High Deductibles or No Insurance- How to Get Great Primary Care Anyway

If you have no health insurance or insurance that is costly yet covers little, you are not alone.

Many Americans fall into what is called a medical coverage gap. Rising costs of health insurance leave many feeling forced into a high-deductible plan (a.k.a., catastrophic plan), or simply opting out of insurance all together. Many feel that their out-of-pocket expenses are so high before any care is covered, that they might as well not have insurance at all.

Additionally, as healthcare costs continue to rise, employers are passing these costs down to their employees, which often means that when an employer does offer health insurance, there are fewer affordable options. If employees choose an employee-sponsored plan, they may avoid getting important preventative care due to high deductibles and high co-pays when they do get care.

The good news is that if you’re underinsured or uninsured, there are options for getting the care you need. Keep reading for our guide to finding a primary care physician when you are underinsured or have no insurance.

Check Your Eligibility for Coverage

If you don’t have insurance, it’s important to see if there are health insurance programs or other programs you qualify for. Even if you don’t think you qualify, you might, especially if you have children.

Be sure to look into coverage through Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). CHIP is a federal program that provides funds to states to help families with children that don’t qualify for Medicaid.

You can also contact local organizations such as the county health department, department of social services, or state/city non-profits that offer assistance with medical needs.

Start Shopping Around

People don’t usually think about shopping around for medical care, but more and more people are saving money by doing just that.

Pricing in healthcare varies greatly between providers, even in the same area. Two seemingly similar practices may charge wildly different rates for their services. If you are self-pay, be sure to ask the primary care practice what their self-pay charges are for services.  If a provider says they can’t provide you with self-pay pricing for visits or services, it might be an indication that they are not the best fit for you.

If you have a high-deductible insurance plan, knowing the price for visits and services is still important, especially since you must meet high out-of-pocket expenses before services are covered.  The first step is to find out what your insurance plan covers (example: are annual physicals or preventative care covered?). Find out how much your co-pay is, which may will probably be different depending on whether you’re seeing a primary care doctor or a specialist. Unfortunately, it can be difficult to uncover pricing when insurance is used for care, but once you have a good understanding of what your insurance plan covers, you’ll know what questions to ask your primary care office.

Some questions include:

  1. Before I arrive for my visit, are you able to check with my insurance company to see if the visit or service I am planning to receive is covered? And if you learn it is not, are you able to tell me how much my out-of-pocket expenses will be?
  2. My co-pay is fairly high. How much time will I generally get with my physician so that I don’t have to make multiple visits for the same concern?
  3. Specialist visits are expensive with my insurance plan. What services do you offer in your office, and what services do you frequently refer out to a specialist?

Getting answers to these questions may not only help you save money. It may also help you get a sense of the quality of care you’ll receive from your primary care doctor.

Ask About Self-Pay Discounts

Many medical providers offer special discounts for patients who pay with no insurance. For example, if you’re paying for care in full at the time of service, you may be eligible for a self-pay discount or cash discount. Even patients with insurance can receive discounts for prompt payment of their remaining balance.

If you have a copay or a service that was applied to your deductible, ask your provider about a discount for paying in full. If you can’t afford to pay right away, you can also ask about setting up a payment plan.

You can find primary care practices in Wilmington, NC that offer full-service primary care plans for patients who self-pay or who offer care for a flat monthly rate. (search Direct Primary Care, Wilmington, NC)

Get it in Writing

Before receiving any medical services, you should discuss pricing and get the agreed-upon price in writing. This helps eliminate confusion in the future and gives you a clear picture of what you can expect to pay.

Health care providers should be able to provide an estimate in writing for services. If they don’t, you can ask for a letter or an email from the provider’s office that states what you will owe.

Prepare Before Appointments

When you’re paying out of pocket, you want to make sure you get the most out of your time with your doctor. Every minute counts.

You can make sure you get the most for your money by coming to your medical appointments prepared. If you haven’t seen this primary care provider before, they won’t have your complete medical record unless you’ve made arrangements to have this information transferred in advance.

This is a major pain point for patients with no insurance who are often forced to go from doctor to doctor. You can prepare for your appointment by bringing your medical records as well as a list of symptoms, concerns, and questions with you.

Be sure to include information about when your symptoms started and what, if anything, has made them better or worse.

Keep Your Own Records

As we mentioned above, patients with no insurance or those with high-deductible insurance plans (a.k.a., high out-of-pocket or “catastrophic plans”) may avoid care due to fears of what it will cost. This can result in seeking care just when they need it, instead of developing a long-term relationship with a doctor.

Also, patients with commercial insurance may find that their insurance company dictates which providers they can see. It’s not uncommon for insurance companies to suddenly drop providers from their network, requiring patients to find a new doctor with short notice. This can also hinder one’s ability to establish a long-term relationship with a primary care doctor.

Sometimes, finding a good primary care provider that you can establish a long-term relationship is worthwhile, even if they aren’t part of your insurance network. In these cases, a primary care provider who offers their services for a flat rate without insurance may be a better fit. (search Direct Primary Care, Wilmington, NC)

Finding a primary care provider who can see all members of your family can help make managing your healthcare needs easier, but it’s important to know that laws require providing patients with access to their previous and current medical records. Your records should include information about where you have been seen, what you were seen for, what tests were done, what the results were, what treatment was given, what the outcome was, what medications you have taken and for how long, as well as what pharmacies you have used.

Although your new primary care physician can access these records form your previous providers once they get your written permission, it’s helpful to keep a detailed history of record for each member of your family, since getting access to old records can take time.

Have a Plan for Emergencies

Most people don’t realize costly going to the emergency room can be. One of the things you can do to cut down on medical costs is to visit your primary care physician as soon as you notice a problem. Prompt evaluation and treatment can save you money down the line by preventing the problem from becoming an emergency.

If you do find yourself in a situation where you need emergency medical care outside of the scope of your primary care provider, you can save money by opting for an urgent care center. Urgent care centers have become increasingly popular in recent years because they provide many of the same services as an emergency room at a fraction of the cost.

Urgent care centers can treat common issues like urinary tract infections, sprains, fractures, and lacerations. When you visit an urgent care center instead of an emergency room, you save money and free up resources for patients with more serious medical conditions.

If you need to visit an urgent care center or emergency room, we recommend discussing pricing upfront and asking about sliding scale payments, payment plans, and self-pay discounts.

Are You Looking for Primary Care in Wilmington, NC with High Deductibles or No Insurance?

If you have high-deductible insurance plan or no insurance and are looking for primary care in Wilmington, we’d love for you to consider our family practice.

Just because you don’t have “great insurance” or no insurance at all, doesn’t mean you don’t deserve high-quality medical care. We offer a full suite of services for family care in Wilmington without the headaches of traditional primary care practices. With us, you’ll have access to a board-certified family physician for all of your primary care needs at a flat monthly rate.

Our team spends less time dealing with insurance so we can spend more time caring for patients like you. Click here to learn more about our pricing and services today.