Navigating the System: When You’re Uninsured
by Krisha McCoy, MS
In the United States, millions of Americans have no health insurance. Being uninsured can be detrimental to your health. Many uninsured people delay getting needed medical care, live with serious medical conditions for too long, and do not receive preventative services. This can cause their health to deteriorate, leading to more serious—and more expensive— illnesses such as heart disease, cancer, and diabetes.
Federal laws have made low-cost health insurance available to some people, especially children of low-income families. And emergency departments and clinics are required to provide a certain level of treatment to everyone, regardless of their insurance status. In addition, some “safety net” facilities offer free care to people who are unable to pay.
Affordable Care Act
The Affordable Care Act (ACA) went into effect in early 2014. The law allows for Americans who were previously uninsured to get insurance. Choices of coverage and premiums are offered througth the Health Insurance Marketplace. Insurance is offered through private health insurers where you choose the level of coverage you need. Take some time to research plans, including out-of-pocket expenses, deductibles, participating doctors, dental care, and coverage areas. If you need additional health coverage or qualify for other government programs, such as Medicaid or Children's Health Insurance Program (CHIP), the Marketplace will share your information with the appropriate agencies for follow-up.
Low-Cost Insurance for Children
Uninsured children are less likely to receive “well-child” check-ups and other forms of preventative care, which can jeopardize their health. If your family does not have health insurance, you may be able to get insurance for your children at little or no cost, depending on your income level.
Medicaid is a health insurance plan that supports the care of low-income families. However, the rules for counting your income and resources to determine eligibility vary from state to state and from group to group.
While Medicaid covers many low-income children, coverage for adults is limited because parent eligibility income levels are set much lower than those of children. Unless they are disabled, even the poorest adults may be ineligible for Medicaid if they do not have children. Individual states set Medicaid limits and share the costs with the federal government.
The Children's Health Insurance Program Reauthorization Act (CHIPRA), provides more children with health insurance under CHIP. This program is meant for children and pregnant women in families that do not qualify for Medicaid, but also cannot afford to buy private health insurance.
The Healthcare Safety Net
America’s healthcare “safety net” is a system that provides healthcare to people who are underinsured or uninsured. Safety net providers undertake a mission to deliver healthcare to people who may not be able to pay for it. They may do so voluntary or out of a legal obligation. These providers may include emergency departments, community health centers, public hospitals, charitable clinics, and teaching and community hospitals. How these institutions are financed varies from state to state. In many cases, the owners of the facilities and the doctors that work there bear much of the financial burden.
The only providers that are legally obligated to provide safety net care are emergency departments. The Emergency Medical Treatment and Labor Act (EMTALA) ensures that anyone who comes to an emergency department—whether they are insured or can pay for the services or not— must receive a medical exam and be stabilized before being transferred to public hospitals.
This means that if you go to an emergency room with a medical problem, your treatment cannot be delayed because of a lack of insurance, and those with insurance cannot receive preferential treatment. There are signs posted in emergency departments that detail your rights according to the EMTALA provisions.
But charitable providers and emergency rooms cannot fully substitute for health insurance. If you are uninsured or underinsured, do your best to make sure this is only a temporary situation. The risk is great: a major illness or injury can lead to financial ruin.
Centers for Medicare & Medicaid Services
4 tips about the health insurance marketplace. Health Care website. Available at: https://www.healthcare.gov/get-covered-a-1-page-guide-to-the-health-insurance-marketplace. Accessed May 17, 2016.
Children's health insurance program (CHIP). Medicaid website. Available at: https://www.medicaid.gov/chip/chip-program-information.html. Accessed May 17, 2016.
Emergency medical treatment & labor act (EMTALA). Centers for Medicare & Medicaid Services website. Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html. Updated March 26, 2012. Accessed May 17, 2016.
Ross JS, Bradley EH, Busch SH. Use of health care services by lower-income and higher-income uninsured adults. JAMA. 2006;295(17):2027-2036.
Last reviewed May 2016 by Michael Woods, MD
Last Updated: 5/17/2016
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