Then, in 2007, Jenkins found Piedmont Health Services, a community health center that charged her a flat $60 for a doctor's appointment. After diagnosing hypertension and high cholesterol, the Piedmont physician put Jenkins on a diet and exercise regimen and prescribed two medications that cost just $8. But Jenkins ignored the health center's follow-up calls, and a bout of dizziness landed her in the emergency room. The bill — $6,500 — was a painful reminder of the financial hazards of inadequate coverage and the need for creative solutions.
Medical costs drive an estimated 60 percent of personal bankruptcies. And little wonder. Many Americans have high-deductible health plans, and about 9.3 million people ages 50 to 64 have no insurance at all. The Affordable Care Act, President Obama's health care legislation, should drive down that figure: The ACA mandates that every state set up health care exchanges where people like Jenkins can buy affordable insurance. Until those exchanges go live in 2014, however, it's up to consumers to solve the riddle of how to pay for good care. Here are four top options.
1. Visit a community health center
At the 9,000 state- and federally supported public community health centers, no one is turned away because of insurance status or inability to pay. The centers now treat more than 22 million Americans, many of them solidly middle class, and that number is expected to jump another 10 million by 2015, as the ACA ramps up.
A survey from the National Association of Community Health Centers found that visits to public health centers by the uninsured increased 21 percent between 2008 and 2009. "Many people didn't know that these centers exist," says Amy Simmons Farber of the NACHC. "Once they go, they are often surprised at the quality of care they get."
Indeed, a 2012 study in the American Journal of Preventive Medicine found that public health centers equaled or exceeded the standard of care offered by private practices.
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."
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