insurance

Dealing without health insurance

HIPAA. The Health Insurance Portability and Accountability Act, or HIPAA, offers some protection against insurance gaps. These "plans of last resort" guarantee coverage for those rejected on the private market. "As long as you have continuous coverage, you are always eligible for some type of program," says Gibbs. "As soon as you're left without coverage, then you are not eligible for a HIPAA plan."

For example, William Fogler of Atlanta made a COBRA payment mistake in November 2007 and lost his insurance before he could move to an individual plan. Because of this gap and a major pre-existing condition, Fogler is now uninsurable.

Individual or family plans. The same insurance providers who offer group plans also sell individual and family plans to those who qualify. Known as "major medical" plans, these insurance offerings use a catastrophic model, where you take responsibility via large annual deductibles (medical expenses paid out of pocket) in exchange for coverage beyond that. Common deductible options can be $1,000, $2,500, $5,000 or even $10,000 per year. Higher deductibles correlate with lower monthly premiums.

Gibbs uses a car insurance analogy to explain the difference. People expect car insurance to cover accidents and maybe a rental car, but they would never expect it to pay for regular maintenance such as wiper blades, oil changes, brakes and tires.

7 ways to access community health care resources

Be prepared to piece community resources together from the hodgepodge available. "It's going to take a lot of effort," says Pennington, who teaches advocacy along with clinical skills. "You're going to be put on hold. You are going to be rerouted and referred before you get the answers you're looking for."

Contact your local health department. Make your first call to the local health department. In some cases, services might go beyond vaccinations and include dental care, mental health services and other diagnostics.

"It's hit or miss," Pennington says. "If they happen to have mammograms, lucky you. Go and have a free mammogram, but that doesn't mean you're going to get a free mammogram when you need one. They may not have them at that point."

Find the nearest community health center. Community health centers provide medical care free or on a sliding scale based on current income. "No matter who you are, where you live, whether you have insurance or not, you will not be turned away at the door of a community health center," says Amy Simmons, communications director for the National Association of Community Health Centers.

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These federally funded centers focus on community needs in addition to basic health care services. Many also include onsite pharmacies or can make referrals to a discount one nearby because doctors like Gary Wiltz, M.D., from the Teche Action Clinic in Franklin, La., know that scraping together money for an exam is only step one. "If I just wrote you five prescriptions that cost $250 to $300 a month," he says, "then you need additional help."

Miriam Hughes of Phoenixville, Pa., is self-employed, earns a good income, but does not qualify for individual health insurance due to prior medical issues. She calls the clinic in Phoenixville a "lifesaver" for giving her access to routine medical care, screenings and other services. "I didn't know it existed," she says, "and it's 10 minutes from my house."

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