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How to See a Doctor Without Health Insurance

“To sum it up…”

  • If you don’t have health insurance, you have a few options for seeing a medical provider
  • Many primary care doctors will accept cash patients. Some even operate cash only practices
  • You could go to a community health clinic
  • The Affordable Care Act requires all Americans to have health insurance or be responsible for paying a penalty fine. You should look into all of your healthcare options
  • Many states have expanded Medicaid. If you do not have health insurance because you think you cannot afford it, you should apply for Medicaid coverage or CHIP for your children

Many doctors run cash-only practices, so you still have medical care options if you are without insurance. Even doctors that do accept insurance may be willing to see you on a case by case basis. Sometimes, they may even offer discounts to patients who pay in cash. Talk to local doctors in your area and see what options you have.

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What are direct primary care providers?


Direct primary care provider refers to doctors who specifically see patients on a cash only basis. They may also be referred to as concierge doctors or just cash clinics. Some of these clinics charge patients a flat monthly rate and the doctor will seem them as often as they need to be seen for their primary care needs and for preventive services.

The fee can vary depending on the doctor and the clinic, but they are often lower than you would expect. Some doctors offer these services at prices as low as $50 a month!

Not all direct primary care providers offer a monthly “membership” fee. Some will just take cash per visit. However, because they do not have to pay many of the administrative and billing fees that are associated with conventional health insurance, they may be able to offer services to you at a discounted rate.

Look for a concierge doctor in your are and talk to them about prices and the services that may be available to you.

Can I go to a community health clinic?


If you do not wish to see a direct primary care provider, you cannot afford one, or you can’t find one in your area, a community health clinic is often a good alternative. These clinics provide services for free or at a low cost on a sliding scale based on your income.

Some of the necessary services community health clinics provide include prenatal care, immunizations for infants, some primary care services for both adults and children, and referrals to specialists.

Community health centers can provide referrals for a variety of problems you might be having including substance abuse and mental health issues. They may also be able to help with specialized HIV/AIDS care. Community health clinics are located in cities, as well in rural areas, so look for one if your area if you are in need of any of these services at a lower cost.

Are there other types of clinics I can go to?


You do still have a few other options. Walk-in clinics and urgent care centers may be helpful in providing you with the care you need. If you are having an issue that your primary care provider cannot treat, such as a broken bone, an urgent care center may be a good idea. Urgent care centers are often equipped with x-rays and other similar technology and often take cash patients.

The cost is similar to that of your doctor’s office, as opposed to the cost of an emergency room visit, which can be extremely expensive. If you are planning to go to an urgent call center, you should call ahead to ensure they have the technology to treat you and that they take cash patients at a reasonable price.

Walk-in clinics offer limited services and are often located in pharmacies or grocery stores. They usually accept cash and are much cheaper than a visit to a doctor’s office. They can treat common infections and offer flu vaccines.

For additional services, you should look for health screenings in your area. Clinics may offer free screenings for breast cancer and other health problems, such as high cholesterol.

If you are a college student, you can most likely go to your on-campus clinic for free or receive the services they offer at a very low cost. Although the services may be more limited than at an urgent care center or even at your primary care doctor’s office, they can typically treat you for common health problems and the convenience and cost make them a great option for students without health insurance.

What happens if I don’t have health insurance?

The Affordable Care Act made it mandatory for all Americans to have health insurance. If you do not have health insurance, you will be responsible for paying a penalty fine, known as the individual shared responsibility payment. You will owe this fee for any month that you and your dependents went without health insurance.

If you were only without health insurance for a period of less than two months, you may qualify for the short coverage gap exemption and not have to pay the fine. If you do not qualify for any sort of exemption, you will pay the fine when you file your taxes for the previous year.

The fee will either be calculated as a percentage of your income or a fixed amount. You will be responsible for paying whichever amount is higher. It will either be 2.5 percent of your household income with a maximum that is equivalent to the average cost of a bronze health plan or you will pay $695 for each adult in the house and $347.50 for each child in your household under the age of 18 with a maximum set at $2,085.

If you were only without health insurance for a few months, you will pay 1/12th of the annual fee for each month that you were without insurance, unless you qualify for the short coverage gap exemption.

If you refuse to pay the fee, the IRS will hold back the amount from any future tax refunds. There will be no criminal penalties or other type of typical collection procedure for not paying the fee.

How can I apply for health insurance?


To avoid having to pay the penalty fine and to protect your health, you should really look in to getting insurance. If you are unemployed or your employer does not offer health insurance, you can apply on the healthcare market place website in one of four ways.

You can apply online, over the phone, by the mail, or with the help of a trained navigator or insurance broker. You can qualify for savings and tax credits when you enroll in a marketplace plan, so it may be more affordable than you think.

Open enrollment for marketplace plans started on November 1, 2016, and will end on January 31, 2017. If your health insurance was recently canceled or you lost your job, you may qualify for a special enrollment period that will allow you to enroll after this date.

Do I qualify for Medicaid?

If you are a low-income individual who does not have health insurance because you think you cannot afford it, you should consider applying for Medicaid. Medicaid coverage varies by state, but many states have expanded the program so that it is now covering more people who are below a certain income level. There is no enrollment period for Medicaid, so you can apply at any time and your coverage will begin immediately if you qualify.

You can apply for Medicaid through the healthcare marketplace who will forward your information to your state social services agency if it looks like you are eligible. You can also go right to your state’s Medicaid office and apply through them.

If your income is too high for Medicaid, your children may still be eligible for the Children’s Health Insurance Program which offers health coverage for your children at a lower cost. Some states even cover pregnant women. Eligibility and benefits vary in each state, but there are some basic benefits that all programs must cover.

Although the benefits that Medicaid offers are different in each state, all Medicaid programs must cover inpatient and outpatient services, primary care visits, lab and x-ray services, as well as some home health services.

If you do not have health insurance, you still have plenty of options to receive medical care. You can pay cash at a direct primary care provider office, a walk-in clinic, or an urgent care center. You can also see what services are available at your local community health center or your on-campus clinic if you are a college student.

However, if you go without health insurance for an extended period of time, you will be responsible for paying the penalty fine under the Affordable Care Act, so be sure to search for low-cost health insurance options in your area!

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  1. http://health.usnews.com/health-news/health-insurance/articles/2015/06/25/5-tips-for-navigating-medical-care-without-health-insurance
  2. https://billadvocates.com/get-medical-help-youre-uninsured/
  3. https://www.healthcare.gov/community-health-centers/
  4. https://www.healthcare.gov/fees/fee-for-not-being-covered/
  5. https://www.healthcare.gov/apply-and-enroll/how-to-apply/
  6. https://www.healthcare.gov/get-answers/
  7. https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
  8. https://www.medicaid.gov/medicaid/benefits/index.html