One of the primary causes of financial debt for Americans is medical debt. In fact, some Americans are finding themselves without sufficient medical insurance or any insurance at all. When they need medical care, whether general or emergency, they may find themselves paying expensive fees out of pocket. Uninsured doctors’ visits can skyrocket into the thousands of dollars in no time, so it is no wonder that so many people struggle with medical debt.
Even those who are insured find themselves at the mercy of their healthcare plan. Individual health insurance plans might include specific routine medical services, but some do not. Many insurance companies find ways to categorize common tests and checkups under unnecessary or nonroutine care, so patients unexpectedly find themselves out of luck when it comes time to pay. Additionally, many insurance companies charge expensive copay fees that can stack up over time, causing financial hurt even for those who are covered by health insurance.
The short answer as to whether you need insurance to see a doctor is no, but it will hurt. Medical care is shockingly expensive in the United States, and patients who have no insurance can receive the care they need only if they are willing and able to pay thousands of dollars from their own personal funds. This process can drag on for years and be draining for the people who experience it.
Access to health insurance varies widely across the United States. As of 2016, slightly under 9 percent were without health insurance coverage of any kind. That is 28.1 million people. This means that they and they alone were responsible for shouldering their own medical costs — or that they went without adequate medical care unless it was an emergency. Of those who were insured, 67.5 percent were covered under a private insurer, such as their employer, while 37.3 percent were covered by government insurance, such as Medicaid, Medicare, direct-purchase, or military coverage.
Unfortunately, many Americans find that they do not qualify for health insurance for a variety of reasons. Self-employed or unemployed individuals do not qualify for healthcare coverage through an employer, which means they usually need to seek government-provided health insurance. However, government insurance, like Medicaid and Medicare, has strict requirements, and many people do not qualify because their household income is too high or because they have other disqualifying factors, such as not having children.
Those who have chronic disabilities, such as blindness or severe illness or injury, as well as pregnant women, children, and low-income families, all have a good chance of qualifying for coverage under Medicaid. This also means that many people do not qualify because their income is slightly too high or they have no chronic health conditions. This is frustrating for many people who barely miss the qualifications and subsequently find themselves without insurance.
Coverage under employer-provided healthcare plans can vary widely. This means that employees are largely at the mercy of the insurance plan their company is willing to pay for. Insurance plans provided by an employer usually also offer coverage for the employee’s family (that is, their spouse and children), but employees are subject to changes in policy and coverage at any time. For example, an employer-provided health insurance plan might not include dental and vision coverage; employers are not under any obligation to provide services that do not fall under the category of routine care.
If they do provide for these services, employees may find themselves under strict allowances. For example, an employer insurance plan may only provide for one dental visit annually. This means that if you or one of your family members needs additional dental care beyond a yearly cleaning, you may simply be out of luck and must pay the fees out of pocket.
Simply put, employer-provided health insurance plans are required to meet minimum coverage requirements at an affordable rate. This includes providing coverage for preventative care, obstetric care for pregnant employees, and preexisting health conditions. It also protects employees from being penalized for seeking medical care too frequently or developing chronic health conditions. In addition, you have the legal right to opt for a marketplace plan instead of your employer-provided insurance plan, as well as take advantage of mental health services, breastfeeding equipment for working mothers, and provisions for birth control. Additionally, most insurance plans only provide employees access to in-network medical services, meaning those healthcare facilities that have agreed to partner with them.
A marketplace insurance plan is an option provided by the United States government allowing employees to shop around for better or more affordable healthcare coverage if they are not satisfied with the plan provided by their employer. There are specific requirements to qualify for these plans, as well, including annual income and household information. However, they are one option for those who feel they are not getting the best possible coverage. Additionally, employees are protected by law from being penalized by their employers for not using their company-provided health insurance plan.
A copay is a specific fee that applies to all individuals under the age of 65 who are covered by health insurance. This fee is charged in addition to the fees that your insurance company pays and is usually required at the time of medical service or when picking up a prescription. Copays are determined entirely by your insurance company and depend on the services being provided. This means that for certain health insurance plans, patients need to bring cash or a check to all doctors’ appointments to pay their copay fee. Copays are applicable until you reach your deductible amount. Medical services that count as deductibles include admitted hospital stays, labs, surgeries, medical devices, and some other services.
