Medical Care You Can Afford

Health center patients pay on a sliding income scale. At the HealthWorks for Northern Virginia facility in Leesburg, for example, people with incomes up to 200 percent of the federal poverty level ($47,100 for a family of four in 2013; roughly half of that for an individual) average $20 to $30 for a doctor visit. Medicare beneficiaries have no copay for annual wellness visits and many preventive services. Older patients can also get low-cost prescriptions.

2. See a nurse-practitioner

At Life Long Care of New London, N.H., Sean Lyon, RN, gives physicals, stitches wounds, prescribes drugs and manages chronic illnesses. Along with the country's other 155,000 nurse-practitioners (NPs), Lyon does nearly everything a primary care doctor does.

Registered nurses with "advanced practice" degrees play a growing role in primary care. Some states don't allow NPs to prescribe drugs, so many practice in partnership with a physician.

Research shows that nurse-practitioners decrease cost per patient visit by as much as a third, because NPs — who are paid less than physicians — tend to order fewer tests and cut down on return visits by coordinating care better. Patients give them high marks for spending time with them, according to a 2011 report in Medscape.

The four-NP staff of nurse-managed FamilyCare of Kent, Wash., sees only 16 to 20 patients a day. "Our patient visits last from 15 to 45 minutes," says Bob Smithing, NP, FamilyCare's clinical director. "People are choosing nurse-practitioners because they care about having a consistent provider who gets to know them."

3. Hire a negotiator

Medical-billing advocates liken a fat medical bill to a car's sticker price. "It's just the starting point for negotiation," says Nick Newsad, senior associate at HealthCare Appraisers Inc. and author of The Medical Bill Survival Guide.

Medical-care advocates help consumers deal with insurers, shop around for care, haggle with providers and fight hospital billing errors. Most work on an hourly or contingency basis, charging a 15 to 50 percent commission on the saved amount. Hiring an advocate can be pricey (to find one, search online for a health care advocate or health care appraiser in your area), but it might stave off disaster if uninsured costs balloon out of control.

4. Visit a health fair

Each April, Rory Turner, 59, attends the Cleveland Clinic's Minority Men's Health Fair to get information on administering and monitoring his insulin. In churches, malls and corporate offices around the country, such health-fair events bring volunteer medical professionals to people who could not afford them otherwise. Most are sponsored by hospitals, university medical centers and corporations. (Search "health fairs" to find one near you.)

Physicians stress that health fairs are not meant to replace regular doctor visits. But the free screenings — for blood pressure, cholesterol, glaucoma, bone density and body-fat measurement — can help underserved patients connect with the health care system. In doing so, they also "educate and prevent and identify disease early," says Carrie Maffeo, director of the Health Education Center at Butler University's College of Pharmacy and Health Sciences in Indianapolis. The center has hosted more than 600 free screenings for chronic conditions such as diabetes and high blood pressure.

No, a yearly free screening or a flu shot isn't an alternative to full medical coverage. But for the millions who lack health insurance, even a little help can make a lifesaving difference.