Searching for affordable health insurance
Many children in the United States are not covered by health insurance or are covered by plans with high deductibles and limited benefits.
If your children are in these groups because you can’t afford adequate coverage or your employer-funded plan doesn’t cover everything, don’t despair. There are programs that offer affordable (or even free) health care and are designed to cover or supplement a person’s health insurance needs.
Your children could be eligible for coverage right now and you may not know it. Below are some options that may be available to your family. How To Find Affordable Health Insurance?
Enroll your child in a public program
In every state, there are two public programs that work together to provide health coverage for children in low- and middle-income families: Medicaid and CHIP (Children’s Health Insurance Program).
Medicaid is run by each state, with a mix of state and federal funds. It offers health coverage for those with limited incomes and covers both children and parents, pregnant women, the disabled, and the elderly. Additionally, children may be eligible for coverage if they are US citizens or legally admitted immigrants, even if their parents are not.
CHIP is a federally funded program administered by each state. Offers health coverage for American children under the age of 19 who belong to working families. Participation in this coverage is based on parental income. CHIP is often helpful for families with incomes that are too high for Medicaid, but still have a hard time paying for health insurance.
Each state has different rules for CHIP. Some CHIP programs, for example, cover pregnant women, parents, and family-related caregivers (such as grandparents raising grandchildren). Each state has its own name for CHIP and Children’s Medicaid programs. For example, Delaware’s CHIP program is called the “Delaware Healthy Children Program” and Connecticut’s is called the “Husky Plan.”
For information about your state’s CHIP and Medicaid programs and other services that may be available to your family, visit InsureKidsNow.gov or HealthCare.gov. There, you can sign up for CHIP or Medicaid. You can also call 1-877-KIDS NOW (1-877-543-7669) to get information about your state’s CHIP program.
A child’s eligibility to participate in these government programs depends on household income. Once your child is enrolled, she will receive a list of medical providers near her home that accept CHIP/Medicaid patients. You can make appointments with these providers whenever your child needs to see a doctor and will also be covered in an emergency.
Look for a private insurer
Most children in low- and middle-income families can receive free or low-cost health care through Medicaid and/or CHIP. But now, through the Patient Protection and Affordable Care Act, many private health insurers will offer similar benefits.
You can find out if your family qualifies for a plan by visiting the online Health Insurance Marketplace at HealthCare.gov. This government service and its site make it easy to apply for insurance and find out what programs are available in your area. Simply fill out an enrollment form and the marketplace will allow you to compare the benefits of each plan and compare medical expenses such as co-pays or deductibles for care.
Visit to local Community Health Center
Another option for low-cost health care for your children is to go to a federally funded community health center. You can take children for regular checkups, immunizations, treatment when sick, medical care, prescriptions, and mental health care.
You can also come for comprehensive care, including pregnancy and substance use care, if needed
These centers often offer care on a sliding scale, depending on your income. Depending on your situation, it could be free. These centers can help you get health insurance and usually accept that insurance once you’re enrolled.
To find a center near you, visit the Health Centers page of the Department of Health and Human Services, and enter your ZIP code in “Find a Health Center.” Visit the website of the center near you for services, costs and hours of operation, and call ahead to make an appointment. Some community clinics are only open certain days and with limited hours.
Rural health centers, which are similar to federally funded community health centers, serve families in rural areas. You can visit the Centers for Medicare & Medicaid Services website to find one in your state.
Also visit the NACF (National Association of Free and Charitable Clinics) website to search for a free or low-cost clinic. There are more than 1,200 free clinics in the United States, staffed by volunteers including doctors, dentists, therapists, pharmacists, professional nurses, technicians, and other health professionals.
You may also be familiar with urgent care centers, which differ 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 are not in the office. They can be expensive and may not accept some types of insurance. Be sure to check with your insurer before going to one of these centers.
Talk money with your doctors
If your children do not qualify for a public program (such as Medicaid or CHIP), need services that are not covered by your insurance, or if you have a high deductible, you can try to negotiate a reduced cash payment rate with your prior physician to receiving services. Doctors discount 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 patient who pays for your care until you meet the deductible. So you can start the money conversation with your doctor like this: “I’ll have to pay 20% of the cost of that procedure and I can’t afford that” or “that’s not covered by my insurance.” Talking about money can be helpful because the doctor may be able to suggest cheaper treatments.
