What happens if I go to the hospital without insurance?

If you’re in good health, you might think you need not spend the money on monthly health insurance premiums. After all, insurance plans can be costly, and it’s hard to rationalize throwing your money to a service you rarely use. But there are many cases where people think to visit the doctor without having health insurance.

With passing the Affordable Care Act in 2014 came the requirement that every American must enroll in a health insurance plan, or else pay a tax penalty. However, the Trump administration repealed the ACA’s individual mandate in 2017, and beginning in 2019; states can now choose whether they’d like to enforce their own insurance mandate.

As a result, many Americans have opted out of health insurance – but this comes with its own set of issues. No one ever plans on going to the hospital, but unfortunately, many of us must take a trip to the emergency room at some point in our lives. If you’re one of the 27 million people in the United States who are uninsured, you might be wondering what your rights are with emergency room trips. Can you still access care? How much will it cost? How will you pay? Can you still go to a doctor without health insurance? We’ve created a guide to help you navigate going to the hospital as an uninsured person.

The Good News

Thanks to the Emergency Medical Treatment and Labor Act (EMTALA), doctors and medical professionals are required by law to treat you if you end up at the hospital, whether or not you have health insurance. The law states that “any individual with an emergency medical condition, regardless of the individual’s insurance coverage, is not denied essential lifesaving services.”

There are three kinds of situations that the federal government qualifies as emergencies:

  • Any incident that is severe or life-threatening,
  • Any incident where bodily functions or organs are impaired,
  • Any incident where delivery (birth) is imminent in a pregnant woman.

Remember that screenings, prenatal care, and other checkups and treatments for non-life-threatening illnesses are not covered by the EMTALA. It’s possible that you might arrive at the hospital for illness and be informed by medical professionals that your situation isn’t dire. However, if you find yourself in a life-threatening emergency, you’ll be able to access the necessary hospital services.

The Not-So-Good News

Unfortunately, if you’re uninsured, you must pay your hospital bills out-of-pocket. According to Healthcare.gov, the average cost of a 3-day hospital stay is around $30,000, and something simple like fixing a broken leg can be as much as $7,500. These unexpected costs can be a huge burden on many Americans.

What happens if I go to the hospital without insurance?

If you find yourself at the hospital, let your medical providers know up-front that you don’t have health insurance, as sometimes hospitals will offer individual discounts for the uninsured. You can also speak to the hospital ombudsman about “charity care,” or financial assistance programs that allow you to pay off your debt. Ombudsmen are put in place specifically to help consumers, so best to negotiate your payment with them first before speaking to the payment department. Luckily, non-profit hospitals are required by law to offer these charity care plans to their low-income patients and enrolling in one will sometimes pause bill collectors.

It’s also important to double-check your bills after a visit in case there are mistakes or overcharges – it’s best to negotiate your costs on the front-end, but you can also dispute charges with the payment department once you receive your bills.

Visiting a hospital might not always be necessary. If you are not sure that your situation is immediately life-threatening, a trip to an urgent care facility is likely a more affordable way to receive treatment. With an emergency, urgent care will refer you to an ER. You can also see a doctor without insurance by researching your local community care clinics, walk-in clinics, and direct care providers. Some clinics, also known as cash-only clinics or direct care providers, offer services specifically to the uninsured. The costs of these providers vary, so best to do your research first if you’re in a non-emergency scenario.

Alternatives to Being Uninsured

The best way to safeguard yourself against unwanted hospital bills is by enrolling in an insurance plan. Plus, receiving regular preventive care and screenings can keep you in good health and prevent later emergencies.

As a low-income person, see if your earnings qualify you for Medicaid. It’s easy to check your eligibility by going to Healthcare.gov, which will also refer you to your state’s Marketplace if they run their own Medicaid program. Medicaid plans offer comprehensive free or low-cost coverage to millions of Americans.

Not eligible for Medicaid? No worries! The Affordable Care Act provides premium tax credits and affordable insurance plans for low-to-middle-income Americans that don’t qualify for Medicaid or Medicare. These plans might require you to pay a deductible, coinsurance, or copayment, but they will have greater financial coverage than if you show up at the hospital without insurance. To enroll for 2021, you must sign up during 2020’s Open Enrollment period

The Open Enrollment period for 2021 starts November 1st, 2020 and ends on December 15th.  PRE-REGISTER NOW to avoid last-minute headaches.

Conclusion

TrueCoverage is here to help you find affordable health care solutions. Rather than take the risk of a costly hospital visit as an uninsured person, we recommend browsing our health insurance Marketplace to find the best plan that fits your needs. Don’t know where to start? Contact us, and our insurance experts will contact you!