Image: Medical doctor © Digital Vision, Getty Images

One out of four working-age adults in the United States experienced a period without health insurance during 2010, the latest year for which statistics are available, according to the national Centers for Disease Control and Prevention (.pdf file).

The youngest U.S. workers were the most likely to be uninsured. Among adults aged 19 to 25, 41.7% went without coverage for at least part of 2010.

The CDC said:

● More than 60 million U.S. residents of all ages lacked health insurance for at least part of the year.

● Nearly 50 million were uninsured at the time they were interviewed.

● Nearly 36 million had been uninsured for more than a year at the time of their interviews.

That's a whole lot of people exposed to catastrophic losses if they get sick or injured.

Insurance exchanges that could help more Americans find affordable health coverage and tax credits to help most of them pay for it are more than a year away -- that is, if the Supreme Court doesn't gut the health care reform law that would create them in 2014.

But some reforms that have already been implemented may help you find coverage -- or keep you from losing the health insurance you have. Even if you can't get insurance, there are ways to still get care.

Liz Weston

Liz Weston


Four major changes that have already happened:

The end of rescission. Insurers can no longer drop you when you get sick and start costing them real money. Before the ban, the staff of the House Committee on Energy and Commerce found that three large insurers rescinded almost 20,000 policies over five years, saving the companies $300 million in medical claims.

The end of lifetime caps on coverage. If you have health insurance, you don't have to worry that an illness or accident will leave you exposed to bankrupting bills because your expenses exceed a policy's limit. Before the change, 105 million Americans had policies with lifetime caps.

Young adults can get coverage through their parents. People under 26 can be added to or remain on their parents' policies. Before health care reform, insurers could remove children from their parents' policies when they turned 19. The ranks of uninsured young people have shrunk by 2.5 million people since the change, according to the U.S. Department of Health and Human Services.

The creation of high-risk pools. These pools, formally called pre-existing condition insurance plans, make health coverage available to people who would otherwise be uninsurable. To get coverage, an applicant:

  • Must be a U.S. citizen or legal resident,
  • Must have been denied health insurance because of a pre-existing condition,
  • And must have been uninsured for at least six months.
  • The pools were expected to help two million people get coverage, said Carolyn McClanahan, a doctor and certified financial planner with Life Planning Partners in Jacksonville, Fla., but they've gotten off to a very slow start. After only 22,000 people signed up, premiums were lowered by as much as 40% last May, and the federal government began offering commissions to insurance agents to sell the plans.

"Now they're paying insurance agents to talk about this," said McClanahan, who noted enrollment is now more than 56,000.

The details of the plans vary by state, but a 50-year-old living in San Francisco would pay $428 a month for a medical plan with a $1,500 deductible. In Florida, which offers three coverage options, the maximum monthly premium for a 50-year-old is $363.

You can start your search for a high-risk pool at HealthCare.gov.

If you don't meet the criteria for a high-risk pool, you may still have alternatives. Check out CoverageforAll.org, a site run by the Foundation for Health Coverage Education. The site's quiz can help you identify your health insurance options and provides links to start your application. Some of the ways you might be able to find insurance coverage include:

COBRA. If you were covered by health insurance at work but are about to lose your job, you're typically entitled to coverage for up to 18 months under the federal Consolidated Omnibus Budget Reconciliation Act of 1985. Unfortunately, you have to pick up the whole tab for this coverage, which can be tough to afford. Coverage for a family now averages nearly $1,300 a month, according to the Kaiser Family Foundation. A federal subsidy that once helped laid-off workers pay for coverage has expired. Talk to your human resources department for details.

High-deductible policies. You'll pay more of your routine medical costs out of pocket, but these policies protect you against catastrophic medical bills. Having the coverage also entitles you to insurer-negotiated discounts with doctors and hospitals. (Many medical providers charge the uninsured higher rates and fees because these consumers aren't covered by such discounts.) An insurance broker or eHealthInsurance can help you find policies.

The right high-deductible policy could also qualify you for a health savings account, which could trim your tax bill. HSAs function somewhat like IRAs, in that you (or an employer) can contribute tax-deductible money that can grow tax-deferred. The difference is that while IRAs are for retirement, HSAs are designed to pay for medical expenses.

Short-term coverage. Many insurers that provide individual policies have a bridge, or short-term option, typically designed to cover you until you land your next job. These are typically cheaper than regular individual policies because the insurer is exposed to claims for a limited time. An insurance broker may be able to help you find coverage.

Small-business plans. If you own your own business, you may be able to purchase a group plan that's more affordable than individual coverage. Requirements vary by state; some allow businesses with only one employee (the owner) to purchase group coverage, while other states require two or more employees. Tax credits can help you cover some of the premiums. You can find available plans and carriers in your area at eHealthInsurance.

