Utilizing Free Clinics and Community Health Centers (Without Insurance)
Author: Lauren Wheeler, MD, BCPA
Purpose of this guidance: Community health centers, low-cost and free clinics, emergency departments—these are a few healthcare options for those who may be uninsured. Read below to know when you can use these services, what to expect when you do, and some search tools to find care near your home.
If you are one of the 27 million Americans without insurance, especially if you used to have insurance, navigating healthcare without coverage might seem overwhelming. The good news is that there are still places and people who want to help you with your health.
Who are the Uninsured and What Special Challenges Do They Face?
According to the Kaiser Family Foundation, most uninsured people are adults in working families. Because each state makes different decisions about who can qualify for Medicaid and CHIP, many people with low incomes are not eligible for government insurance programs. However, private insurance is still unaffordable for many.
Not having insurance is a risk factor for having more severe disease and even early death. Many people without insurance decide to skip or delay treatment for health problems, which causes their health problems to be more severe when they finally do get care. Of course, it’s hard for people to have to choose between paying rent, buying groceries, or going to the doctor.
Aside from cost, lots of uninsured people don’t have a place to go when they need medical care or advice—they don’t have a longstanding relationship with a doctor or a clinic. One way to help with this problem is to find a local free or low-cost clinic.
What Are Low-Cost or Free Clinic Options for Uninsured People?
Because navigating without insurance has been a challenge for many Americans for many years, there are places dedicated to helping people with their health regardless of their ability to pay. Together, these hospitals and clinics are called the safety net.
One thing to note is that safety net facilities will differ in their mission and business structure. Many are supported by religious institutions, nonprofit groups, government agencies, or community groups. One way to group affordable options for the uninsured is:
- Volunteer-run free clinics (no cost)
- Community health centers (may have a sliding scale)
- Public health departments (low fee)
- Hospital emergency rooms (variable)
Volunteer-Run Free Clinic (Students or Not)
Many communities, both rural and urban, have clinics where patients can get free medical care. Because these clinics are charitably funded, they often have very limited budgets and are only able to accept specific types of patients. For instance, you may have to live within a certain zip code, not qualify for other insurance, and prove that your income falls within certain guidelines for your family size. (One example in North Carolina.)
Typically, the doctors, nurses, and almost everyone else you meet at a charitable clinic are volunteers. Often, to increase the amount of help that can be provided, students and trainees participate in caring for patients. That means that when you visit a free clinic, it’s likely that you will see medical students, nursing students, etc. and that you may see a different doctor on different visits.
(As a side note, many students value volunteering at student-run clinics as it gives them hands-on experience with medicine. Students who volunteer during their training are also more likely to volunteer after they finish training, so they help their communities throughout their careers.)
Community Health Centers
If you don’t meet the eligibility requirements for a free clinic or you don’t have one near your home, another option to consider is a community health center (CHC). (Some are also Federally Qualified Health Centers, FQHCs.) Like volunteer-run clinics, these centers provide primary care to people regardless of ability to pay.
Unlike volunteer-run clinics, usually community health centers are staffed by paid employees who work full-time. (Though some include well-supervised trainees, as do many academic medical center clinics.) CHCs offer integrated health services—that means in addition to seeing the doctor, a patient may also be able to see a dentist, pick up medications from a low-cost pharmacy, and receive specialized care for HIV/AIDS, pregnancy, or substance abuse.
Often, community health centers have a sliding-scale fee, which means patients are asked to provide their income information, and then pay some amount for services based on earnings. Community health centers typically have more inclusive eligibility requirements, meaning that they welcome patients with insurance (including government insurance or private) as well as uninsured patients.
County Public Health Department
While either of the above options are great places to establish a long-term relationship, sometimes a person just needs something simple done quickly. In that case, your local public health department may be a good option. Public health departments usually charge a small, flat fee to everyone for their services. They may or may not accept insurance. Usually, the focus is on contagious diseases, like those prevented by vaccines, tuberculosis, and sexually-transmitted infections.
Services are different in each state and county, but generally may include:
- Vaccinations for adults and children
- Sexually transmitted infection (STI/STD) testing and treatment
- Tuberculosis testing
- Health screenings for children (newborns, blood lead)
- Screenings for adults (blood pressure, cholesterol, etc.)
- Special resources for mothers and families (connection to other resources/help with food and breastfeeding, etc.)
- Help with quitting smoking
Your local health department should always be able to tell you about free clinics, community health centers, and other resources in your area. Depending on your location, it may also be possible to travel to a nearby county health department for certain services.
Emergency Department at a Hospital
Legally speaking, every emergency department (ED) in the US is required to treat every person that enters their doors regardless of ability to pay. However, they are also allowed to bill that person after treating them, and the bill may be large.
If you show up to the ED, you have the right to be seen by a medical provider who can find out if the problem you’re having is an emergency or not. If it is an emergency, they will stabilize you before you leave. Technically speaking, emergency medicine doctors don’t have to treat non-emergency conditions, say running out of blood pressure medicine, but they may choose to do so.
Most of the time, when uninsured people go to the emergency room, it’s for the same reasons as insured people. However, the amount of the bill that the patient has to pay can be very different. On average, the cost of an ED visit is >$1500. Urgent care centers, where simpler concerns can be treated (like sprained ankles, stitches, or dehydration) often cost around $300 per visit.
What is the patient experience like in a safety-net clinic? What should I expect?
If you’ve decided to visit a free or low-cost clinic, your experience will mostly be similar to every other doctor’s visit. However, you may notice certain differences, including:
Different Resources: If you visit a community health center in particular, you should be informed of multiple resources you could benefit from, like a visit with a social worker (especially if you might be able to get insurance), a low-cost pharmacy, or maybe even a personal trainer.
What to bring: In most cases, you will need to bring proof of your income to your visit. Ask which types of documents are acceptable. You may also need to bring proof of where you live, like official mail or a letter from who you are staying with.
Hours: Many free clinics and CHCs have some evening/weekend hours. This is to make it easier for working people to get medical help.
Walk-in/time in clinic: Some free clinics will see patients in the order they arrive, not necessarily in the order of their appointment. Plan to wait a long time or call ahead to ask about your clinic’s policies.
Dignity and respect: Regardless of money, everyone deserves to be treated kindly. Ideally, everyone who works and volunteers in healthcare wants to help people get the care they need. If you aren’t being treated with respect, consider calmly asking to speak to someone else or calling back at a different time.
Tools to Find Care
https://nafcclinics.org/get-involved/get-care/
https://www.safetynetcenter.org/find-a-facility/
https://findahealthcenter.hrsa.gov/
https://www.naccho.org/membership/lhd-directory
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC-BY-SA-4.0), available at https://creativecommons.org/licenses/by-sa/4.0/. SPDX-License-Identifier: CC-BY-SA-4.0
Signed-off-by: Lauren Wheeler