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Thread: Information for US residents without health insurance.

  1. #1
    Super Moderator Top User
    Join Date
    Dec 2011

    Information for US residents without health insurance.

    This sticky is intended to provide information to U.S. residents without health insurance. The information in it is up to date as of December 16, 2017.

    The window for enrolling in health insurance through the Affordable Care Act (also known as Obamacare) ended 12/15/17 in most states. The following states have extended deadlines:

    CA 1/31/18
    CO 1/12/18
    CT 12/22/17
    DC 1/31/18
    MA 1/23/18
    MN 1/14/18
    NY 1/31/18
    RI 12/31/17
    WA 1/15/18

    Disclaimer: Please note that I am not a medical professional nor an insurance professional, so all of the advice below is just based on reading, experience & making phone calls.

    We frequently see posters here in the "Worried" forum who are uninsured and hope to get a diagnosis or reassurance from the forum, or from the internet generally. Unfortunately, the internet doesn't work as a diagnostic tool. An actual physical examination, by a qualified person, of your own personal body is the only way to find out what's going on!

    Options for being seen by a medical professional are listed below.

    Be aware that you are facing three possible levels of expense.

    First level Physical exam. Just going in to be seen is financially feasible for most people, and may even be free in some cases. There may be lab fees for blood and urine tests, or these may also be free. At this level, though, you could be spending hundreds of dollars.

    Second level Tests and scans. These may include needle biopsies, biopsies, CT scans and/or MRIs. At this level, you're looking at thousands of dollars. However, some scans may be free in some states or communities.

    Third level Actual diagnosis with cancer. If you are diagnosed, your treatment may include surgery, chemotherapy, radiation... the list goes on. Here you will certainly be looking at tens of thousands to hundreds of thousands of dollars.

    Here are the First Level options, which will of course vary greatly according to where you live.

    Free cancer screenings. Depending on where you live, free cancer screenings may be available for high risk individuals. Most often these are breast cancer and colon cancer screenings. Information about this is often posted in public libraries and county social services departments.

    Free clinics. These are most common in cities and in socially-conscious smaller towns. They are generally staffed by volunteers. The quality of care is (in my experience) highly variable. You may wait a long time to be treated. Some of these clinics may be able to refer you to specialists who will see you on a pro bono (free) basis, but this not common and is usually reserved for the neediest cases.

    Sliding scale facilities. These facilities will often see you on a sliding scale based on income, and the scale slides all the way down to zero. The sliding scale applies to tests that can be done at the clinic, but not to scans or tests for which you have to be sent elsewhere.

    Community health clinics. These are sometimes affiliated with a hospital. In my experience the quality is dicey.

    Planned Parenthood. If you are female and have symptoms related to the reproductive system or the pelvic area, you can be seen here. In my experience the quality of care is usually very good.

    Least expensive full-price options.

    Dentists. If you have oral symptoms, you might try visiting a dentist. Some (not all) are used to being paid by the patient so their fees tend to be lower than those of medical facilities. Ask about the fee when you make the appointment.

    Optometrists. They are not medical doctors, but they are qualified to examine symptoms you may have that are related to the eye.

    Urgent Care Clinics. These places, often found in strip malls or city shopping districts, are often private businesses. In my experience the quality of these places is high. I recently paid $130 to be seen at one of these, less than I would have had to pay at the community health clinic (since I didn't qualify for the sliding scale). I had to wait about an hour to see a physician's assistant.

    Mexico. Tijuana has some English-speaking doctors who will see US patients, sometimes on a walk-in basis. This option may be convenient if you live near the border, but not otherwise.

    The Most Expensive Option

    Emergency Room Care. Emergency rooms are not permitted to turn away uninsured patients. However, these facilities are extremely expensive. Sometimes it may be possible to set up a monthly payment plan.

    Bottom Line

    All of the above options address the first or early second level of care, and will work only in a situation where your fears turn out to be completely groundless... that is, a situation where you go to see a medical professional, are given a couple tests, maybe a scan, are told you're just fine, and are sent on your merry way. If you have an ongoing health problem which has been undiagnosed for some time, then you're likely to be looking at lots of tests, lots of specialists, lots of bills.

    You need to get insurance. You need to get it ASAP.

    Insurance you can get right now.

