Bridging the Gap: Affordable Health Care Options in the Pre-Medicare Years

Bridging the Gap: Affordable Health Care Options in the Pre-Medicare Years

Increasingly, people in their pre-Medicare years who have retired early or lost employer covered health benefits are contacting us with concerns about health insurance. Some have pre-existing medical conditions and/or accumulated medical debt. They need assistance but don’t know where to turn. For example, one woman who is caring for her husband contacted our office. He currently has Medicare due to disability, suffered four heart attacks in the past several years, and was in and out of the hospital, resulting in huge bills. Facing considerable medical debt, the couple finally had to file for bankruptcy. The medical visits and bills have continued and have taken a toll on the wife’s health as well. Where can she turn to for help?

Sadly, this example is not uncommon as a growing number of people face medical debt due to the skyrocketing cost of health care. One resource we refer people to is the federally funded health care centers. These are overseen by the Health Resources and Services Administration (HRSA), the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable. HRSA’s Get Health Care website has links to:

  • Health Centers that provide primary medical and dental care to people of all ages, whether or not they have health insurance. Services are provided on a sliding fee scale, based on one’s ability to pay.
  • Free or Reduced Cost Care at Hill-Burton Obligated Facilities. About 200 hospitals, nursing homes and other facilities across the U.S. are required to provide a specific amount of free or reduced-cost health care to people unable to pay. This comes from a law Congress passed in 1946, where in exchange for government grants and loans for modernization construction costs, hospitals and nursing homes agree to provide a certain amount of services to people unable to pay who live in their facility’s local area. While the program ended in 1997, about 200 facilities nationwide have not met their “quota” of providing such services are still obligated to provide free or reduced cost care. Visit the link above to determine if there are obligated facilities in your area.
  • HIV/AIDS Care. This care is provided through the HIV/AIDS programs funded by the Ryan White Act that connects people living with the disease to health care and support services.

Eligibility Information for Health Center or Hill-Burton Program

Basically, anyone can get care at a health center or Hill-Burton obligated facility.

How much you pay for care at a health center is based on a sliding scale at each facility. To find out more, contact your local community health care center.

The amount you pay for services at a Hill-Burton obligated hospital or other health care facility depends on both how much funding they still have available and on your income. If your income is at or below the current Health and Human Services (HHS) Poverty Guidelines, you may be eligible for free care. If your income is higher, as much as two times the HHS Poverty Guidelines, you may be eligible for reduced-cost care.

Other Resources for People Without Health Insurance

A few other resources for people in their pre-Medicare years include:

  • The Pre-existing Condition Insurance Plan (PCIP). This plan insures individuals with a pre-existing condition and is a result of health care reform. It is also available in every state. The federal government administers the PCIP programs in 23 states and the District of Columbia. The remaining states, including California, operate their own PCIP programs using federal funds provided by the Affordable Care Act. For more information, see our article about California’s PCIP.
  • The website. This website lists many public and private health insurance options in California.
  • The website provides simplified public and private health insurance eligibility information for all 50 states. They also have a national helpline for the uninsured: 1-800-234-1317.

People can also call their local Health Insurance Counseling & Advocacy Program (HICAP). Although HICAP works mainly with Medicare beneficiaries, they may have information and referrals for county-specific health insurance programs or low cost services. Here’s a list of HICAP offices by county.

If you come across other helpful resources not listed here, please let us know. You can contact Karen Fletcher at

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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