Dr. You

If you find it hard to afford health insurance, do not worry; there are many ways to access healthcare services at a reduced cost or even for free. This section can help you find the right options for you.

Patient Story – (The story is true; the patient’s and provider’s names have been changed.)

Mike’s Journey: After becoming unemployed and depleting his savings, Mike was diagnosed with Guillain–Barré syndrome, a rare and serious autoimmune disorder. He received care at the Arlington Free Clinic for multiple health issues and eventually regained his strength. Mike reflected, “I never expected to need free health care, but I shudder to think where I’d be without the Clinic.”

Jim’s Story: Jim, a 30-year-old graduate, lost his job and health insurance after September 11th. When he collapsed on the street due to leg pains, he was taken to the Venice Family Clinic, where doctors discovered a blood clot that had traveled to his lung. This free clinic potentially saved his life by diagnosing and facilitating his treatment for pulmonary embolism.

Options include:

• Government programs
• Free clinics
• Medicaid
• Insurance companies
• Pharmaceutical companies
• Health organizations
• Local charities
• Hospitals and health systems

Government Assistance Programs

Government programs can assist if you qualify.

How to find programs: Visit the official Benefits.gov website. This site offers a free and confidential online screening tool. You will be asked to enter your location and answer questions about your situation to see a list of government benefits programs you might be eligible for and how to apply. You do not need to provide personally identifiable information.

Free Clinics

These clinics offer services to individuals without insurance or the means to afford private healthcare.

How to find a free clinic: Search the National Association of Free & Charitable Clinics website. This website provides a searchable directory of free clinics across the U.S.

Rural Health Clinics (RHCs)

More than 3,500 Rural Health Clinics are providing primary care in underserved rural areas throughout the U.S. They typically offer physician services and on-site lab testing, but the specific services can vary. Some RHCs may also arrange for home visits for homebound patients or have arrangements with hospitals that furnish services not available at their RHC. You may see a physician, nurse practitioner, or physician assistant.

How to find an RHC

A list of clinics near you can be found through a search on the HRSA’s Find a Health Center website by entering your address.

Community Health Centers

Federally funded community health centers offer services on a sliding scale, meaning you pay what you can afford based on your income. Services typically include:

• Checkups
• Treatment for illnesses
• Prenatal care
• Immunizations
• Checkups for children
• Dental care
• Prescription drugs
• Mental health
• Substance abuse care

How to find a health center: Visit the HRSA’s Find a Health Center website. Enter your address in the search box to find the health center nearest to you.

Local Hospitals

Do not overlook local hospitals. They can be a source of low-cost or discounted healthcare. Many are required to give a certain amount of charitable care yearly.

Managing Hospital Bills

If you have bills or need care, contact the hospital’s billing or patient services department. Explain your situation and ask about available assistance. The hospital is required to set up an affordable monthly payment plan. If you pay a few dollars a month, most hospitals do not pursue the debt.

Hospital Clinic Systems

Many large hospitals have clinic systems that offer discounted or free care, especially for Medicaid patients. These clinics are often staffed by medical residents and supervised by attending physicians. They may also offer discounted medications.

The downside to using a large hospital clinic system is that your clinic doctor is not likely to be taking care of you when you are admitted to the hospital. Instead, you will be admitted as a service case, and other residents in training will care for you. If you go to a top-notch hospital, you could end up with better care than if you paid thousands of dollars out of pocket for care in a mediocre community hospital.

Federal Programs

Hill-Burton Program

This program requires certain hospitals and healthcare facilities that received federal grants and loans to provide free or reduced-cost care to those unable to pay. Care at a Hill-Burton obligated facility is not automatically free or at reduced cost. You must apply at the admissions or business office at the obligated facility and be found eligible to receive free or reduced-cost care.

Eligibility: Eligibility is based on family size and income, often tied to the Health and Human Services Poverty Guidelines.

How to Apply:

• Find a Hill-Burton obligated facility.
• Visit the facility’s admissions or business office and ask for a copy of the Hill-Burton
• Individual Notice.
• Follow the instructions in the Individual Notice to apply for free or reduced-cost care.
• Provide required documents, such as proof of income.
• If asked, apply for Medicaid, Medicare, or other financial assistance programs.
• Request a Determination of Eligibility after submitting your application.

