How to Find Affordable Health Care
Article Translations: (Spanish)
Many kids in the United States aren't covered by health insurance, or are covered by plans with high deductibles and limited benefits.
If your kids are among them because you can't afford adequate coverage or your employer-sponsored plan doesn't cover everything, don't despair. Programs are available that provide affordable — even free — medical care and are designed to meet or supplement a person's medical insurance needs.
Your kids could be eligible for coverage right now and you might not know it. Here are some options that may be available to your family.
Enroll Your Child in a Public Program
Two public programs work together in every state to provide health coverage for children in low- and middle-income families: Medicaid and Children's Health Insurance Program (CHIP).
Medicaid is run by states with a mix of state and federal funding. It offers health coverage for those with limited incomes, including children and parents, pregnant women, those with disabilities, and seniors. And kids might be eligible for coverage if they're U.S. citizens or lawfully admitted immigrants, even if their parents are not.
CHIP is a program funded by the federal government that each state administers. It provides health coverage for American kids under age 19 in working families who qualify based on their parents' income. CHIP is often helpful for families with incomes too high for Medicaid, but who are still having a hard time affording health insurance.
Each state has different CHIP rules. Some CHIP programs, for example, cover pregnant women as well as parents and related caregivers (such as grandparents raising their grandchildren). Each state has its own name for its CHIP and children's Medicaid programs, too (for instance, the CHIP program in Delaware is called Delaware Healthy Children Program; in Connecticut, it's called the Husky Plan).
To learn about your state's CHIP and Medicaid programs and other services available to your family, visit InsureKidsNow.gov or HealthCare.gov. There, you can apply for CHIP or Medicaid online. You also can call 1-877-KIDS NOW (1-877-543-7669) to find out about the CHIP program in your state.
A child's eligibility for these government programs is based on household income. Once your child is enrolled, you'll receive a list of medical providers near you who accept CHIP/Medicaid patients. You can then make appointments with those providers any time your child needs to see a doctor and also be covered in case of an emergency.
Find a Private Insurer
The majority of kids from low- or middle-income families will qualify for free or low-cost health care through Medicaid and/or CHIP. But now, through the Patient Protection and Affordable Care Act, many privately run health insurance companies will offer similar benefits.
To find out if your family is eligible for a plan, visit the virtual health insurance marketplace at HealthCare.gov. This government service and its website make it easy to apply for insurance and learn which programs are available in your area. By just filling out one application form, the marketplace allows you to compare and contrast the benefits of each plan, as well as compare out-of-pocket expenses like co-pays and deductibles for care.
Visit a Local Community Health Center
A federally funded community health center is another option for low-cost medical care for your kids. You can take your kids there for checkups, immunizations, treatment when they're sick, dental care, prescription drugs, and mental health care.
You also can go there for complete care yourself, including when you're pregnant and for substance abuse care if you need it.
These centers tend to offer medical care on a sliding scale based on your income. Depending on your situation, it could be free. These centers can help you get health insurance and usually will accept that insurance once you are enrolled.
To find one near you, visit the Department of Health & Human Services (DHHS) health center page and enter your zip code under "Find a Health Center." Check the website of the center near you about services, costs, and hours and call ahead for an appointment. Some community clinics are only open on certain days or for limited times.
Rural health centers, which are similar to federally funded community health centers, serve families in rural areas. You can find one in your state by visiting the Centers for Medicare and Medicaid Services website.
Also, visit the National Association of Free and Charitable Clinics' website to find a free or low-cost clinic. The U.S. has more than 1,200 free clinics, which are staffed by a volunteer workforce of doctors, dentists, nurses, therapists, pharmacists, nurse practitioners, technicians, and other health care professionals.
You also might know about urgent-care centers, which are different from community health centers, rural health centers, and free clinics. These centers are designed for people who need care right away or when their doctors aren't in the office. They can be expensive and might not take some types of insurance. Be sure to check with your insurance company before going to one of these.
Talk Dollars With Your Doctors
If your kids don't qualify for a public program (such as Medicaid or CHIP), they need services that aren't covered by your insurance, or you have a high deductible, you can try negotiating a reduced, cash-paying rate with your pediatrician before getting services. Cutting deals with doctors is done more often than you might think.
Start by asking: "Do you accept patients on a fee-for-service basis?" If your insurance has a high deductible, consider yourself a self-paying patient until that deductible is met. So, your discussion about money with your doctor might begin like this: "I'm going to have to pay 20% of the cost of that procedure and I can't afford it" or "that's not covered by my insurance." Talking dollars can be helpful because the doctor might be able to suggest less expensive treatments.
And don't be afraid to shop around for a doctor who can provide care at the lowest price. If specialist A agrees to do a certain type of surgery for $2,000, for example, and surgeon B can do it for $1,500, you'll save $500 by going to doctor B. But be sure that you're never compromising the quality of your child's health care for cost. When comparing rates, look for providers who've been referred by your doctor or another source you trust.
