Many kids in the United States aren't covered by health insurance, or are
covered by plans with high deductibles and limited benefits.
If your kids are among them because you can't afford adequate coverage or
your employer-sponsored plan doesn't cover everything, don't despair. Programs are
available that provide affordable — even free — medical care and are designed
to meet or supplement a person's medical insurance needs.
Your kids could be eligible for coverage right now and you might not know it. Here
are some options that may be available to your family.
Enroll Your Child in a Public Program
Two public programs work together in every state to provide health coverage for
children in low- and middle-income families: Medicaid and Children's Health Insurance
Medicaid is run by states with a mix of state and federal funding.
It offers health coverage for those with limited incomes, including children and parents,
pregnant women, those with disabilities, and seniors. And kids might be eligible for
coverage if they're U.S. citizens or lawfully admitted immigrants, even if their parents
CHIP is a program funded by the federal government that each state
administers. It provides health coverage for American kids under age 19 in working
families who qualify based on their parents' income. CHIP is often helpful for families
with incomes too high for Medicaid, but who are still having a hard time affording
Each state has different CHIP rules. Some CHIP programs, for example, cover pregnant
women as well as parents and related caregivers (such as grandparents raising their
grandchildren). Each state has its own name for its CHIP and children's Medicaid programs,
too (for instance, the CHIP program in Delaware is called Delaware Healthy Children
Program; in Connecticut, it's called the Husky Plan).
To learn about your state's CHIP and Medicaid programs and other services available
to your family, visit InsureKidsNow.gov
or HealthCare.gov. There, you can apply
for CHIP or Medicaid online. You also can call 1-877-KIDS NOW (1-877-543-7669) to
find out about the CHIP program in your state.
A child's eligibility for these government programs is based on household income.
Once your child is enrolled, you'll receive a list of medical providers near you who
accept CHIP/Medicaid patients. You can then make appointments with those providers
any time your child needs to see a doctor and also be covered in case of an emergency.
Find a Private Insurer
The majority of kids from low- or middle-income families will qualify for free
or low-cost health care through Medicaid and/or CHIP. But now, through the Patient
Protection and Affordable Care Act, many privately run health insurance companies
will offer similar benefits.
To find out if your family is eligible for a plan, visit the virtual health insurance
marketplace at HealthCare.gov.
This government service and its website make it easy to apply for insurance and learn
which programs are available in your area. By just filling out one application form,
the marketplace allows you to compare and contrast the benefits of each plan, as well
as compare out-of-pocket expenses like co-pays and deductibles for care.
Visit a Local Community Health Center
A federally funded community health center is another option for low-cost medical
care for your kids. You can take your kids there for checkups, immunizations, treatment
when they're sick, dental care, prescription drugs, and mental health care.
You also can go there for complete care yourself, including when you're pregnant
and for substance abuse care if you need it.
These centers tend to offer medical care on a sliding scale based on your income.
Depending on your situation, it could be free. These centers can help you get health
insurance and usually will accept that insurance once you are enrolled.
To find one near you, visit the Department of Health & Human Services (DHHS)
health center page
and enter your zip code under "Find a Health Center." Check the website of the center
near you about services, costs, and hours and call ahead for an appointment. Some
community clinics are only open on certain days or for limited times.
Rural health centers, which are similar to federally funded community health
centers, serve families in rural areas. You can find one in your state by visiting
the Centers for Medicare and Medicaid Services website.
Also, visit the National Association of Free and Charitable Clinics' website
to find a free or low-cost clinic. The U.S. has more than 1,200 free clinics, which
are staffed by a volunteer workforce of doctors, dentists, nurses, therapists, pharmacists,
nurse practitioners, technicians, and other health care professionals.
You also might know about urgent-care centers, which are different from community
health centers, rural health centers, and free clinics. These centers are designed
for people who need care right away or when their doctors aren't in the office. They
can be expensive and might not take some types of insurance. Be sure to check with
your insurance company before going to one of these.
Talk Dollars With Your Doctors
If your kids don't qualify for a public program (such as Medicaid or CHIP), they
need services that aren't covered by your insurance, or you have a high deductible,
you can try negotiating a reduced, cash-paying rate with your pediatrician before
getting services. Cutting deals with doctors is done more often than you might think.
Start by asking: "Do you accept patients on a fee-for-service basis?" If your insurance
has a high deductible, consider yourself a self-paying patient until that deductible
is met. So, your discussion about money with your doctor might begin like this: "I'm
going to have to pay 20% of the cost of that procedure and I can't afford it" or "that's
not covered by my insurance." Talking dollars can be helpful because the doctor might
be able to suggest less expensive treatments.
And don't be afraid to shop around for a doctor who can provide care at the lowest
price. If specialist A agrees to do a certain type of surgery for $2,000, for example,
and surgeon B can do it for $1,500, you'll save $500 by going to doctor B. But be
sure that you're never compromising the quality of your child's health care for cost.