Health insurance for kids. Most states sponsor low-cost or free health insurance for children, and a few will cover their parents for an additional fee. A family of four in most places can qualify for insurance for their kids with an annual income up to $44,100 a year; in higher-cost areas, that limit may be higher. For more information, visit InsureKidsNow.gov, a government-run website.

Medicaid. This government-funded coverage is generally reserved for people with very low incomes and few assets. Each state has different guidelines. For more information, visit the Centers for Medicare & Medicaid Services, a U.S. government website.

If none of those options works for you, you'll be relegated to a patchwork system of government and charitable programs that try to provide help for America's uninsured.


Because there are so many people in the same boat, however, some of these resources are overwhelmed.

That doesn't mean you should delay screenings and treatments, only that you may need to wait longer for an appointment than if you were privately insured.

Low- and no-cost health care

Here are some of the resources available for various kinds of treatment:

Routine and diagnostic care. The National Association of Free & Charitable Clinics has links to free and low-cost health providers across the U.S.

In addition, hundreds of community health centers around the country offer free or low-cost care. To find a site near you, visit the U.S. Health Resources and Services Administration's Health Center Program. You can also use this link to the Centers for Disease Control and Prevention's website to find state health departments, which provide additional clinics and resources for the uninsured.

The CDC also has this guide for women looking for inexpensive mammograms and Pap smears. The American Cancer Society at 1-800-ACS-2345 can direct you to services that provide free or cheap screenings for various types of cancer.

Keep an eye out, too, for any health fairs sponsored by local employers or community organizations. Free and low-cost screenings for common ailments, from depression to high cholesterol, are a routine part of these festivals.

Birth control and reproductive care. Many of the free and low-cost clinics listed above provide reproductive care, or you can contact Planned Parenthood Federation of America, which specializes in free and low-cost help for men and women.

Prescriptions. Some companies market drug discount cards that might entitle you to small breaks on prescription prices, but if you're low income you might qualify for assistance programs run by the pharmaceutical companies. Three sites to check: NeedyMeds, RxAssist and the Partnership for Prescription Assistance.

Also, ask your doctor for free samples of any drugs prescribed. Most physicians have closets full of them.

Vision.Lions Club International is famous for its charity eye care campaigns, which provide free screenings and recycled glasses. If you have a low-wage job but no vision coverage, the American Optometric Association may be able to hook you up with a volunteer doctor of optometry for a free exam through its Vision USA program. If you're 65 or older, the American Academy of Ophthalmology may be able to provide exams and treatment through its EyeCare America foundation.

Dental. If going to the dentist terrifies you, the idea of going to a rookie dentist probably isn't going to put you any more at ease. But dental schools provide inexpensive and well-supervised treatment. To find the one nearest you, visit the National Institute of Dental and Craniofacial Research. In addition, some of the free clinics listed above provide dental services.

Emergency care. If you're facing a life-threatening situation, hospital emergency rooms are required to evaluate and stabilize you before asking about your ability to pay. A very limited number of hospitals are required to provide such care for free if you're poor, but the vast majority can bill you (and may hound you aggressively with collection agencies).

That's why if your situation is anything less than critical, you may want to explore alternatives to emergency room treatment. Many uninsured Americans wind up in the ER with non-critical conditions simply because they don't know where else to go. With the information here, you now know some of your other options.

And don't forget . . .

Finally, three other things to consider:

Medical coverage through your auto insurance. When you have a good health plan, you typically don't need the medical protection offered on your auto insurance policy. If you're uninsured, though, this coverage could pay your bills if you or your passengers are injured in an auto accident.

Negotiating discounts. Many medical providers offer charitable care or financial aid that can significantly reduce the bill for low- and middle-income people without insurance. Also, you should ask to be charged the same rate as large insurance companies, since otherwise you'll pay the much higher "sticker price" for care. You may also get a discount for paying cash, or paying the bill within a short amount of time. Read "How to haggle over medical bills" for tips on successful strategies.

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Bankruptcy protection. If you're hit with catastrophic medical bills, consider consulting with a bankruptcy attorney sooner rather than later. Bankruptcy laws have recently been toughened, but people with incomes below the median for their states can still erase medical bills and most other unsecured debts.

Liz Weston is the Web's most-read personal-finance writer. She is the author of several books, most recently "The 10 Commandments of Money: Survive and Thrive in the New Economy" (find it on Bing). Weston's award-winning columns appear every Monday and Thursday, exclusively on MSN Money. Join the conversation and send in your financial questions on Liz Weston's Facebook fan page.