    Medicaid. If you are below the poverty line, in most states you are eligible for Medicaid, which is completely free. Ask at your county social services department or visit your state's department of health website.

    In some states-- most notably Texas-- only the extremely poor qualify for Medicaid.

    Subsidized health insurance or full-priced insurance. Certain qualifying events (marriage, divorce, losing employer-provided insurance, becoming a legal US resident, moving to a new state or coverage area, having a birthday and thus becoming too old to be included on your parents' plan) may make you eligible to buy subsidized or full-priced health insurance through the government exchanges even though you've missed the annual enrollment period. Consult your state's department of health website.

    You can find your state's website via the federal website healthcare.gov.

    Insurance available outside the government marketplace. It looks to me, just from surfing the web, like you can still buy insurance through insurance agents or other non-government programs. For example, my attempt to get a quote for the CostCo plan (not available in all states) didn't run into any hitches.

    If all that's available right now is an expensive plan, know that you'll only need it for a few months. Once the government health insurance marketplace reopens in November, you can look for something else.

    Insurance you can apply for on November 1, 2017, to take effect January 1, 2018.

    Subsidized health insurance. This is available for those with incomes less than four times the poverty level. There are many different plans and levels of coverage.

    Full-price insurance. This is available for those with incomes greater than four times the poverty level. There are many different plans and levels of coverage.

    Both of the above will be available through your state's website.

    Whether you buy subsidized or full-priced insurance, if you're still having ongoing health problems come November, I would strongly advise you to buy a plan with low or no deductible that covers many different kinds of care. You may be looking at a long process of multiple tests, scans and visits to specialists, and you want to pay as little out-of-pocket as possible. Be very picky in making your insurance choice. I would advise doing all of the following:

    1. Read carefully to understand what is and isn't covered. If you don't understand, call the company and ask.
    2. Look up to see if your preferred doctor or hospital is covered by the plan.
    3. Make sure the best hospital in your region is covered by the plan.
    4. Make a test phone call to the insurance company. See how long it takes you to get an actual human and how helpful that human is. Don't skip this step. This is really important. I learned the hard way.

    If you are in the US illegally, see post #5 below.

    I will update this sticky as I get more information and/or as the situation changes. Please do not use this forum, or any forum, as a substitute for diagnosis by qualified professionals! If you think you may have cancer, you can't afford to mess around.
    Last edited by GBMsibling; 12-16-2017 at 04:02 PM. Reason: To add new information and fix dead links.

  2. #2
    Super Moderator Top User
    Join Date
    Dec 2011

    Things to Know About Choosing an Insurance Plan

    When you select a health insurance plan, pay attention to the following four things:

    Deductible The deductible is the amount you have to pay each year before the insurance kicks in. In general, the cheaper the plan, the higher the deductible. For example: if a plan has a $3000 deductible, that means the insurance covers nothing until your medical bills for the year go over $3000. (You have to pay the first $3000 of bills.)

    Co-Pay The co-pay is the amount you have to pay for an appointment or treatment after the deductible is paid. For example, if your co-pay is $20 for a doctor's visit, that means that before the deductible is fulfilled, you pay the full price of a doctor's visit. After the deductible is fulfilled, you pay $20.

    Covered Treatments These are listed on the description of the plan. If you're not sure, ask.

    Covered Doctors and Facilities Check before you buy! Make sure the insurance plan covers your doctor if you have one, the hospital nearest your home, the best hospital in your region, and, if necessary, the best cancer center in your region.

    Here's an example of how it works. Let's look at two hypothetical insurance plans, which we'll call plan 1 and plan 2:

    Plan 1: Has a monthly premium (cost) of $200 a month, a deductible of $6000, and a co-pay of $35. Covers Hospital A but not Hospital B.

    Plan 2: Has a monthly premium of $500 a month, a deductible of $500, and a co-pay of $20. Covers Hospital A and Hospital B.

    Say you have Plan 1 and are suddenly rushed to the ER at Hospital A. They give you a scan and a few tests, admit you for observation overnight, give you some drugs, and you leave with a bill for $8000. The first $6000 is going to be paid by you. The rest, you'll pay the co-pay for each treatment. If you're rushed to Hospital A again a week later, you'll pay only the co-pay for each treatment, nothing more. However, if you're rushed to Hospital B, which is not covered, you'll pay everything.

