Uninsured? You still have health care options
Since the Affordable Care Act was implemented in 2009, the number of Americans without health care coverage has declined. In Illinois, the rate of uninsured dropped from nearly 14% in 2010 to 7.5% in 2019.
That's the good news. The bad news is nearly 1 million Illinois residents remain uninsured. And the number has been rising since 2020 because of job losses and other factors. People of color and those with low incomes are the most likely to be uninsured.
According to a report from the Kaiser Family Foundation, 73% of uninsured people cited cost as the reason they don't have coverage, and more than 20% (likely younger adults) said they do not need or want coverage. That's concerning for a couple of reasons.
First, without health care coverage an individual is less likely to care for chronic health conditions, such as diabetes or hypertension, that will cost more in the long run. A study by the Transamerica Institute reported that 66% of the uninsured suffered from a chronic illness, and that 90% of the $4 trillion the U.S. spends each year for health care is due to chronic disease and mental health issues.
Second, the uninsured will incur more costs when eventually they do need medical care. Medical debt is the single most common reason for personal bankruptcy, which will affect your credit record for years to come.
So my main recommendation is to try to get some sort of coverage. Although the ACA annual enrollment period has passed, you can enroll anytime if you experience a life change, such as unemployment, or if you become eligible under Illinois' Medicaid expansion because of low income, disability or age. The Children's Health Insurance Program, or CHIP, provides free or low-cost coverage for children in families of certain incomes. In Illinois, CHIP also covers pregnancy.
Let's say you can't afford coverage or aren't eligible, or have made the choice (unwise in my opinion) to go without insurance. What can you do when medical needs arise? Here are some options.
• Do you qualify for financial aid? Hospitals that accept federal money must provide a certain amount of free or reduced fee care. Check with the hospital's financial aid department to see if you qualify.
• Can you pay up front? If surgery or hospitalization is necessary, talk with the hospital billing department beforehand about the total cost for a self-pay patient and get it in writing. Sometimes a hospital will discount the bill for a patient who pays up front.
• Can you ask for help? I recommend people ask their church if they can help with medical bills. There are also county social service agencies that can help you find resources. According to the Illinois Association of Free and Charitable Clinics (www.illinoisfreeclinics.org), more than 40 free medical clinics are operating in Illinois, many in the suburbs. Its website has a directory.
• Can you afford a monthly retainer? The number of "boutique" or "concierge" health practices has been growing, run by doctors who provide coordinated care in exchange for a monthly retainer instead of accepting insurance. But if you can afford a retainer, you can probably afford an insurance premium that will provide wider coverage.
• Do you need medication? Go generic whenever it's available. GoodRx (www.goodrx.com) lets you see what nearby pharmacies are charging for your medications, and the discounts can be substantial. A new company, DiRX (www.dirx.com), offers deeply discounted generics by mail order.
• Do you need expensive medications? A number of drug companies have patient assistance programs (PAPs) to help qualifying individuals pay for the pricey brand-name medications they need. RxAssist (www.rxassist.org) keeps a directory of these programs.
• Do you have or think you have COVID? Under the HRSA COVID-19 reimbursement program, providers can bill the federal government for COVID-19 services to the uninsured so you don't have any out-of-pocket costs. Testing, treatment and vaccines are included in the covered services, but be sure to ask your provider if they are participating in the program.
It takes time and you have to ask a lot of questions, but being uninsured or underinsured does not have to mean you have no avenue to health care. The options are limited, but always worth exploring.
• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.