“When you don’t have health insurance, you’re constantly gauging just how severe your ailment is and whether it’s worth taking that trip to the hospital,” says Steve DiMatteo, an Ohio resident.
Many people think accessible healthcare should be a given, but what happens when you can’t afford health insurance or choose to forgo paying upwards of $500-$1,000 each month for medical attention you may or may not need?
“Those without health insurance often go without until they are in crisis,” says Kryss Shane, a dual-licensed social worker from Ohio.
According to PBS, approximately 44 million people in the U.S. don’t have health insurance, and another 38 million have inadequate health insurance. In fact, research from 2017 shows that up to 11.3 percent of Americans can’t afford health insurance at all.
“This means that nearly one-third of Americans face each day without the security of knowing that, if and when they need it, medical care is available to them and their families,” the study reads. So what do they do?
For one, they don’t get sick.
They can’t afford to. Staying healthy becomes top priority when you don’t have insurance, says digital marketer Richard Kelleher, who lives in Arizona. “That means eating correctly, being in the gym every morning. It takes regiment and dedication”
As a self-proclaimed “solopreneur” who prefers to invest in digital marketing education and training, Kelleher has known what it’s like to be uninsured for the past decade. But he notes there’s a downside. “Last year, I went to a dental school after visiting two dentists with a toothache. I ended the year spending $3,000 on dental work.”
According to one study, uninsured people are both less likely than those with coverage to use any health services in a given year and have lower expenditures for services on average.
Dorma McGruder, who lives in the greater Detroit area, hasn’t had insurance since 2013 and has instead learned to manage her health issues by working on her weight and stress levels. Despite struggling with migraines, high blood pressure, astigmatism in both eyes, and much-needed dental work, she relies on a combination of natural remedies, prayer, and exercise. “Sometimes the pain is unbearable and my blood pressure shoots up to 190/110.”
“I take something over the counter, lay down and rest,” she says. “But I have to keep going.”
They self-diagnose.
Google becomes the go-to for all things health. Those without insurance will often self-diagnose using resources they find on the internet, according to Shane, and this can cause unnecessary stress and anxiety. Back in 2012, in a piece for The Atlantic, writer Gary Stern reported that a staggering 97.5 million Americans used health websites to obtain information.
While this can seem perfectly convenient in the moment (when you’re unsure what that suspicious rash is), it poses significant risks in that you can’t really know for sure what that rash is unless it’s seen by a medical professional.
Here are just a few dangers that arise from self-diagnosis:
Unwarranted panic and worrying about worst outcomes (which goes back to the stress Shane mentioned).
Trusting unreliable sources. Health blogs written by unqualified advice-givers don’t equate to a doctor that knows your medical history.
Dangerous self-medicating, aka using products with unforeseen side effects. Experts advise instead to try alternatives like 24-hour nurse hotlines, where you can discuss symptoms and whether it’s urgent for you to be seen at a clinic.
They take their health issues abroad.
“I travel internationally often and get all my work done overseas in countries that have better healthcare than where I live in Seattle—and is only 20 percent of what it would cost in the U.S.,” says Alex, who prefers to be identified by his first name only. He goes to Bangkok to get his teeth deep cleaned annually and receives his regular cleaning when he’s in Vietnam or Korea.
This form of medical tourism, where people live in one country and travel to another to receive medical, dental, and surgical care, is nothing new. In fact, there’s a whole association devoted to it, and that association says Americans can enjoy a 90 percent cost savings if they opt to receive healthcare abroad.
As of this year, Nian Hu of INSIDER reports that more people than ever are ditching U.S. healthcare in favor of traveling to other countries for medical procedures that are more affordable.
“Compared to the rest of the world, people in the US pay much higher prices for medical services such as hospitalization, doctors’ visits, and prescription medication,” Hu writes, pointing to a 2015 report that found 150,000 to 320,000 Americans travel abroad every year to receive healthcare.
While the pros are advantageous for people living with chronic illnesses and who can budget in a yearly trip, what about those who don’t travel abroad for work and can’t afford a quick flight out of town?
Fortunately, there are a growing number of assistance programs for those without insurance or who need help paying their premiums. Below are just a few to look into:
CoverageforAll.org offers a state-by-state directory answering all of your insurance-related questions and information on eligibility for programs based on the federal poverty level.
Free clinics are an option for those who don’t have insurance or have limited healthcare coverage. Check out this handy list of free clinics provided by the United States Department of Health and Human Resources.
BenefitsCheckup.org and Eldercare.gov are resources for older Americans without insurance. They can help them explore their long-term care benefits and assistance options for food and nutrition.
They become over-the-counter connoisseurs.
Shane points out that those who do seek healthcare treatment typically go to a drugstore or grocery store clinic for their medical needs. This is true for Alex, who refuses to buy insurance through his employer. He says he’ll try to tough it out when he gets sick. “I take over the counter meds, and usually it goes away within a few days.”
“If I do need to visit a doctor, I will usually pay out of pocket, and that is still less than what I would have paid with insurance.”
