A survival guide for the uninsured

By Liz Pulliam Weston

If you recently lost your health insurance, or if you've never had coverage, then you're part of an unfortunate but growing national trend.

The ranks of the uninsured have grown by nearly 18% just since 2000, according to a study updated in 2006 by the Kaiser Commission on Medicaid and the Uninsured. More than 46 million people under 65 lack insurance, and millions more are considered underinsured, with gaps in their coverage that leave them exposed to catastrophic medical bills.

In fact, medical bills are a factor in about half of all consumer bankruptcies filed, according to a Harvard University study.

The uninsured die sooner

But financial troubles aren't the only risk. According to an earlier Kaiser report:

• People without health insurance receive less preventive care and are less likely to have major diseases detected early.

• The uninsured are more likely to die prematurely than the insured, with various studies putting the mortality rate for the uninsured somewhere between 1.2 times to 1.6 times the rate for the insured.

• Uninsured infants have relative odds of dying that are 1.5 times higher than infants with private insurance.

• The poorer health associated with being uninsured depresses workers' average lifetime earnings significantly. The commission estimated that better health would boost earnings by 10% to 30%.

If you don't have insurance, there are things you can do to protect your health and pocketbook. Before we get into those, however, I want to tell you about some ways you might be able to find insurance coverage that you might not have considered.

Some of the options include:

COBRA: If you were covered by health insurance at work but are about to lose your job, you're typically entitled to coverage for up to 18 months under the federal Consolidated Omnibus Budget Reconciliation Act of 1985. Unfortunately, you have to pick up the whole tab for this coverage, which can be tough to afford. Coverage for a family of three can easily cost $500 to $1,000 a month.

High-deductible policies: You'll pay more of your routine medical costs out of pocket, but these policies protect you against catastrophic medical bills. Having the coverage also entitles you to insurer-negotiated discounts with doctors and hospitals. (It's shocking, but many medical providers charge the uninsured higher rates and fees because they aren't covered by such discounts.)

An individual HMO policy from Blue Cross with no deductible might cost a single 24-year-old female in San Francisco $265 a month. Choose a plan with 20% co-pays and a $1,000 deductible, however, and the cost drops to $62 a month.

Short-term coverage: Many insurers that provide individual policies have a bridge or short-term option, designed to cover you until you land your next job. These are typically cheaper than a regular individual policy because the insurer is exposed to claims for a limited time. Try the nearest Blue Cross, or talk to an experienced health-insurance broker.

High-risk pools: If a health issue, rather than the cost, is keeping you from being insured, check to see if your state has a high-risk insurance pool. Georgetown University's Health Policy Institute maintains a list of state high-risk programs and contact information.

Health insurance for kids: Most states sponsor low-cost or free health insurance for children, and a few will cover their parents for an additional fee. A family of four in most places can qualify for insurance for their kids with an annual income up to $34,100; in higher-cost areas, that limit may be higher. (A family of four in California, for example, could qualify for that state's Healthy Families program with an income of up to $51,636. Monthly premiums in Los Angeles County, for example, would be $8 to $30, depending on income.) For more information, visit Insure Kids Now!, a government-run Web site.

Medicaid: This government-funded coverage is generally reserved for people with very low incomes and few assets; each state has different guidelines. For more information, visit Centers for Medicare and Medicaid Services.

If none of those options works for you, you'll be relegated to a patchwork system of government and charitable programs that try to provide help for America's uninsured.

Because there are at least 46.1 million such people, however, that means some of these resources are overwhelmed.

That doesn't mean you should delay screenings and treatments, only that you may need to wait longer for an appointment than if you were privately insured.

Low- and no-cost health care

Here are some of the resources available for various kinds of treatment:

Routine and diagnostic care: Hundreds of community health centers around the country offer free or low-cost care. To find a site near you, visit the Bureau of Primary Health Care.

The national Centers for Disease Control and Prevention has information on state health departments, which provide additional clinics and resources for the uninsured.

The CDC also has a guide for women looking for low-cost mammograms and Pap smears. The American Cancer Society at 1-800-ACS-2345 can direct you to services that provide free or cheap screenings for various types of cancer.

Keep an eye out, too, for any health fairs sponsored by local employers or community organizations. Free and low-cost screenings for common ailments, from depression to high cholesterol, are a routine part of these festivals.

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