How to Get Mammograms and Other Crucial Tests if You Don't Have Insurance
We may not typically think of a routine mammogram, pap test, colonoscopy, or cholesterol check as a privilege. But these screenings—although sometimes uncomfortable and time-consuming—can be lifesaving. Unfortunately, not everyone in the US has the same access to preventive services. If you've found yourself among the growing number of uninsured or underinsured folks in America, here are some solutions to accessing the care you need.
Nearly 30 million adults under age 65 in the US don't have health insurance. Uninsured adults are more likely to skip out on preventive services because they don't have affordable options or a regular care provider, according to Kaiser Family Foundation research. People without health coverage are also more likely to land in the hospital for health issues that could have been avoided through routine and preventive care. And because of these disparities, when hospitalized, the uninsured have higher mortality rates than those who have coverage.
Although access to health insurance does improve access to care, having insurance doesn't necessarily equal health care affordability. About 43% of Americans don't have adequate coverage, according to a survey by The Commonwealth Fund. One issue is when patients are required to pay out of pocket for crucial screenings.
When it became law, the Affordable Care Act (ACA) required insurance plans created after March 23, 2010, to provide—at no out-of-pocket cost to patients—coverage for preventive services recommended by the U.S. Preventive Services Task Force. But some plans were grandfathered in to skip this requirement. Plus, the Trump administration imposed regulations that now allow health plans to be non-ACA-compliant, putting patients at risk of not being able to afford screenings when they're required to pay out of pocket.
For the uninsured and underinsured, safety-net providers are available. "Options for health care include community health centers, walk-in clinics, concierge clinics, cash-only clinics, and direct care providers," Gaither says. "These can offer free services, or services with a sliding-scale fee. Others may be able to assist patients to sign up for free or low-cost health insurance like Medicaid."
See if you're eligible for Medicaid
While Medicare coverage is for people 65 or older (or those who are younger and have a disability or end stage renal disease), Medicaid is different. Medicaid is coverage if you have a low income level.
"The first thing you should do is find out if you are eligible for Medicaid," says Christian Worstell, a licensed health insurance agent with MedicareAdvantage. "Each state has its own Medicaid program, and eligibility rules will vary. Individuals on Medicaid typically do not pay anything for the included health benefits."
However, more than 2 million Americans fall into what's known as the "coverage gap." In the 12 states that have not adopted Medicaid expansion, people in the gap make an income that's above what qualifies for their state's Medicaid coverage. Yet their income is below the federal poverty line, which is the minimum income eligibility for tax credits under the ACA marketplace. In other words, you may not qualify for either of these two safety-net coverage options.
Seek emergency care when needed
Regardless of your insurance status or ability to pay for care, and even if you are undocumented, you can receive emergency treatment in the US. So if you are experiencing a medical emergency, absolutely go to the nearest emergency room.
"The federal law called EMTALA, or Emergency Medical Treatment and Labor Act, mandates hospitals to perform a screening to see if there is a medical emergency that could jeopardize your life or limb," says Nick Bryant, founder of Houston Case Managers, which helps medical professionals connect clients to community resources. "If you are having a medical emergency, then EMTALA requires the hospital to treat you." You must also be treated if you're in active labor.
Try Federally Qualified Health Centers
For routine and preventive care, Federally Qualified Health Centers (FQHCs) can be helpful. FQHCs receive funds from the Health Resources and Services Administration (HRSA) to provide health care to underserved populations. They provide primary care to patients on a sliding-fee scale. You can use the HSRA locater to find clinics near you.
"FQHCs are a great option," Bryant says, "because they will treat you regardless of income or even if you lack health insurance. Essentially the amount that you pay depends on your monthly income."
Check with county health systems
Search for your county's health department website and see if they operate a clinic. "These local health care systems offer outpatient primary care, specialty clinics, dental care, and more," Bryant says.
Services may include free screenings, blood draws, immunizations, sexually transmitted infection (STI) testing, family planning services, breastfeeding support, hearing and vision assessments, and more.
Search for free or pro bono clinics
Although not associated with any government agency, FreeClinics.com offers a location-based list of FQHCs, county health systems, and additional clinics that offer free or low-cost care and screenings. If you'd like to receive care at a clinic that's not on the list, ask about their resources.
"Many walk-in health clinics provide discounts for cash payments and payment plans for the uninsured," Worstell says. "I recommend calling around to the local health clinics in your area and asking about their options for the uninsured. Some doctors even work a select number of 'pro bono' appointments into their schedule."
You can also search for free clinics by looking for the specific service you need. "For example, an uninsured person in South Carolina can Google 'free birth control' and be directed to a clinic participating in the Choose Well initiative, which subsidizes the cost of birth control for low-income patients," says Sarah Kelley, chief operating officer of New Morning, a nonprofit currently leading the Southeast's first statewide contraceptive access initiative.
Turn to Indian Health Services (IHS)
Check if you're eligible for free cancer screenings
Everyone deserves preventive care, regardless of insurance coverage or income level. The Centers for Disease Control and Prevention (CDC) operates the National Breast Cervical Cancer Early Detection Program (NBCCEDP). You may qualify if you have no insurance—or if your insurance doesn't cover breast or cervical cancer screenings, if your income is at or below 250% of the federal poverty level, and if you meet certain age requirements (21 to 64 for cervical and 40 to 64 for breast).
The CDC also operates the Colorectal Cancer Control Program (CRCCP), which provides colorectal cancer screening to uninsured and underserved populations through various health departments. If you live in one of the 20 states, near one of the eight campuses, or by one of the other entities that is a CRCCP award recipients, call to see if you qualify for a free screening.
Many nonprofit organizations also offer lists where you can gain access to preventive screenings. The National Cervical Cancer Coalition has a location-based search tool for free or low-cost pap testing. The National Breast Cancer Foundation's National Mammography Program features a network of partnered medical facilities that offer free mammograms (including 3D), ultrasounds, and even biopsies. For colorectal cancer screening, check with the Colorectal Cancer Alliance Blue Hope Financial Assistance Fund.
Look into patient assistance programs
If you're managing a chronic condition, gaining access to affordable medications can be just as complicated as finding care. If you either don't have insurance or your provider won't cover a medication, ask about a patient assistance program (PAP). You can also search if your drug has a PAP. Under a PAP, a manufacturer will provide medication to you at no cost after verifying your income level. The income level threshold may be higher than you think. Some thresholds are actually around $100K.
The bottom line
You don't have to—and you shouldn't—forgo crucial screenings and routine care. Although it's a patchwork of services out there, you can find safety-net providers. Never hesitate to call ahead and ask a hospital system or clinic about its resources for those who are uninsured or insured but low-income. Some places even have social workers or other staffers whose very job it is to help.