood tests, IV medications, or other drugs.
A big bill like this can do significant damage to your credit rating if you’re unable to pay it right away. The longer it goes unpaid, the more likely it is to end up in debt collectors’ hands. You might end up having to take out a personal loan to pay your medical debt or even declare bankruptcy. A 2018 study published in the American Journal of Public Health, summarized by CNBC, found that medical problems are responsible for more than 65% of American bankruptcies.
There are two ways to avoid becoming part of that statistic. First, use the emergency room only for true emergencies — problems that can’t wait until your local free clinic or urgent care center is open to treat them.
And second, if you absolutely must go to the ER for care, go straight to the hospital’s billing office as soon as you get out and explain your financial situation. Once the hospital knows you’re uninsured, it can arrange a repayment plan for you on terms you can afford. It may also be able to help you apply for emergency insurance, such as Medicaid. In some cases, the hospital might even be willing to waive all or part of your bill.
Other Ways to Save on Health Care
If you can’t get the treatment you need from one a more affordable care provider, there are a few other ways to keep the cost under control. Medical discount plans and health care sharing ministries can cover some of your medical expenses without insurance. And if you have a major health problem you can’t afford to treat any other way, there’s a chance of getting the care you need by taking part in a clinical trial.
Medical Discount Plans
If you can’t afford health insurance, a medical discount plan offers an alternative way to reduce your out-of-pocket cost for health care. These plans can also help people with insurance pay for health care costs that their plans don’t cover, such as dental, vision, or hearing care.
Medical discount plans work much the same way as prescription drug discount cards that can get you lower prices on medications at the pharmacy (in fact, they’re a type of medical discount plan). You pay a monthly fee for a health care discount card, and you receive discounts on care from a network of physicians and other providers who have contracts with the card issuer. According to Accuhealth, some plans claim to provide discounts of up to 80%, but a 20% to 30% discount is more typical.
Benefits vary from one medical discount plan to another. Some programs cover only dental care, vision care, and prescription drug benefits, while others offer discounts on a wider range of care, including office visits, hospital stays, health care supplies, and chiropractic care. However, you can only get discounts from providers within the network.
Fees for medical discount plans also vary by card. For example, discount cards from CoHealthUSA range from $10 to $22 per month, depending on the benefits you select. However, some discount plans, such as WellCard, are free. You can also use eHealthInsurance to get instant quotes on insurance and discount plans.
A medical discount plan is not the same thing as insurance. It only covers a limited range of services from a limited network of providers, and it does nothing to protect you from devastating health care costs in case of a major illness or injury. However, it can be a useful option for lowering the cost of your everyday care.
Health Care Sharing Ministries
Health care sharing ministries, or HCSMs through companies like Medi-Share, are faith-based plans under which members help cover each other’s health care costs. These plans, which are typically available only to church-going Christians, charge each member a monthly fee called a “share.” The HCSM pools these shares to pay a portion of their health care costs. However, each family must typically pay a certain amount out of pocket before the HCSM coverage kicks in.
Like medical discount plans, HCSMs do not cover all the costs of care. Most of them cover doctor visits, emergency room care, surgery, and prescription drugs needed for a limited time, such as antibiotics. However, they typically do not cover maintenance drugs, routine care like checkups, or mental health care. Most plans also cap the dollar amount of coverage each member receives in a year.
HCSMs also limit coverage in ways that insurers can’t. They typically refuse to cover care for preexisting conditions or for any illness or injury caused by behavior the HCSM considers inconsistent with a Christian lifestyle. For instance, they typically don’t cover treatment for substance abuse, STIs, or any care associated with an out-of-wedlock pregnancy.
Because HCSMs are not the same as insurance, many doctors don’t accept them. That means you must typically pay your bills out of pocket, then submit them to the HCSM for reimbursement. That limits their usefulness for patients who can’t afford to pay their bills upfront.
If you have a serious illness and you’ve exhausted every other option for care, there’s one more option worth trying: participating in a clinical trial. Clinical trials are medical research studies to test the effectiveness of new drugs and other treatments for disease. Taking part in one gives you a chance to test new therapies before they come to the market. That’s especially helpful if you have a condition that’s not responding well to any of the treatments currently available.
However, there are several drawbacks to clinical trials as a source of health care:
- You May Not Find One. There’s no guarantee a trial is available for the problem you have. Even if there is, you can’t be sure they’ll accept you.
- You May Not Get a Real Treatment. Most clinical trials divide patients into two groups. One group gets the new treatment researchers are testing, and the other, called the control group, gets a fake treatment called a placebo. That allows scientists to make sure patients aren’t just getting better because they expect to get better. So even if they accept you into the trial, you might not receive a real treatment. (However, according to the American Cancer Society, trials for deadly diseases like cancer generally give the control group an actual treatment that is the current standard of care.)
- The Treatment May Not Work. The whole point of clinical trials is to find out whether new treatments are safe and effective. So even if you receive the new treatment, you can’t be sure it will work. And even if it does, it may have serious or even dangerous side effects.
- It May Not Cover Your Costs. In a clinical trial, you don’t have to pay for the drug you are testing. However, you’re still responsible for the rest of your treatment costs. Some study sponsors pay for all or part of them, but many do not.
However, if you are out of other options, it can’t hurt to look for a clinical trial to take part in. Organizations such as the National Cancer Institute, the National Institutes of Health, and CenterWatch maintain lists of clinical trials looking for participants. These lists typically include a description of each study, the criteria for participating, and contact information. You can also look for a clinical trial through matching services, such as EmergingMed, which connect scientists with patients willing to participate in a study.
It’s always a good idea to be honest with health care providers about your insurance situation. If they know upfront you don’t have insurance, they can steer you toward affordable treatment options, including affordable sources of prescription drugs. They may also offer you a payment plan, allowing you to pay your medical bill over several months rather than all at once. Some providers even offer sliding-scale fees for patients who have difficulty paying their bills.
Also, always check your medical bills after you receive care. Sometimes, when you get a bill that seems unreasonably high, it’s not because your care was too expensive. It’s because they billed you for care you never actually received. If you see anything on your bill that looks wrong, call the provider to dispute the charge.
However, the best way to get your health care costs under control is to get health insurance if you can. Cost-saving measures like going to free clinics or using telemedicine can help you deal with everyday expenses, but they won’t protect you from high bills in a true health crisis, such as a chronic illness that requires expensive, long-term treatment. According to the KFF, non-elderly adults with no insurance are more than twice as likely to face bills they can’t pay as those who have insurance.
So, before deciding health insurance is too expensive for you, make sure you’ve checked out all the options. Visit healthcare.gov to see if you qualify for Medicaid or a health care plan at a subsidized rate. The site can also tell you whether uninsured children in your household qualify for the Children’s Health Insurance Program. Even if you’ve tried that and they turned you down before, you could still be eligible now if your financial situation has changed.
If you can’t get a subsidy and can’t afford a standard plan without one, you may qualify for a catastrophic health plan. These plans don’t cover most routine medical care, but they protect you from the kind of medical bills that could drive you into bankruptcy. By combining a catastrophic plan with low-cost sources of care like free clinics, you can keep your everyday care affordable and also have emergency coverage.
Do you have any other tips for finding affordable medical care without insurance?