Where to get medical care: ER, urgent care, health centers

Step 1 — Learn the three main places for care

The emergency room (ER) is for an emergency medical condition: an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm (HealthCare.gov). You don’t need an appointment, but if it’s not an emergency, you may wait for several hours. The ER provider may not know your health history and may treat only the emergency (CMS — Roadmap).

An urgent care center is for an illness, injury or condition serious enough that you’d want care right away, but not so severe that it needs the ER (HealthCare.gov). Urgent care centers may offer flexible hours and walk-in visits. With insurance, they usually cost more than your regular provider, so call your health plan first (CMS — Roadmap).

Primary care is your regular care: prevention, check-ups and treatment for common illnesses. A primary care provider (PCP) can be a doctor, a nurse practitioner or a physician assistant who often stays with you long term and coordinates your care with specialists (HealthCare.gov — Primary care, Primary care provider). You usually need an appointment, and you may need a referral from your PCP to see a specialist (CMS — Roadmap).

Step 2 — Find a regular place for care before you need it

Depending on your coverage and where you live, you may find a PCP in a doctor’s office, a clinic, a health center or a free clinic. With insurance, ask your plan which providers are “in network”; others usually cost you more. Before you choose, ask whether they take new patients and your coverage, and whether they speak your language or have a translator. Some offer telehealth, a visit by phone or computer (CMS — Roadmap). How to get coverage is explained in our guide on health insurance for newcomers.

Step 3 — Low income or no insurance? Look for a community health center

If you can’t afford a health plan and don’t qualify for Medicaid or CHIP (public programs that give free or low-cost coverage to some people), you can get low-cost care at a community health center (HealthCare.gov).

According to HRSA, the federal agency that funds and monitors health centers (HRSA — What is a Health Center?):

• health centers are local clinics for medical, dental, mental health, substance use and other needs;
• all of them adjust their fees based on income and family size, and must serve everyone, even people who cannot pay;
• many help with transportation and have on-site pharmacies with discounted prescription drugs.

HRSA-funded health centers are in every state and territory and in D.C. (HRSA). To find one, enter a city, ZIP code or address in Find a Health Center (HRSA).

Step 4 — Know your rights in the emergency room

A 1986 federal law, the Emergency Medical Treatment and Labor Act (EMTALA) (CMS — EMTALA), covers hospital emergency departments that receive Medicare funds, which includes most U.S. hospitals. It gives you the right to (CMS — Emergency Room Rights):

• a medical screening exam to check for an emergency medical condition;
• if you have one, treatment until your condition is stabilized (unlikely to get much worse), or a transfer to a hospital that can stabilize you, after the risks and benefits are explained.

You can’t be denied this exam or treatment because you have no insurance, can’t pay or aren’t a U.S. citizen, or because of your race, color, national origin, sex, religion, disability or age. The hospital may ask about insurance, as long as that doesn’t delay your exam or treatment (CMS).

These rights are about getting care, not about the price; Step 6 covers bills. If a hospital broke these rules, you can file a complaint online or with your State Survey Agency, even anonymously (CMS — EMTALA complaints).

Step 5 — Ask for a free interpreter

The HHS Office for Civil Rights (OCR) says that services such as the emergency room, a doctor’s or dentist’s office and the pharmacy likely get HHS funding or are covered by the civil rights laws it enforces. Two federal laws require these programs to provide language help free of charge (HHS OCR). You don’t have to bring your own interpreter, pay for one, or rely on a child or family member. People with disabilities can get free aids and services too (HHS OCR fact sheet).

When you book, ask if the office can provide a translator (CMS — Roadmap). To report unfair treatment because of your race, color, where you come from, sex, age or disability, contact HHS OCR (fact sheet) at 1-800-368-1019 (HHS OCR) or online, within 6 months (CMS).

Step 6 — Understand costs and medical bills

No insurance, or not using it? Under the No Surprises Act, providers usually must give you a good faith estimate (a list of expected charges) when you schedule care at least 3 business days ahead, or when you ask. You won’t get one during emergency care. Each estimate covers one provider or facility, so ask each one, and keep it in writing. If a provider’s bill is at least $400 more than its estimate, you may be able to dispute it within 120 days of the first bill (CMS — Without insurance).

Using insurance? The same law protects you from most surprise out-of-network bills for ER visits, some care at in-network hospitals and air ambulances, but generally not ground ambulances. Signing a “notice and consent” form gives up these protections (CMS — With insurance).

Can’t pay?

• Ask the billing department about financial assistance (“charity care”). Nonprofit hospitals must give it to eligible patients who can’t afford to pay. Hospitals can sometimes lower the price or offer a payment plan. If a debt collector has your bill, tell them you’re applying for help and ask them to pause (CMS — Financial assistance).
• Check the bill. Ask for an itemized list of charges, and look for errors like being charged twice for the same service (CFPB).
• Ask for a patient advocate. Many hospitals have one who can help you understand your bill and apply for assistance (CMS — Patient advocate).

Step 7 — Get ready for your appointment

When you call, ask whether they accept your insurance, how to pay any costs, and whether there are forms to fill out first. Then bring (CMS — Roadmap):

• a photo ID, such as a driver’s license, a government or school ID, or a passport;
• your insurance card, if you have one, and any completed forms;
• the names and doses of your medicines, or the medicines themselves;
• your medical records and health history, including allergies;
• your questions, written down.

Arrive early. If you can’t come, tell the office quickly: many providers charge a fee for missed appointments or late cancellations, which most health plans won’t pay. Worried about the cost of a medicine? Tell your provider; they may know cheaper options (CMS — Roadmap).