And don’t be afraid to change doctors until you find one who can offer you care at the lowest price. If Specialist A agrees to do a certain type of surgery for $2,000 and Surgeon B can do it for $1,500, you’ll save $500 if you go to Doctor B. But make sure you never sacrifice the quality of your child’s health care for a matter of money. When shopping around, look for providers that your doctor or another trusted person has recommended.
For a list of suggested fees for a variety of medical services, visit the Health Care Bluebook website.
Since each provider is often paid separately, be prepared to negotiate with each of the providers that treat your child. For example, if the procedure you’re discussing for your child requires general anesthesia, be sure to ask the surgeon which anesthesiologist they work with, and contact that doctor as well to negotiate a cash payment price for their services. And don’t forget to ask if there is a fee for the facility where the surgery is performed; if necessary, you should negotiate that rate as well.
Search for a hospital belonging to the ‘Safety-Net’ group
In 1946, Congress passed the Hill-Burton Act, which gave hospitals and other healthcare facilities money for construction and modernization. In exchange, the hospitals agreed to offer a reasonable volume of services to people who could not pay for them. The program stopped receiving funding in 1997, but approximately 170 healthcare facilities across the country must offer free or low-cost medical services. These “Safety-Net” hospitals are committed to providing care to people with limited or no access to care due to their financial situation, insurance status or medical 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 in all territories except Puerto Rico.
In general, to receive free care at a Safety-Net hospital, you must have a gross annual income of less than $23,550 for a family of four. If you earn up to twice that amount, you may qualify for reduced-cost care.
You can learn more or find a Safety-Net hospital near you on the DHHS Safety-Net Hospitals page.
Ask at your local hospital
As an alternative to searching for a Safety-Net hospital for your child, you can contact local medical centers or hospitals and ask if they offer free or low-cost services to the public. Many large teaching hospitals and medical centers offer free or low-cost quality care to families who cannot access it.
If you find a hospital that offers this service, you should meet with the institution’s financial advisors to determine a payment rate. They can also connect you with other resources within your community so you can get care at a lower cost.
Pay less for prescription drugs
Prescription drugs can leave your pockets empty, especially if your child isn’t enrolled in a public program like Medicaid or CHIP. Here are the best ways to manage your drug money:
- Find out if your child can take generic (non-brand) medicines. These drugs often have the same active ingredient as the brand name drug, but cost less.
- Find out if there is an over-the-counter alternative. Ask your doctor or pharmacist if there are over-the-counter versions of the prescription medicines your child takes.
- Compare prices at local pharmacies. Call each of the pharmacies and ask the price of your child’s prescription drugs. Many small private pharmacies are able to negotiate the price of medications.
- Contact the pharmaceutical company that makes the drug. All of the large pharmaceutical companies have prescription drug assistance numbers you can call for help.
- Beware of free prescription drug samples (or coupons and discounts). They may sound appealing, but they are usually for expensive, brand-name drugs. No problem while samples last. But because many doctors prefer not to change drugs if they’re working for a patient, you could be forced to pay full price once the samples run out. Before accepting a sample, talk to your doctor about whether you can afford the medication long-term. If it’s something your child will only need while the samples last, take advantage of the gift.
- If you don’t have money to buy more medicine, contact the doctor who prescribed it. Tell him that your son’s medicines are very expensive and he needs a cheaper alternative. If there isn’t an alternative, ask what you can do to lower the cost. These days, it’s not unusual for people to ask for this kind of help, and doctor’s offices often know how to get the medication or put you in touch with someone who can get it.
Do you have special needs? Contact Family Voices
If your child has special needs, Family Voices, an organization created to help families like yours, can help. Its Family-to-Family Information Centers offer contacts, support, and information for every state about pediatric health issues.
They can also help you manage insurance and other challenges, like taking charge of the appeals process if you’re denied an insurance claim. Each state office is run by parents who have children with special healthcare needs.