How to Find Affordable Health Care
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.
You can find out if your family is eligible for a plan by visiting 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 .