Since the passing of the Affordable Care Act (ACA), millions of more Americans have been able to get insured for health care.

Unfortunately, that’s still not everyone and the struggle is ongoing for those with little or no money.

There is some help out there, however, and many will be surprised at the options available, even without insurance. Here are 10 ways to get affordable health care even without a typical insurance policy:

1)  Don’t Be Afraid to Explain your Situation

 While healthcare providers are not there to haggle and barter, many do have policies to help the uninsured and those genuinely struggling. If you explain your financial situation they may charge you less on a sliding scale. They may also offer a flat discount if you meet certain criteria.

It is also common to get a discount if you pay a certain amount upfront.

The key is to ask, as many of these discounts will not be advertised to you directly.

 2) Charitable Clinics and Community Health Centers

 There are several types of charitable clinics that provide low-cost services to those who are uninsured or under-insured. The first falls under the National Association of Free & Charitable Clinics (NAFC), which have 12,000 locations across the United States.

There are also 13 states that have Hill-Burton facilities, which are hospitals obliged to provide free or reduced-cost health care due to the federal funds they receive.

Certain services can also be provided at low-cost via community health centres, including prenatal care, baby vaccinations, general primary care and referrals to specialized care.

Related: 8 Tips for Getting Affordable Life Insurance

3) Via your Spouse or Domestic Partner

 Even if you don’t have health insurance yourself, you could be eligible through your spouse or domestic partner’s policy, which is commonly called ‘group insurance.’ Adding you to the policy will work out cheaper than taking out your own insurance, so it’s an option worth discussing if you both want to be insured. 

4) Third Party Loans

 It’s not the most attractive option but if you’re faced with steep medical bills you could take out a loan to spread the cost, almost like paying for insurance in reverse. Keep in mind that all other discounts and options apply; no provider has to know that you have borrowed money to pay for your healthcare.

Some lenders have loans tailored specifically for healthcare, such as dental financing, but you could also take out a regular personal loan from the bank.

 5) Medicaid or County Programs

There have been several changes to the Medicaid criteria since the introduction of ACA and the number of people who qualify has increased greatly. Many people do not realize this and are missing out on coverage.

The exact requirements vary from state to state, so you will need to contact your state insurance commissioner to find out more.

If you don’t qualify for Medicaid you can still apply for your county’s medical assistance program, which will commonly provide uninsured or under-insured citizens care on a sliding scale based on their circumstances. In some cases, care can be provided at no cost.

6) Direct Primary Care Providers (DPCP)

A different model for health care is offered by Direct Primary Care Providers (DPCP).  You sign-up and pay a small monthly fee (less than insurance) and get access to primary care physicians by appointment an unlimited amount of times.

This doesn’t mean everything is free (prescriptions and lab tests still cost), and subsequent specialized care is not covered, but it does allow you to see a doctor and get primary care.

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7)  Children’s Health Insurance Program (CHIP)

 If you are a pregnant woman without insurance or access to health care through other programs, you might qualify through the Children’s Health Insurance Program (CHIP). This is typically aimed at families who earn too much to qualify for Medicaid, offering low-cost health coverage to the children in the family, but it can also cover expecting moms as well, regardless of income.

While CHIP is available in every state, each state has their own set of requirements and not all cover pregnant women – so be sure to check locally.

8) COBRA

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act and allows people who were previously insured on a group policy with their employer to continue receiving coverage.

It’s ideal for those who have recently been laid off but need to continue with treatments.

The downside is that it is not especially cheaper than any other insurance plan. If you are uninsured for financial reasons it might not be the option for you. In fact, you might be able to find cheaper insurance, though this will obviously take longer to finalize.

9) Worker’s Compensation

 If you are out of work due to an injury that occurred on the job and need to have a medical procedure, your state Workers’ Compensation program may be able to foot some or all of the bill depending on the circumstances.

10) Discount Cards

 An alternative to insurance that works in a similar way is health insurance discount cards.

You sign up for the card and pay a membership fee.  In return you get discounted health care via participating providers.

In many scenarios, it works out cheaper than traditional insurance.

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