According to an article published in the Journal of Bioanalysis and Biomedicine, many older adults rely on self-management of medications to treat common medical conditions such as the common cold, pain, diarrhea, and constipation. And while using over-the-counter meds have their advantages, they’re also associated with risks of misdiagnosis, excessive drug dosage, prolonged duration of use, and unknown drug interactions.
If you can see a doctor and do get a prescription, trying to get a prescription filled without insurance can be a daunting task, but it’s not impossible.
The good folks at USA Today compiled this helpful list of options including alternatives to paying out of pocket, including an overview of discount and pharmaceutical assistance program that can save you up to 85 percent on the prescriptions you need.
They get by with a little help from their friends.
“When you’re single and under a certain age, you don’t think about health issues until ‘it’ happens,” says Los Angeles resident Nicholas Christensen.
And by “it,” he means a big enough health scare.
In his case, it was flu-like symptoms that gradually appeared in a 12-hour period which became monumentally worse during a short flight home. “I was doubled over with stomach cramps, feeling nauseous, gassy, bloated, and literally started to morph into a white walker from the Game of Thrones.”
All kidding aside, it was not looking good. “I went to urgent care, which is advertised as an ‘affordable alternative’ to emergency rooms.” He assumed the medical attention would be within his budget since he had missed the open enrollment period for health insurance, but he was wrong.
While the doctor in attendance wanted to admit him to the emergency room, Christensen resisted. “After getting a rough estimate of the urgent care treatment, which came with sticker shock, I decided to call my high school friend who is a third-year resident in NYC.”
Together, they determined that his symptoms were most likely a virus or bacterial infection caused by swimming in stagnant lake water. “Sometimes the more affordable option is finding a doctor friend or google your symptoms—free of charge!”
While somewhat extreme, Christensen’s concerns are not exactly unfounded.
According to Maureen Groppe of USA Today, while emergency departments are required by law to stabilize and treat anyone entering their doors regardless of their ability to pay, that doesn’t mean the uninsured can get treatment for any old ailment. “It also doesn’t mean that hospitals won’t try to bill someone without insurance. And the bill they send will be higher than for an insured patient because there’s no carrier to negotiate lower prices,” she writes.
Groppe points to one 2016 study published by the National Bureau of Economic Research, which found that someone who goes into the hospital without insurance doubles their chances of filing for bankruptcy over the next four years.
While opting out of the ER is certainly more affordable, it’s also a slippery health slope that can have dire consequences. Luckily, WebMD offers five tips to consider for ER visits, the top one being, “Don’t assume it’s the right place for you (if it’s not broken, burnt, or cut deeply, you’re better off at urgent care).” In other words, if your symptoms are bad enough to think your health will be in danger if you don’t get care right away, the ER is probably the right place for you.
They seek help online.
Approximately 56 percent of American adults with a mental illness do not receive treatment, according to an article by Nicole Spector for NBC News. And in many cases, it’s the cost of therapy and prescription drugs that deters people from getting the help they need. So what’s a person to do?
According to Shane, those who need mental healthcare often use social media to request support when they feel lonely, or seek out online or texting therapists in an attempt to get care.
Sites like BetterHelp offer online counseling as a more affordable and convenient way to seek mental health support, but it’s also come under scrutiny related to ethical questions regarding privacy and safety challenges.
In her NBC article, Spector recommends checking out other resources such as private therapists who will work on a sliding fee scale (sometimes offering their services for as low as $10 an hour), finding out whether you are eligible for Medicaid, or even turning to local training institutes that sometimes provide patients with free sessions for up to two years.
They use HealthShare plans.
“I am very healthy physically and think it is a waste to spend $500 to $1,000 a month on health insurance when there is very little chance of something happening,” notes 27-year-old Stacy Caprio in Boston. “And I’m self-employed, so I would have to cover the whole cost myself as opposed to being partially reimbursed by an employer.”
Caprio currently has a HealthShare plan that fulfills the Affordable Care Act (ACA) requirement (otherwise known as Obamacare) but is also, according to her, “low cost and low coverage.”
As of 2016, due to the rise in healthcare costs, health sharing memberships have more than doubled—going from about 200,000 to about 530,000 participants annually.
While attractive because of their low monthly costs, it’s important to note that these plans are cooperatives (often faith-based) and do not equal health insurance—meaning consumers have very few legal protections.
“For me right now, it is okay, because I am young and healthy,” explains Caprio, “but it is a risk that I am living with day to day.”
They try to maintain a positive mindset.
They have to. “I have more good days than bad by using a lot of prayer and mental discipline,” says 61-year-old McGruder. She says it’s scary being unemployed and wondering about her health future at this age.
“It’s embarrassing because I have never been in this place before,” she adds. “I have to get healthier so I don’t end up in a facility with no insurance to cover basic needs.”
Ultimately, maintaining a positive mindset makes her work harder to be healthier and less dependent on medicine.
“I have to. I can’t get any.”
More Than Positivity
Overall, staying healthy and positive can only take you so far when you’re in the midst of an unexpected health scare (appendicitis comes to mind).
Taking the time to research your options and learn what resources are available can help you better prepare and avoid putting your life at risk. Remember, even some coverage is better than none at all.