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A survival guide for the uninsured

The more than 46 million Americans without coverage will get sick more, earn less and die earlier than those with insurance. Here's where to find help if you're caught without it.

 By Liz Pulliam Weston


If you recently lost your health insurance, or if you've never had coverage, then you're part of an unfortunate but growing national trend.


The ranks of the uninsured have grown by nearly 18% just since 2000, according to a study updated in 2006 by the Kaiser Commission on Medicaid and the Uninsured. More than 46 million people under 65 lack insurance, and millions more are considered underinsured, with gaps in their coverage that leave them exposed to catastrophic medical bills.

In fact, medical bills are a factor in about half of all consumer bankruptcies filed, according to a Harvard University study.

The uninsured die sooner

But financial troubles aren't the only risk. According to an earlier Kaiser report:


  • People without health insurance receive less preventive care and are less likely to have major diseases detected early.


  • The uninsured are more likely to die prematurely than the insured, with various studies putting the mortality rate for the uninsured somewhere between 1.2 times to 1.6 times the rate for the insured.


  • Uninsured infants have relative odds of dying that are 1.5 times higher than infants with private insurance.


  • The poorer health associated with being uninsured depresses workers' average lifetime earnings significantly. The commission estimated that better health would boost earnings by 10% to 30%.


If you don't have insurance, there are things you can do to protect your health and pocketbook. Before we get into those, however, I want to tell you about some ways you might be able to find insurance coverage that you might not have considered.


Some of the options include:


COBRA: If you were covered by health insurance at work but are about to lose your job, you're typically entitled to coverage for up to 18 months under the federal Consolidated Omnibus Budget Reconciliation Act of 1985. Unfortunately, you have to pick up the whole tab for this coverage, which can be tough to afford. Coverage for a family of three can easily cost $500 to $1,000 a month.


High-deductible policies: You'll pay more of your routine medical costs out of pocket, but these policies protect you against catastrophic medical bills. Having the coverage also entitles you to insurer-negotiated discounts with doctors and hospitals. (It's shocking, but many medical providers charge the uninsured higher rates and fees because they aren't covered by such discounts.)

An individual HMO policy from Blue Cross with no deductible might cost a single 24-year-old female in San Francisco $330 a month. Choose a plan with 20% co-pays and a $1,000 deductible, however, and the cost drops to $62 a month.


Short-term coverage: Many insurers that provide individual policies have a bridge or short-term option, designed to cover you until you land your next job. These are typically cheaper than a regular individual policy because the insurer is exposed to claims for a limited time. Try the nearest Blue Cross, or talk to an experienced health-insurance broker.


High-risk pools: If a health issue, rather than the cost, is keeping you from being insured, check to see if your state has a high-risk insurance pool. Georgetown University's Health Policy Institute maintains a list of state high-risk programs and contact information.


Health insurance for kids: Most states sponsor low-cost or free health insurance for children, and a few will cover their parents for an additional fee. A family of four in most places can qualify for insurance for their kids with an annual income up to $34,100; in higher-cost areas, that limit may be higher. For more information, visit Insure Kids Now!, a government-run Web site.


Medicaid: This government-funded coverage is generally reserved for people with very low incomes and few assets; each state has different guidelines. For more information, visit Centers for Medicare and Medicaid Services.


If none of those options works for you, you'll be relegated to a patchwork system of government and charitable programs that try to provide help for America's uninsured.


Because there are more than 46 million such people, however, that means some of these resources are overwhelmed.

That doesn't mean you should delay screenings and treatments, only that you may need to wait longer for an appointment than if you were privately insured.

Low- and no-cost health care

Here are some of the resources available for various kinds of treatment:


Routine and diagnostic care: Hundreds of community health centers around the country offer free or low-cost care. To find a site near you, visit the Bureau of Primary Health Care. (NOTE THIS LINK NO LONGER WORKS)


The national Centers for Disease Control and Prevention has information on state health departments, which provide additional clinics and resources for the uninsured.

The American Cancer Society at 1-800-ACS-2345 can direct you to services that provide free or cheap screenings for various types of cancer.


Keep an eye out, too, for any health fairs sponsored by local employers or community organizations. Free and low-cost screenings for common ailments, from depression to high cholesterol, are a routine part of these festivals.


Birth control and reproductive care: Many of the free and low-cost clinics provide reproductive care, or you can contact Planned Parenthood Federation of America, which specializes in free and low-cost help for men and women.


Prescriptions: Some companies market drug discount cards that might entitle you to small breaks on prescription prices, but if you're low-income, you might qualify for assistance programs run by the pharmaceutical companies. Two sites to check: NeedyMeds and the Partnership for Prescription Assistance.

Also, ask your doctor for free samples of any drugs prescribed. Most physicians have closets full of them.


Vision: Lions Club International is famous for its charity eye-care campaigns, which provide free screenings and recycled glasses. If you have a low-wage job but no vision coverage, the American Optometric Association may be able to hook you up with a volunteer doctor of optometry for a free exam. If you're 65 or older, the American Academy of Ophthalmology may be able to provide exams and treatment through its EyeCare America foundation at 1-800-222-EYES.


Dental: If going to the dentist terrifies you, the idea of going to a rookie dentist probably isn't going to put you any more at ease. But dental schools provide inexpensive and well-supervised treatment. To find the one nearest you, visit the National Institute of Dental and Craniofacial Research.



Some of the free clinics also provide dental services.


Emergency care: If you're facing a life-threatening situation, hospital emergency rooms are required to evaluate and stabilize you before asking about your ability to pay. A very limited number of hospitals are required to provide such care for free if you're poor, but the vast majority can bill you (and may hound you aggressively with collection agencies).


That's why if your situation is anything less than critical, you may want to explore alternatives other than emergency-room treatment. Many uninsured Americans wind up in the ER with noncritical situations, simply because they don't know where else to go.



With the information here, you now know some of your other options. Finally, three other things to consider:

  • Medical coverage through your auto insurance. When you have a good health plan, you typically don't need the medical protection offered on your auto insurance policy. If you're uninsured, though, this coverage could pay your bills if you or your passengers are injured in an auto accident.


  • Negotiating cash discounts. Some readers have reported being able to win discounts from hospitals and doctors when they agree to pay cash, while others say they've met resistance. One reader thought he'd be granted a 40% cash discount for his wife's labor and delivery, only to have the hospital renege on the deal and turn the unpaid 40% over to a collection agency.


  • Bankruptcy protection. If you're hit with catastrophic medical bills, consider consulting with a bankruptcy attorney sooner rather than later. Bankruptcy laws have recently been toughened, but people with incomes below the median for their states can still erase medical bills and most other unsecured debts.


Liz Pulliam Weston's latest book, "Easy Money: How to Simplify Your Finances and Get What You Want Out of Life," is now available. Columns by Weston, the Web's most-read personal-finance writer and winner of the 2007 Clarion Award for online journalism, appear every Monday and Thursday, exclusively on MSN Money. She also answers reader questions on the Your Money message board.


Updated Sept. 5, 2007