Uninsured patients tend to pay more for medical services because they don't have access to the discounts medical providers grant to insurance companies. Nonetheless, uninsured patients have the right to necessary care, even if they are unable to pay for it. They also have the right to some medical coverage under state and federal programs for low-income households. Patients' rights are mainly governed by state law and vary significantly across the United States.
Access to Emergency Care
Uninsured patients have the right to emergency medical care. The Emergency Medical Treatment and Labor Act requires that emergency facilities provide medical screening and stabilize anyone who comes for assistance regardless of his ability to pay. Similarly, facilities that are part of the health care safety net--including community health centers, public hospitals, some teaching hospitals and charitable clinics--must offer medical care to all patients, whether or not they can pay customary charges.
Medicaid Coverage
Some uninsured patients with limited income have the right to Medicaid coverage. The rules for eligibility differ from one state to another, but considerations include income, liquid assets, property that could be sold for cash, age, disability, blindness and pregnancy. Medicaid pays health-care providers directly, but depending on your circumstances, you may be required to contribute toward the cost of services you or a family member receive. The health-care reform legislation of 2010 expanded Medicaid to cover families whose income is 133 percent of the federal poverty level or less. Childless adults will be eligible for Medicaid as of 2014.
State Children's Health Insurance Program
Some children without health insurance have the right to medical coverage under the State Children's Health Insurance Program, or SCHIP. The program, which is a joint federal-state partnership, provides benefits to children of working families who make too much money to quality for Medicaid but not enough to pay for private health insurance. Eligibility differs between states, but coverage may include physician visits, hospitalization and medications.
Rights Under State Laws
Uninsured patients' rights differ from one state to another. For example, California law mandates that hospitals cannot charge more than the public price set by Medicare or Medi-Cal to uninsured patients with a family income of less than 350 percent of the federal poverty level. In Connecticut, unpaid medical bills are exempt from the normal punitive debt-collection procedures and state law limits the interest rates that hospitals may charge on outstanding debt. Illinois legislation requires hospitals to charge no more than 135 percent of cost to uninsured patients who meet certain criteria.
Voluntary Hospital Charity Programs
Largely due to negative publicity about billing and collection practices concerning uninsured patients, some hospitals have instituted their own voluntary policies regarding low-income patients without insurance. For example, some hospitals have reclassified charges listed as outstanding debt as charity write-offs. If you need a medical procedure and believe you cannot afford it, check with local hospitals to see if they have charity programs that may cover some or all of the costs.
References
- Families USA: A Pound of Flesh: Hospital Billing, Debt Collection and Patients' Rights
- American College of Emergency Physicians: The Uninsured: Access to Medical Care
- CBS News: Health Care Reform Bill Summary
- U.S. Department of Health and Human Services: Medicaid Eligibility
- Illinois Hospital Association: Hospital Uninsured Patient Discount Act
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