Low-cost doctor visits without insurance: community health centres

Community health centres are nonprofit or public clinics funded in part by the Health Resources and Services Administration (HRSA). In return for federal funding, they must serve everyone in their area regardless of ability to pay, offer a sliding fee discount programme for people with low income, and provide comprehensive primary care. There are well over a thousand health centre organisations operating many thousands of sites across the country, including in rural areas and inside schools, public housing and homeless services.

The sliding fee scale is the key. If your income is under a set threshold relative to the federal poverty level, you pay a reduced fee - often a small flat charge per visit - for services. At the lowest incomes the charge is nominal. You must apply for the discount, usually by showing proof of income and household size, but the application is simple and many centres do it at your first visit.

Services go well beyond check-ups. Most centres offer care for chronic conditions such as diabetes and high blood pressure, prenatal care, children's care and immunisations, and preventive screenings. Many have dental clinics, behavioural health and substance use treatment, on-site or partner pharmacies with discounted medicines through the federal 340B programme, and enabling services such as interpreters, transport and help enrolling in Medicaid or Marketplace coverage.

Health centres accept Medicaid, Medicare, CHIP and private insurance too. If you have insurance with a high deductible, ask whether the sliding scale can apply to what you owe - policies vary, but some centres extend discounts to insured patients with low income.

Because they also help with enrolment, a health centre is often the fastest way both to get care and to get coverage. Their staff can screen you for Medicaid and Marketplace subsidies on the same day as your appointment.

Sliding fee discounts require proof of income and household size. If you have no income or cannot document it, explain your situation - centres have procedures for this.

1. Find a centre near you

   Use findahealthcenter.hrsa.gov or call 211. Note which locations offer the services you need, such as dental or behavioural health.

2. Call to book and ask about the sliding fee

   Ask what documents you need for the discount and what the fee will be at your income.

3. Bring proof of income and ID

   Pay stubs, a benefit letter, or a letter explaining no income. Bring any insurance card.

4. Complete the sliding fee application

   Usually a short form at registration. It may be valid for a year.

5. Ask about enrolment help

   Staff can check you for Medicaid, CHIP or Marketplace coverage.

6. Use the pharmacy

   Ask whether the centre's pharmacy offers discounted medicines.

7. Make the centre your medical home

   Regular care with the same team prevents emergencies.

FQHC

Federally qualified health centre - a community health centre receiving federal funding and serving everyone regardless of ability to pay.

Sliding fee discount

Reduced charges based on household income and size.

Medical home

A regular primary care practice that coordinates all your care.

Integrated behavioural health

Counselling and mental health care provided alongside primary care in the same practice.

Enabling services

Support such as interpreters, transport and enrolment help offered by health centres.

Look-alike

A health centre meeting FQHC requirements without receiving the same federal grant.

• HRSA - find a health centrefindahealthcenter.hrsa.gov