For suggested self-pay rates on a variety of medical services, visit Health Care Bluebook's website.
Because each provider typically receives payment separately, be prepared to negotiate with each provider your child sees. If the procedure you're discussing for your child requires general anesthesia, for example, be sure to ask the surgeon which anesthesiologist she works with and contact that doctor, too, to negotiate a cash-paying price for his services. And don't forget to ask if there's a facility fee for where the surgery takes place — and negotiate that, too.
Find a Safety-Net Hospital
In 1946 Congress passed the Hill-Burton Act, which gave hospitals and other health care facilities money for construction and modernization. In return, hospitals agreed to provide a reasonable volume of services to people who can't pay. The program stopped receiving funds in 1997, but about 170 health care facilities nationwide still must provide free or low-cost medical services. These "safety-net hospitals" are committed to providing access to care for people with limited or no access to health care due to their financial situation, insurance status, or health condition.
There are safety-net hospitals in every state except Alaska, Indiana, Maryland, Minnesota, Nebraska, Nevada, North Dakota, Rhode Island, South Dakota, Utah, Vermont, Wyoming, and all the territories except Puerto Rico.
To qualify for free care at a safety-net hospital, you generally have to make a gross yearly income of less than $23,550 for a family of four. If you make more than that, you still may be eligible for reduced-cost care if your income is up to double that amount.
You can get more information or find a safety-net hospital near you on DHHS's safety-net hospital page.
Ask at Your Local Hospital
As an alternative to finding a safety-net hospital for your child, you can call your local hospitals or medical centers and ask if they provide low-cost or free services to the public. Many large teaching hospitals and medical centers provide free or low-cost quality care for families who otherwise can't afford it.
If you find a hospital that offers this service, you'll meet with financial counselors there to work out a pay rate. They may also connect you to other resources in your community for discounted care.
Pay Less for Prescriptions
Prescriptions can really drain your wallet, especially if your child isn't enrolled in a public program such as Medicaid or CHIP. Here are some ways to better manage the money you spend on medicines:
- Find out if your child can take generic (non-brand) medicines. These often have the exact same active ingredient as the name-brand medicine, but cost a lot less.
- Find out if there is an over-the-counter alternative. Ask the doctor or pharmacist if over-the-counter versions are available for the prescription medicines your child takes.
- Compare prices at local pharmacies. Call each one to ask what they're charging for your child's prescriptions. Many small private pharmacies can negotiate their prices for medications.
- Contact the pharmaceutical company that makes the medication. All the big pharmaceutical companies have prescription assistance numbers you can call for help.
- Beware of free prescription samples (or coupons and rebates). They sound appealing, but they often are for expensive, name-brand medications. That's fine while the samples last. But since many doctors don't like to change a medication if it's working for a patient, you could get stuck paying full price after the samples run out. Before accepting a sample, talk to your doctor about whether you can afford that medication in the long term. If it's something your child only needs for as long as the samples last, take advantage of the freebie!
- If you can't afford to refill a prescription, call the doctor who prescribed it. Say your child's medications are too expensive and you need a lower-cost alternative. If there's not an alternative available, ask what for you can do about lowering the cost. It's not unusual these days for people to ask for this kind of help, and doctor's offices often know how to get it or put you in touch with someone who can.
Have Special Needs? Contact Family Voices
If you have a child with special needs, Family Voices, an organization created to assist families like yours, may be able to help. Its Family-to-Family Health Information Centers offer contacts, support, and information for each state regarding pediatric health issues.
It also can help you manage insurance and other care challenges, such as handling the appeal process if your insurance claim is denied. Each state's office is run by parents who have children with special health care needs.
Know Your Health Plan
Learn as much as you can about your health insurance policy before your child gets treated so you don't get stuck with medical bills you can't pay. You're in a better position to navigate the system and negotiate self-pay rates, if necessary, when you know if your doctor is in-network, what's covered, and what percentage of the cost you're responsible for.
Go to your health insurance carrier's website and log into its insurance portal with your health insurance card number. There, you'll find your benefit plan, including a list of in-network providers, your deductibles, co-insurance, and co-payments. These tools can help you estimate the cost of treatment. If you're not sure about something, call your health insurance company and ask. Make a note of the name of the person you speak to and the date of your conversation in case there's an issue later.
Health insurance companies can't refuse someone coverage or limit a person's benefits because of a pre-existing medical condition. They can't put a lifetime cap on the dollar amount that they will spend on benefits either.
Stay Positive, Stay on Track
Trying to find affordable health care for your family can be overwhelming. But you'll feel better knowing your child's health care needs are taken care of. Lots of kids are eligible for programs that provide free or reduced-cost care, even if their parents are working.
If you don't know where to start, contact your local community health center or county health department and explain your situation. If they can't help you, they can probably direct you to an organization that can. You can also call your state's 211 Helpline, which offers free and confidential information about health care and other services.
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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