Important Points:

• You can apply before or after receiving care.
• Only facility costs are covered, not private doctor bills.
• Facilities may have different eligibility standards and can stop providing care once they have met their allocated amount.

When you apply for Hill-Burton care, the obligated facility must provide you with a written statement that tells you what free or reduced cost care services you will get or why you have been denied.

A facility may deny your request if:

• Your income is more than the income specified in the Allocation Plan.
• The facility has given out the required amount of free care as specified in its Allocation Plan.
• The services you requested or received are not covered in the facility’s Allocation Plan.

• The services you requested or received are to be paid for by a governmental program such as Medicare, Medicaid, or insurance.
• The facility asked you to apply for Medicare, Medicaid, or another governmental program, and you did not.
• You did not give the facility proof of your income, such as a pay stub.

When Your Request for Charitable (Free) Care is Denied

You can file a complaint with the U.S. Department of Health and Human Services. Send complaints to: Director, Division of Facilities Compliance and Recovery, 5600 Fishers Lane, Room 10- 105, Rockville, MD 20857

For More Information: The U.S. Department of Health & Human Services offers comprehensive information about the Hill-Burton program. Free and Low-Cost Care for Children

Child Health Insurance Program (CHIP)

The federal government provides low-cost health coverage to children in families who earn too much to qualify for Medicaid but cannot afford private insurance. CHIP typically covers:

• Doctor visits
• Dental care
• Prescription medicines and immunizations
• Hospitalizations
• Care for children with special health care needs.

How to Apply: Call 1-800-318-2596 or apply through the Health Insurance Marketplace website: https://www.healthcare.gov/get-coverage/.

Eligibility: Varies by state.

State Applications: Find applications for every state at InsureKidsNow.gov.

Medicaid

Medicaid provides medical assistance to low-income individuals and families who meet specific eligibility requirements.

Eligibility: Varies by state and poverty level and depends on factors like age, pregnancy, disability, income, and resources. Medically needy people who would be eligible except they have too much income or assets may become eligible for Medicaid solely because of excessive medical expenses.

How to Apply: Apply through your state’s Medicaid agency.

Income Guidelines (Example – 2016):

People in the Household 2016 Federal Poverty Level
1 $11,880
2 $16,020
3 $20,160
4 $24,300
5 $28,440
6 $32,580
7 $36,730

Other Sources of Free Care

• Shriners Hospitals for Children: Provides specialized pediatric care for children up to age 18 with orthopedic conditions, burns, spinal cord injuries, and cleft lip and palate. Services are provided with no financial obligation to families. Call 1-800-237-5055 to see if a child is qualified.

• National Association of Free and Charitable Clinics: Offers information on 1,200 free clinics staffed by volunteer healthcare professionals.

• Pharmaceutical Company Prescription Drug Assistance Programs

• Partnership for Patient Assistance (PPA): Helps people find prescription drug assistance programs. Visit PPARX for more information.

Check Your Benefits

GovBenefits and Benefits Check Up

If you want to know if you qualify for Medicaid, or you’re a senior needing help paying for prescription drugs, health care, and other health services, or you want to know what government assistance programs you qualify for at both the Federal and State levels, you can go to http://www.benefitscheckup.org. BenefitsCheckUp is a service of the National Council on Aging. They include both public and private programs for all fifty states and D.C.

Health care related programs are available that cover prescription drugs, nutrition (including Food Stamps), general health care, and in-home services. These organizations have helped more than two million people and provided almost $8 billion dollars in annual benefits.

Health Resources and Services Administration (HRSA) Information Center

The HRSA information center provides publications, resources, and referrals on health care services for low-income, uninsured individuals and those with special health care needs via a comprehensive website located at http://www.hrsa.gov/index.html, or a toll-free number: 1-888-Ask-HRSA.

Users will find detailed listings of facilities that provide free or reduced-cost health services, information on sites that provide comprehensive primary health care services for people living with HIV, listings of dental providers who provide care to people living with HIV, organ donor cards, etc.

Foundation for Health Coverage Education

The Foundation for Health Coverage Education offers to help people find free or low-cost health coverage by phone at 800-234-1317, via their website at https://coverageforall.org, through state guides, and by online applications for specific programs. They aim to simplify public and private health insurance eligibility information to help more people access coverage.

This information is intended as a general guide and may not reflect the most current policies or programs. Always verify details and eligibility requirements with the relevant organizations or agencies.