Since its passage in 2010, the Affordable Care Act (ACA), commonly known as Obamacare, has expanded health insurance coverage to millions of Americans. However, nearly 30 million Americans — over 9% of the population — still lacked health insurance in 2019. This included 5.7% of all children under age 19.
Cost is the main reason people remain uninsured. Millions of low-income Americans fall into the ACA coverage gap, which leaves them unable to qualify for either ACA subsidies or Medicaid services. For others, the family glitch makes them ineligible for subsidies because a family member can get affordable care from an employer. And some have simply decided to take their chances without a policy.
However, living without insurance is expensive too. In 2019, one in four uninsured adults had trouble paying medical bills, and three in 10 went without necessary medical care 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 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 resources cover the uninsured and the underinsured. These populations include many at-risk groups, such as migrant workers, residents of public housing, and people experiencing homelessness.
Subsidized health clinics provide such basic care as vaccinations, prenatal care, and general preventive health care services like checkups and health screenings. Some also provide pharmacy services and specialized care, such as mental health or substance abuse treatment.
Subsidized health clinics fall into two main categories:
- Free Clinics. 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. Sliding-scale clinics treat everybody, but the amount they charge for care depends on your ability to pay. The highest-income patients pay full price for medical services. 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 to low-income individuals. It includes 1,400 charity care clinics and 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.”
U.S. Health Resources and Services Administration (HRSA)
The HRSA funds nearly 1,400 community health centers across the country. Its centers operate in every U.S. state, district, and territory. In 2020, they had over 255,000 providers and served nearly 29 million patients. Use the Find a Health Center tool to locate one in your area.
FreeClinics.com
FreeClinics.com lists over 10,000 free and low-cost clinics spanning all 50 states. It includes medical and dental clinics using both income-based and sliding-scale models. It provides details and contact information for each clinic, plus reviews from patients.
Planned Parenthood
One of the best sources for low-cost reproductive care is Planned Parenthood. Its services include birth control, abortion, prenatal care, testing and treatment for sexually transmitted infections (STIs), and routine health care for women and men. Enter your zip code on the site to find the health center nearest you.
NeedyMeds
NeedyMeds’ main purpose is to help people afford medications without insurance. However, it also maintains a list of free, low-cost, and sliding-scale 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. These clinics are usually staffed by nurse practitioners or physician assistants rather than doctors, which helps keep their costs down.
Most retail health clinics can provide care like:
- Physical examinations
- Vaccinations
- 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 pinkeye
- Treating minor injuries like strains, sprains, cuts, and burns
You don’t need an appointment to use a retail clinic. You can walk in at any time and receive care after a short wait. They’re open for longer hours than most doctors’ offices, typically 7am to 7pm seven days per week. And because they’re in retail stores, you can visit one while running other errands.
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 $8 to $95 for lab tests.
According to Dr. Ateev Mehrotra of Harvard Medical School, retail clinics typically charge 30% to 40% less for care than a doctor’s office and 80% less than the emergency room. And for minor problems, retail health clinics provide care on a par with most doctors’ offices and better than most emergency rooms, according to a 2016 Rand Institute report.
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.
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, and Walmar. 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) 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.
According to Consumer Reports, most DPC patients pay under $100 per month for care. That’s 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 the American Academy of Family Physicians, DPC usually covers office visits and basic lab tests. However, you must pay either with insurance or out of pocket for other types of care, such as medication, surgery, a hospital stay, a specialist visit, or an in-office procedure — even if it’s done by your primary care provider.
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.
Telemedicine
Another way to see a doctor without insurance is to connect online. You can have a virtual visit with your doctor through videoconferencing or ask a quick question via text rather than coming into the office. Telemedicine saw a big boost during the COVID-19 pandemic 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 remotely for much less than that. In the GoodRx Telehealth Marketplace, the lowest available prices for various health concerns as of November 2021 included:
- Anxiety starting at $5 for your first month on LemonAid
- Birth control (including a prescription) starting at $17 through TwentyEight
- Erectile dysfunction starting at $32 through Sesame
- 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 GoodRx. 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 CDC website.
- 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.
Hill-Burton Hospitals
In 1946, Congress passed a law giving grants and loans to health care facilities, including hospitals and nursing homes, for construction and modernization. In return, the facilities had to agree 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. 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
Some health problems aren’t life-threatening but still need immediate attention. For these problems, an urgent care center can almost always provide cheaper and faster service than a hospital ER.
Urgent care centers differ from ERs in several ways, including:
- Hours. Emergency rooms are open 24/7. Most urgent care centers are open seven days per week, usually from around 7am to 9pm.
- Conditions Treated. Urgent care centers 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. However, they can’t treat life-threatening problems such as a heart attack.
- Wait Times. 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, the average wait time at a hospital ER is around 40 minutes. Millions of patients each year wait two hours or more for treatment. By contrast, most urgent care patients wait less than 30 minutes to see a doctor, according to Solv.
- Medications. Many urgent care centers stock drugs they can dispense directly to patients. If you come in with an infection, for instance, you can leave with an antibiotic. By contrast, most ERs can only give you a prescription for an antibiotic that you must pay a pharmacy to fill.
- Payment. Emergency rooms must treat all patients regardless of their ability to pay. By contrast, urgent care centers require payment at the time of your visit.
- Cost. Urgent care centers typically charge much lower fees than ERs. For example, 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 in 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.
There are two ways to avoid high ER costs. 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 assistance programs, 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 Without Insurance
If you can’t get the treatment you need from a more affordable care provider, there are a few other ways to keep the cost under control.
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 their plans don’t cover, such as dental, vision, or hearing care.
With a medical discount plan, you pay a monthly fee for a health care discount card. Then you present the card to get discounts on care from a network of physicians and other providers who have contracts with the card issuer.
However, the value of a medical discount plan can be hard to determine. According to Wisconsin’s Bureau of Consumer Protection, some plans claim to provide discounts as high as 60% to 70%, but most actual discounts are much lower.
Benefits vary from one medical discount plan to another. Some programs cover only dental care, vision care, or prescription drug benefits. 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.
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 (HCSMs), such as 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 don’t 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, HCSMs typically don’t 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 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 if you can’t afford to pay your bills upfront.
Clinical Trials
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. Only one group gets the new treatment researchers are testing. The other, called the control group, sometimes 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. (However, according to the American Cancer Society, trials generally use placebos only for diseases that have no known treatment. If there’s a standard treatment for a disease, the control group gets that instead.)
- 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.
- You May Experience Side Effects. Even if the new treatment works, 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’re 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.
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. These services connect scientists with patients willing to participate in a study.
Final Word
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.
For instance, a doctor can help you find affordable sources of prescription drugs, such as samples. 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.
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, Medicare, or a subsidized health care plan through a health insurance marketplace. 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 them with low-cost care like free clinics, you can afford both emergency and everyday care.