Copays range depending on your insurance company and plan. As long as you are visiting in-network doctors, they are fairly predictable. For a routine doctors’ appointment, copays usually are in the range of $15 to $25 but may be as low as $0 (Medicaid requires a $0 copay). Specialists and unusual medical services can be much higher, with emergency room visits sometimes requiring a copay of up to $300. Copays for prescription drugs, meanwhile, can vary widely depending on what prescription is being filled and whether your doctor has ordered a brand-name or generic drug for you.
Prescription costs are a little more difficult to predict since they depend not only on your insurance plan but also on your pharmacy, the prescription in question, and whether your doctor has ordered a brand-name or generic prescription. For example, the brand-name antidepressant Zoloft goes by the generic name of sertraline. Because the patent on this drug has expired, any company is free to produce sertraline, offering a range of lower-cost options for patients.
Unfortunately, there is always the option that your insurance company may discontinue coverage for a certain prescription medication. However, there are options for medications not covered by your insurance. You may also be able to access a one-time refill or switch to a different form of the same medication to avoid excess prescription drug costs. There are also pharmacies that offer discounts for medications not covered by your insurance plan.
Bear in mind that just as your health insurance plan requires you to use in-network doctors, it also requires you to visit in-network pharmacies. The pharmacies that have legally agreed to work in conjunction with your insurance company are considered in-network and can provide you with lower-cost prescriptions, whether these are covered in full by your insurance plan or simply require a lower copay. It is easy to switch pharmacies if your new insurance company does not cover medications filled by the pharmacy you have used in the past.
Options That Do Not Require Insurance
Even regular doctors’ appointments can quickly become unmanageable expensive for those with no insurance. Emergency room costs without insurance can mean paying thousands of dollars out of pocket, which for many people can lead to years of medical debt. Thankfully, there are some medical services and facilities where there is no insurance required.
One option is to visit urgent care clinics for medical services that classify as non-emergencies. These are appropriate for situations in which no one’s life is in danger, but quick treatment is required. This might be a sprained wrist, a cold or the flu, an allergic reaction, or conditions that are comparably serious. If you require follow-up treatment, urgent care medical professionals can refer you to specialists, testing centers, or emergency room facilities.
A benefit of urgent care clinics is that they do not require insurance in order to seek services. They also are designed to offer options for patients with no health insurance, so there are plenty of ways that you can access care even without coverage. There are several ways urgent care clinics do this, from offering discounts to arranging payment plans.
Another growing option for those with no health insurance is taking advantage of telehealth services.
Telehealth is a growing service in the field of medicine. It is a particularly good option for those who cannot access medical care in traditional ways for any reason, including living in a rural area or being uninsured. These services are provided by a qualified medical professional over the phone, on the internet, or via video chat. Patients can access instant medical advice without the need for a physical appointment, expensive copays, or proof of insurance. Medical services provided by telehealth companies have only grown in recent years and now include everything from obstetric care to mental health services.
Most telehealth providers do not require patients to have health insurance to take advantage of their services. Usually, patients pay a single, annual fee that covers all consultations. Telehealth medical providers can assess and diagnose patients remotely, as well as share medical records with specialists and labs, refer patients to other facilities, and even write prescriptions and send them to the patient’s nearest pharmacy.
Bonum Health is a top provider of quality telehealth services. Our certified medical professionals have more than 15 years of experience in their respective fields, from family medicine to obstetric care to specialty services. We pride ourselves on providing top care to patients anywhere, at any time.
Our telehealth services mean you have access to the best medical care 24 hours a day, seven days a week. Contacting us online or via phone means that you do not need to sit and wait to be seen at an urgent care facility or make an appointment ahead of time — we are available to you whenever and wherever you need assistance.
Consult board-certified doctors face-to-face online for as little as $99 per year
Our patients are of every insured status and do not need to provide proof of health insurance to take advantage of our top-quality medical services. Instead, they pay a single annual fee of $99, which covers all of our services across the board. You will never pay a copay or be denied service because you cannot pay at the moment.
All of your information is completely protected by HIPAA and uploaded to our secure patient portal, which you can access online or via our mobile app. This platform even allows you to have prescriptions filled or submit questions to our team, enabling us to connect in real-time. Instant access to the best medical care has never been more possible, especially for patients who are not covered by health insurance. With Bonum Health, you can be sure you will have the best possible care regardless of your coverage.
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