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by EBSCO Medical Review Board

Navigating the System: When You’re Uninsured

image Millions of Americans do not have health insurance. Many uninsured people delay getting needed medical care, live with serious health problems for too long, and do not get preventive care. This can cause their health to get worse. It can also lead to more serious and costly health problems, such as heart disease, cancer, and diabetes.
Federal laws have made low-cost health insurance available to some people, especially children of low-income families. Emergency departments and clinics also need to provide a certain level of care to everyone, regardless of their insurance status. In addition, some “safety net” facilities offer free care to people who are unable to pay.

Affordable Care Act

The Affordable Care Act (ACA) went into effect in early 2014. The law allows Americans who were previously uninsured to get insurance. Choices of coverage and premiums are offered through the Health Insurance Marketplace. Insurance is offered through private health insurers where you choose the level of coverage you need. Take some time to research plans, including out-of-pocket expenses, deductibles, participating doctors, dental care, and coverage areas. If you need more health coverage or qualify for other government programs, such as Medicaid or Children's Health Insurance Program (CHIP), the Marketplace will share your information with the right agencies for follow-up.

Low-Cost Insurance for Children

Uninsured children are less likely to get “well-child” check-ups and other forms of preventive care. If your family does not have health insurance, you may be able to get insurance for your children at little or no cost. It depends on your income level.
Medicaid is a health insurance plan that supports the care of low-income families. However, eligibility varies from state to state and from group to group.
Medicaid covers many low-income children, but coverage for adults is limited. This is because parent eligibility income levels are set much lower than those of children. Unless they are disabled, even very low-income adults may not be eligible for Medicaid if they do not have children. Individual states set Medicaid limits and share the costs with the federal government.
The Children's Health Insurance Program Reauthorization Act (CHIPRA) provides more children with health insurance under CHIP. This program is meant for children and pregnant women in families that do not qualify for Medicaid, but also cannot afford to buy private health insurance.

The Healthcare Safety Net

America’s healthcare safety net is a system that gives healthcare to people who are underinsured or uninsured. The goal of providers is to deliver healthcare to people who may not be able to pay for it. They may do so on their own or out of a legal obligation. These providers may include emergency departments, community health centers, public hospitals, charitable clinics, and teaching and community hospitals. How they are financed varies from state to state. Often, the owners of the facilities and the doctors that work there take on much of the financial burden.
The only providers that are legally obligated to provide safety net care are emergency departments. The Emergency Medical Treatment and Labor Act (EMTALA) makes sure that anyone who comes to an emergency department must receive a medical exam and be stabilized before being transferred to public hospitals. This means that if you go to an emergency room with a medical problem, your treatment cannot be delayed because of a lack of insurance. People with insurance cannot also be given preferred treatment. There are signs posted in emergency departments that detail your rights.
Charitable providers and emergency rooms cannot fully take the place of health insurance. If you are uninsured or underinsured, do your best to make sure this is only a temporary situation. The risk is great: a major illness or injury can lead to financial ruin.

RESOURCES

Centers for Medicare & Medicaid Services
https://www.cms.gov
Health Care
https://www.healthcare.gov

CANADIAN RESOURCES

Alberta Health
http://www.health.alberta.ca
Health Canada
http://www.canada.ca

References

Children's health insurance program (CHIP). Medicaid.gov website. Available at: https://www.medicaid.gov/chip/index.html. Accessed October 19, 2021.
Emergency medical treatment & labor act (EMTALA). Centers for Medicare & Medicaid Services website. Available at: https://www.cms.gov/regulations-and-guidance/legislation/emtala. Accessed October 19, 2021.
Tips about the Health Insurance Marketplace. HealthCare.gov website. Available at: https://www.healthcare.gov/quick-guide. Accessed October 19, 2021.

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