    If you have Plan 2, you will pay the first $500 of your medical bills the first time you're rushed to Hospital A or Hospital B, and after that you'll pay the co-pay.

    If you're young and in good health, Plan 1 may be the way to go. If you're in the midst of diagnosis or if you have cancer, Plan 2 is better. You'll be paying $3600 a year more in premiums, but your deductible will be $5500 less so you'll come out ahead.

    It's important to read through the covered treatments to see what is excluded. If something is excluded that you think you might need (or know you will need) don't buy that plan.

    It's also important to find out what doctors and facilities in your area are covered. It can be a nasty shock to sign up for an insurance plan, pay your bills, and then discover that the hospital where you need to be seen isn't in the plan.

    Before you buy, visit the insurer's website and call their help center. If it takes half an hour to get a real live person on the phone, do not buy the plan no matter how good it looks.

    Bronze, Silver, Gold or Platinum: This doesn't tell you everything you need to know.

    If you buy through your state's health insurance website, you will find that the plans are ranked as Bronze, Silver, Gold or Platinum. For the most part, this has to do with the deductible and the co-pay. However, you still need to read the fine print, check the company's website, and call them on the phone.

    I didn't! And here's what happened.

    I bought a Platinum Plan from Brand New Company. No deductible, $10 co-pay, sounds great. Then I found out that Brand New Company's plan was not accepted by any of the doctors in my area. Also, Brand New Company wouldn't cover any bills at certain facilities that didn't share their religious beliefs. I had to call Brand New Company on the phone to find all this out, and each call involved being on hold for half an hour and then talking to someone who couldn't answer my questions. I also had to call them several times because they "lost" the checks I sent, although my bank said they were cashing them.


    Fortunately, there were still a few days left in the enrollment period. I went back to my state's health insurance website. I looked at the plans much, much more carefully. I visited the company websites of each of the plans I was considering. I made test phone-calls just to see how long it took to get a human, and how knowledgeable the human was. I ended up buying a Gold Plan, not a Platinum Plan. The Gold Plan actually costs more than the Platinum Plan I had before, but it's from Old Established, Inc. I have had none of the problems listed above with Old Established.

    So the moral to my story is: check everything out first, rather than suffer later.
    Last edited by GBMsibling; 08-06-2014 at 01:35 AM.

  3. #3
    Super Moderator Top User ddessert's Avatar
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    Oct 2013
    Blog Entries
    Limiting the choice of doctors in the plan is part of the strategy the ACA insurance providers are using to boost profits/contain costs. They can negotiate lower rates from the few doctors in the plan and the doctors are assured of more patients.
    Last edited by ddessert; 08-05-2014 at 08:05 PM.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
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    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919

  4. #4
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    Dec 2011

    State-Specific Information For Buying Insurance Outside the Open Enrollment Period.

    In addition to the information below, all of the states will allow you to purchase insurance outside the enrollment period if you have a qualifying life event. These usually include moving to the state, losing your job, getting married or divorced, being released from prison, getting adopted, turning 26, or becoming a US citizen.

    Other options outside the enrollment period:

    California, under their Covered California program, will assess individual circumstances to decide if you can purchase insurance outside the regular enrollment period.

    New York State has a new program, The Essential Plan, for which you can enroll at any time. (You don't have to wait till November.) Maximum income is $23,540 for a single person and about $8000 more for each family member-- so maximum income is $48,500 for a family of four. The program costs $0 to $20 a month and has no deductible.

    Texas provides a list of insurers who will sell insurance outside of the state government website, and thus presumably outside the open enrollment period.
    Last edited by GBMsibling; 12-16-2017 at 04:10 PM.

  5. #5
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    Join Date
    Dec 2011

    If you are in the US illegally.

    The health care law makes no provision for insuring the estimated 10 to 12 million US residents who are in the US illegally. You are not eligible for Medicaid or for the subsidized or unsubidized plans sold through the state department of health websites.

    The only exception to this is California, which has requested permission from the Federal government to include illegal immigrants in its health insurance plan.

    Depending on where you live, you may be able to purchase insurance through other means.

    If you are in the US illegally, most of the options for "First level" care that I listed in the first post above are available to you. If you are actually diagnosed with cancer and do not have insurance, the most viable option may be returning to your home country for treatment, if that is possible.
    Last edited by GBMsibling; 12-16-2017 at 04:11 PM.


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