Health policy changes in Washington will ripple through the country, resulting in millions of Americans losing their Medicaid or Affordable Care Act coverage. But there are still ways to find care.
Over the next decade, the GOP’s One Big Beautiful Bill Act is expected to slash nearly $1 trillion in spending from Medicaid, the state-federal program for people with low incomes and disabilities. The implementation of new work rules will cause some beneficiaries to lose their Medicaid coverage.
Millions of Americans are facing enormous increases in their out-of-pocket costs for ACA coverage. So far, 1.2 million fewer people have signed up for Obamacare plans compared with last year, and health policy analysts estimate more will lose coverage as they fail to pay their premiums.
Health costs are a top concern for Americans. Two-thirds of the public say they are somewhat or very worried about affording health care, more than express the same worries about utilities, food, housing, or gas, according to a January poll from KFF, a health information nonprofit that includes KFF Health News.
“All of this pain just doesn’t have to be there,” said Cheryl Fish-Parcham, director of private coverage at the health consumer group Families USA.
Doctors and health policy researchers say health coverage, of any kind, is the best protection against major medical debt.
Caitlin Donovan, a senior director at the Patient Advocate Foundation, recommends exhausting every available option for health coverage before going uninsured.
Even a high-deductible plan can protect patients from medical bankruptcy “if the absolute worst-case scenario happens,” she said.
Here are five ways that the uninsured can find affordable care.
1. Don’t be afraid to talk with your doctor about money
Patients can be hesitant to tell their doctors they’re uninsured or be wary of expressing concern about being able to afford care.
But some hospitals, physicians, and other providers offer cheaper cash pay options, said Cynthia Cox, a senior vice president and the director of the Program on the ACA at KFF.
Often prices are negotiable. “Always ask,” she said.
Health care providers can make adjustments if they know patients are worried about money, said Ateev Mehrotra, a doctor and researcher at Brown University.
“If my patient tells me, ‘Doc, I’m gonna have to pay for this out-of-pocket,’ I’m gonna make a different risk calculus,” Mehrotra said.
That doesn’t mean a patient won’t get the care they need, he said. A doctor, for instance, might order an ultrasound instead of an MRI, which is more expensive.
2. Search for providers that specifically work with uninsured patients
If your usual provider won’t budge on prices, then search for providers that cater to patients without insurance.
Federally qualified health centers, or FQHCs, and other community clinics offer routine and non-emergency care, such as treatment for flu or infection, for low-income residents and the uninsured. Community health centers charge based on a sliding scale and see 52 million patients annually in some of the country’s most underserved areas, according to the National Association of Community Health Centers.
The Trump administration has made funding cuts that might lead some of the country’s approximately 1,500 FQHCs to close or cut services. But the administration still maintains a site to find a local center.
Planned Parenthood also accepts uninsured patients. Its centers test for sexually transmitted diseases, provide birth control options, and offer postpartum and gender-affirming care and other services.
And the National Association of Free & Charitable Clinics also offers a tool to help people find free or low-cost care.
Most community clinics don’t offer specialty care, but they can usually refer patients who need more intensive services to providers willing to work with uninsured patients.
And academic medical centers tend to have more charity care programs that help uninsured patients lower their bills.
“If you’re uninsured or even underinsured, you might be able to qualify for a significant discount on the cost of your care,” Cox said.
Still, be wary of heading to the emergency room, which is the most expensive place to get care. While ERs are federally required to stabilize all patients regardless of their ability to pay, they can still leave you with a big bill — and often do.
3. Call your local health department
Health services vary widely from county to county, but many offer free vaccinations, family planning services, and testing for sexually transmitted infections, as well as for flu, covid, and tuberculosis.
Some county health departments also offer more advanced care, such as dental services and mental health or substance abuse programs. And some states have consumer assistance programs that can guide residents in finding care, Fish-Parcham said.
In addition, the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program makes free or low-cost breast and cervical cancer screenings available to low-income women in all states and territories. And some states cover screenings for other types of cancer as well.
4. It’s easier to shop around for drugs than doctors
Don’t just fill your prescription at the closest pharmacy. Instead, research generic drug options and look around for the best price on brand names.
A handful of sites such as GoodRx and WellRx offer comparison shopping tools and information on other ways to get drug discounts.
And some retailers offer low-cost access to common prescription drugs — at prices cheaper than you would find if you had insurance. Walmart, for instance, sells 90-day prescriptions of dozens of generic versions of drugs for $10. As do Target, Costco, and a new site called the Cost Plus Drug Company.
Many drugmakers also offer patient assistance programs, coupons, and rebates on some medications. Check their websites for details on how to apply.
States also offer drug assistance programs. The steps to qualify and types of drugs vary, but this tool has a list of programs and how they work.
Joining a clinical trial is another way to access treatment. The National Institutes of Health and its National Cancer Institute have lists, but patients must first meet the criteria. Clinical trials aren’t necessarily free, even with insurance, Donovan said, so be sure to ask about any associated costs.
5. Your diagnosis might lead you to specialized resources
Patients with a specific diagnosis might have additional options for specialty treatment.
For example, someone with breast cancer should check with the American Cancer Society and the nonprofit Susan G. Komen organization, Cox said.
The Patient Advocate Foundation hosts a list of vetted foundations that can help offset the cost of medical bills and provide other resources such as transportation and lodging, Donovan said. Just type in basic information such as age, location, and diagnosis to see what is available.
Disease-specific foundations such as those for lupus or irritable bowel syndrome can also steer patients to free or low-cost resources or cover some costs of care, Donovan said.
“Everything is out there,” she said.
As you research affordable care options, don’t be tricked by plans that look like health insurance but don’t offer guaranteed protection against big bills.
Some short-term plans and health care sharing ministries might seem like good deals, but read the fine print. Some red flags to look for: too-good-to-be-true monthly payments; no coverage for preexisting conditions; morality clauses such as those prohibiting the use of alcohol or drugs; or a lack of coverage for benefits such as mental health counseling that are required in ACA plans.
KFF Health News correspondent Sam Whitehead contributed to this report.
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