When comparing rates, look for providers who've been referred by your doctor
or another source you trust.
For suggested self-pay rates on a variety of medical services, visit Health Care
Because each provider typically receives payment separately, be prepared to negotiate
with each provider your child sees. If the procedure you're discussing for your child
requires general anesthesia, for example, be sure to ask the surgeon which anesthesiologist
she works with and contact that doctor, too, to negotiate a cash-paying price for
his services. And don't forget to ask if there's a facility fee for where the surgery
takes place — and negotiate that, too.
Find a Safety-Net Hospital
In 1946 Congress passed the Hill-Burton Act, which gave hospitals and other health
care facilities money for construction and modernization. In return, hospitals agreed
to provide a reasonable volume of services to people who can't pay. The program stopped
receiving funds in 1997, but about 170 health care facilities nationwide still must
provide free or low-cost medical services. These "safety-net hospitals" are committed
to providing access to care for people with limited or no access to health care due
to their financial situation, insurance status, or health condition.
There are safety-net hospitals in every state except Alaska, Indiana, Maryland,
Minnesota, Nebraska, Nevada, North Dakota, Rhode Island, South Dakota, Utah, Vermont,
Wyoming, and all the territories except Puerto Rico.
To qualify for free care at a safety-net hospital, you generally have to make a
gross yearly income of less than $23,550 for a family of four. If you make more than
that, you still may be eligible for reduced-cost care if your income is up to double
As an alternative to finding a safety-net hospital for your child, you can call
your local hospitals or medical centers and ask if they provide low-cost or free services
to the public. Many large teaching hospitals and medical centers provide free or low-cost
quality care for families who otherwise can't afford it.
If you find a hospital that offers this service, you'll meet with financial counselors
there to work out a pay rate. They may also connect you to other resources in your
community for discounted care.
Pay Less for Prescriptions
Prescriptions can really drain your wallet, especially if your child isn't enrolled
in a public program such as Medicaid or CHIP. Here are some ways to better manage
the money you spend on medicines:
Find out if your child can take generic (non-brand) medicines.
These often have the exact same active ingredient as the name-brand medicine, but
cost a lot less.
Find out if there is an over-the-counter alternative. Ask the
doctor or pharmacist if over-the-counter versions are available for the prescription
medicines your child takes.
Compare prices at local pharmacies. Call each one to ask what
they're charging for your child's prescriptions. Many small private pharmacies can
negotiate their prices for medications.
Contact the pharmaceutical company that makes the medication.
All the big pharmaceutical companies have prescription assistance numbers you can
call for help.
Beware of free prescription samples (or coupons and rebates).
They sound appealing, but they often are for expensive, name-brand medications. That's
fine while the samples last. But since many doctors don't like to change a medication
if it's working for a patient, you could get stuck paying full price after the samples
run out. Before accepting a sample, talk to your doctor about whether you can afford
that medication in the long term. If it's something your child only needs for as long
as the samples last, take advantage of the freebie!
If you can't afford to refill a prescription, call thedoctor
who prescribed it. Say your child's medications are too expensive and
you need a lower-cost alternative. If there's not an alternative available, ask what
for you can do about lowering the cost. It's not unusual these days for people to
ask for this kind of help, and doctor's offices often know how to get it or put you
in touch with someone who can.
Have Special Needs? Contact Family Voices
If you have a child with special needs, Family Voices, an organization created
to assist families like yours, may be able to help. Its Family-to-Family Health Information
Centers offer contacts, support, and information for each state regarding pediatric
It also can help you manage insurance and other care challenges, such as handling
the appeal process if your insurance claim is denied. Each
state's office is run by parents who have children with special health care needs.
Know Your Health Plan
Learn as much as you can about your health insurance policy before your child gets
treated so you don't get stuck with medical bills you can't pay. You're in a better
position to navigate the system and negotiate self-pay rates, if necessary, when you
know if your doctor is in-network, what's covered, and what percentage of the cost
you're responsible for.
Go to your health insurance carrier's website and log into its insurance portal
with your health insurance card number. There, you'll find your benefit plan, including
a list of in-network providers, your deductibles, co-insurance, and co-payments. These
tools can help you estimate the cost of treatment. If you're not sure about something,
call your health insurance company and ask. Make a note of the name of the person
you speak to and the date of your conversation in case there's an issue later.
Health insurance companies can't refuse someone coverage or limit a person's benefits
because of a pre-existing medical condition. They can't put a lifetime cap on the
dollar amount that they will spend on benefits either.
Stay Positive, Stay on Track
Trying to find affordable health care for your family can be overwhelming. But
you'll feel better knowing your child's health care needs are taken care of. Lots
of kids are eligible for programs that provide free or reduced-cost care, even
if their parents are working.
If you don't know where to start, contact your local community health center
or county health department and explain your situation. If they can't help you,
they can probably direct you to an organization that can. You can also call your state's
211 Helpline, which offers free and confidential information about health care and