Understanding Options for the Underinsured or Uninsured

Some people will not be able to find health coverage. Others will find coverage, but it will not cover their medical needs. For these people, there are programs and strategies for those seeking free or reduced-cost healthcare.

Where can I find free or reduced healthcare?

One stop shopping for free or reduced care is difficult, if not impossible. You may have to approach several programs and institutions to find help.

Community health clinics

The federal government funds a network of community health clinics that provide free or low-cost health care to people who are uninsured or underinsured. Services vary significantly from center to center, so it is important to find the center that provides the type of care that you need. Many community health centers provide prescription drugs.

You can find a directory of health centers online or call HRSA at 1-888-ASK-HRSA (1-888-275-4772). Search the directory by ZIP code to find the center(s) nearest you.

Hospital based charity care

Many hospitals voluntarily provide free or reduced-cost care. Hospitals vary significantly in the amount and type of benefits they offer.

For a list of community hospitals, visit the National Association of Public Hospitals and Health Systems. In addition, hospitals affiliated with academic institutions, although not always considered public institutions, often provide free or reduced-cost care.

The American Hospital Association has guidelines for hospital billing practices that state that all hospitals should help patients who cannot pay some or all of their hospital bill. Under these guidelines, each hospital can have its own program and should make it easy for patients to learn about the program. More than 4,200 hospitals in the U.S. have pledged to follow these guidelines. If you need hospital care you cannot afford, contact the patient services department of the hospital to ask about available programs. 

Prescription drug assistance programs

The cost of medications can be especially unaffordable for people with bone marrow diseases who don't have adequate prescription drug coverage. Pharmacy assistance programs can help. These programs may be offered through your state or the company that manufactures the medication you need to take.

A comprehensive list of state programs, eligibility standards, and help offered is available on the AARP Web site (search for "state pharmacy assistance programs" and locate the AARP Bulletin article, "State-by-State, Plan-by-Plan List of Pharmacy Assistance Programs").

An organization called The Partnership for Prescription Assistance maintains a comprehensive database of these privately sponsored programs. You can access this database online.

The resources section of this guide includes links to pharmacy assistance programs run by the companies that make drugs specifically used by patients with bone marrow diseases. 

For a more extensive discussion on places you can go for free or reduced health care, see Chapter 1 of Options For Avoiding and Managing Medical Department, available online.

Is it possible to negotiate discounts on the price of healthcare?

If you are uninsured or underinsured and can't obtain the care you need for free, it is worth asking a doctor or hospital for a reduced price. This is a very reasonable request. Here are some tips on asking for a discount for healthcare:

• Ask in person. This can be more effective than asking by phone or letter
• Ask your provider directly to waive or reduce the bill for care. If you do not feel comfortable asking your provider, ask the office manager or billing manager. In the hospital setting, start with business manager or head of the billing office. Also try the hospital social worker.
• Don't stop at the first no. It could be that the first person that you asked was not aware of the provider's policy on discounting fees.
• Find out what others are paying for the same care. Information showing that you are being billed more than others can be support your request to discount your care. Most doctors, hospitals, and other providers discount their fees for insurance companies, but charge full price for people who must pay themselves.
• Ask about a payment plan. It is also reasonable to ask if you can pay the fee over time, for example $50 per month. For a more extensive discussion on negotiating discounts for medical care, see Chapter 2 of Options For Avoiding and Managing Medical Department, available online.