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A survival guide for the uninsured

If you recently lost your health insurance, or if you've never had coverage, you know you're not alone. The U.S. Census Bureau reports that more than 47 million Americans are living without health insurance, including 8.7 million children.

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If you're currently uninsured and with no prospects for buying group coverage through work (typically the least expensive way to get health insurance), there other possible routes.

Early retiree, or lost your job to foreign trade?

If you've recently lost your job because it moved overseas or because of increased imports, the federal Trade Adjustment Assistance Reform Act may pay 65 percent of your health insurance for up to one year, and possibly longer. Contact the Health Coverage Tax Credit (HCTC) Customer Contact Center at (866) 628-HCTC.

Health insurance payment assistance from the HCTC is also available to some early retirees. If you are a retiree aged 55 or older, your former employer no longer provides your pension, and your pension benefit is paid by the federal Pension Benefits Guaranty Corp., you can receive help with 65 percent of the cost of health insurance until you are eligible for Medicare.

COBRA: If you were covered by health insurance at work but lose your job, you’re typically entitled to continue your group health coverage for up to 18 months under the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Unfortunately, you have to pick up the whole tab for this coverage, plus a 2 percent administrative fee, which can be tough to afford. COBRA regulations do not apply to all employers. See Know your COBRA rights for more.

Purchase a high-deductible policy: 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 in the insurer's network. (It's true — many medical providers charge the uninsured higher rates because prices haven't been negotiated.) For more, see The basics of catastrophic health insurance.

The right high-deductible policy could also qualify you for a Health Savings Account, which could trim your tax bill.

Short-term coverage: Many insurers provide short-term individual policies for one to 12 months, typically designed to cover you until you land your next job. These are typically cheaper than regular individual health policies because the insurer is exposed to claims for only a limited time. However, the policy usually includes high deductibles, co-insurance payments and exclusions of pre-existing conditions. For more, see The basics of short-term health insurance.

High-risk pools: If a health condition is keeping you from being insured, check to see if your state has a high-risk insurance pool. Often these programs have sliding monthly premium scales dependent upon age and income. For more, see High-risk health insurance pools.

Health insurance for kids: Most states sponsor low-cost or free health insurance for children under State Children's Health Insurance Programs (SCHIP). A few states will expand coverage to their parents for an additional fee. For more, see State Children's Health Insurance Program.

Medicaid: This government-funded coverage is generally reserved for people with very low incomes and few assets; each state has different eligibility guidelines.

If none of these options works for you, you’ll be relegated to a patchwork system of government and charitable programs that try to provide health care for America’s uninsured. Some of these resources are overwhelmed. That doesn’t mean you should delay needed health care, 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. The U.S. Department of Health and Human Services has state-by-state lists of affordable health care centers where you pay based on what you can afford.

Other possibilities

Medical payments 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 individuals have been able to win discounts from hospitals and doctors when they agree to pay cash, while others say they’ve met resistance. It certainly never hurts to propose a negotiation of rates with your medical provider.

For veterans: Medical care and presciption drugs are available to veterans through VA medical centers. Contact the VA Health Benefits Service Center at (877) 222-VETS.

The CDC provides low-income and uninsured women access to screening and diagnostic services to detect breast and cervical cancer at the earliest stages. Low-cost mammograms and pap smears are offered through its National Breast and Cervical Cancer Early Detection Program.

The American Cancer Society at (800) ACS-2345 can direct you to services that provide free or inexpensive 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 events.

Prescriptions: You may qualify for the "pharmacy assistance program" in your state. BenefitsCheckUp.org has an online form you can fill out to find out if you're eligible. While the site is geared for those age 65 and older, pharmacy-benefit programs are also available to younger folks.

In addition, drug makers themselves run assistance programs. RxAssist.org can help you find free or low-cost medicine.

Some companies market drug-discount cards that might entitle you to small breaks on prescription prices. In addition, major store chains offer low flat-rate prices for generic prescription drugs: Wal-Mart and Target have lists of prescriptions available for $4.

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

Hospitalization: Some states require hospitals to provide care for free or at reduced prices to people who are eligible. In addition, many hospitals have financial-assistance programs. Ask for a financial counselor or a patient advocate at the hospital. You may be able to negotiate a lower bill or a more affordable bill-payment plan.

Emergency room 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 non-critical situations because they don’t know where else to go. With the information here, you now know some of your other options.

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