Community health centers come first
Federally funded health centers exist in almost every county. They provide primary care, dental, mental health and often pharmacy services, and they charge on a sliding scale set by household income. They see patients whether or not you have insurance.
This is the single most useful thing on this page, because it works today, without an application window, an eligibility ruling or a premium.
Programs worth checking, in order
Each of these is free to apply for. None require a broker, an agent or a fee.
- Medicaid — year-round applications, income-based, expanded in most but not all states.
- CHIP — covers children in households that earn too much for Medicaid; the income limits are often much higher than people expect.
- Community health centers — sliding-scale primary, dental and behavioural health care.
- Hospital financial assistance — non-profit hospitals must publish a policy; bills can be reduced or written off entirely.
- Free and charitable clinics — volunteer-staffed, usually free, common in larger towns.
- Prescription assistance — manufacturer programs and pharmacy generic lists cut drug costs sharply.
- 211 — a free national helpline that routes you to local health, food and housing services.
- Vaccination and screening programs — public health departments run these at no cost.
How to handle a hospital bill you cannot pay
Do not ignore it and do not pay it immediately either. Ask for an itemised bill, then ask, in writing, for the hospital's financial assistance policy — this is the phrase that triggers a formal process at a non-profit hospital.
Two more things are worth doing before you agree to any payment plan. Check the itemised bill for services you did not receive, which is also how medical identity theft surfaces. And ask whether the balance qualifies for reduction under federal surprise-billing protections if the care was emergency care or from an out-of-network provider at an in-network facility.
Warnings
People without coverage are the most heavily targeted by bad products, so a short list of things to refuse:
- Anyone charging a fee to enrol you in Medicaid, CHIP or a Marketplace plan. Those applications are free, and licensed Marketplace assisters and navigators cost nothing.
- Coverage sold as insurance that will not confirm in writing that it covers pre-existing conditions and essential health benefits.
- Discount cards presented as insurance — they are not coverage and do not cap your costs.
- Any offer that requires an immediate decision or asks for your Medicare number over the phone.