Getting health care can be a daunting task, and even more so if you don’t have insurance, citizenship, or money.
But most Angelenos can get some kind of health insurance, including low, or no-cost, plans, since the expansion of Medicaid under the Affordable Care Act (ACA, nicknamed “Obamacare”). In addition, California offers Medi-Cal enrollment to undocumented people younger than 26, and 50 and older — and will begin offering it to undocumented people of all ages in 2024.
Even people who don’t qualify for public insurance still have options, and this article offers some guidance for finding insurance and a doctor, regardless of immigration status.
First, if you’re having any life-threatening symptoms, such as signs of a heart attack or significant bleeding after an accident, don’t hesitate to seek care. By law, hospitals must provide emergency stabilizing care to anyone who enters their doors — but those bills quickly add up, and having insurance is essential.
Having medical insurance helps protect your health and financial wellbeing. One of the first places to look for policies, including some with subsidies, is on the Health Insurance Marketplace.
Health insurance Marketplace
The ACA established the marketplace, a government-operated shopping and enrollment online service to purchase most insurance plans. Covered California is the state-run marketplace and can be accessed at www.coveredca.com. Covered California and Medi-Cal use the same application. Once you apply, you’ll find out what program you qualify for, and some families can qualify for both. Financial assistance is available for some policies in Covered California, and Medi-Cal has free or low-cost coverage. Open enrollment occurs every year in late fall through January, though people can enroll at other times due to life changes, such as losing their job.
Undocumented people are barred from buying a plan on a marketplace by the ACA. However, some undocumented individuals, including people younger than 26, 50 and older, DACA recipients, pregnant or recently pregnant, may qualify for Medi-Cal “look-alike” coverage – so-called because those plans use state (not federal) funds. Everyone can explore plans on the Covered California website, but if you’re undocumented, you need to call 1-800-1506, or apply with a certified enroller or at a L.A. County Medi-Cal site.
The information provided in an insurance application on a marketplace is only supposed to be used for that application and is not supposed to be used for immigration enforcement. The information is supposed to be protected by privacy rules. Thus, applying for insurance should be considered safe, according to the National Immigration Law Center, an advocacy organization for the rights of low-income immigrants and their families in the U.S.
Public or private insurance
Private and public are the two broad categories for health insurance. Public plans include Medicare (for people 65 and older) and Medicaid, called Medi-Cal in California, for low-income individuals and families. The federal government also offers a few specialized plans, such as TriCare for military personnel and their families.
Another program offered by the government is the Children’s Health Insurance Program, (CHIP), for children 18 and younger, in families who earn too much to qualify for Medicaid, but have limited finances. In California, pregnant women and primary caretakers of children may also qualify.
Private plans are typically provided through an employer or purchased from an insurance company. Immigration status is generally not a factor for enrolling in private insurance.
Health insurance available to immigrants with or without documentation
In California, anyone who’s under 26 or over 50 and considered “low-income” can receive Medi-Cal, even if you’re undocumented. In 2024, access to affordable insurance will be opened to low-income immigrants, age 26 to 49.
My Health LA is a Los Angeles County funded health program that is available to low-income people who live in the county and aren’t eligible for Medi-Cal, regardless of documentation status. Participants must have a county address and meet certain criteria, including age (26 to 49). Participants can receive primary care at community partner clinics or county clinics, but specialty, emergency care and hospitalizations are provided at Los Angeles County Department of Health Services (DHS) facilities.
Where to find care
Most Angelenos, including immigrants, regardless of insurance or citizenship, can receive care at a variety of health care facilities, including federally qualified health centers (FQHCs), free clinics, urgent care clinics and county-funded public hospitals, as well as emergency rooms.
Federally Qualified Health Centers (FQHC)
Federally qualified health centers (FQHC) and so-called “look-alike” clinics provide low to no-cost health care to low-income or uninsured individuals. Look-alike clinics are similar to FQHCs but have some different funding sources, which may limit the services that they can offer.
Los Angeles County is home to more than 250 FQHCs, and some facilities offer programs specifically for undocumented people. Services at local FQHCs vary, but most provide preventive care including vaccinations and checkups, urgent care and prescription medications, among others. FQHCs in a specific area can be found on the locator at findahealthcenter.hrsa.gov.
“St. John’s has always provided care to the undocumented, regardless of their ability to pay,” said Jim Mangia, president and CEO of St. John’s Community Health in a phone interview.
The organization is one of the county’s largest FQHC with 21 clinics, predominantly located in the eastern and southern areas of L.A.. Annually, they provide services for nearly 120,000 people, of whom about 30% are undocumented.
“All of our services are available to patients, regardless of immigration status,” said Mangia.
In addition to medical care, St. John’s services include benefit counselors to help with insurance enrollment and assistance programs for food, housing, legal and other support services
Another well-established FQHC is the Venice Family Clinic (VFC), which has clinics mainly on the county’s west and south side and a unique unit called “Street Medicine” which takes the medical team to unhoused people on the street, primarily on the westside of the county.
“We are a FQHC. We absolutely take care of people regardless of income, insurance or immigration status,” said Michelle Stuffmann, VFC communications director.
Stuffmann said about 90% of their patients live at or below 200% of the federal poverty level and most qualify for medical coverage.
Los Angeles County Department of Health Services
The Los Angeles County DHS operates three acute care hospitals, including Harbor-UCLA Medical Center in Torrance, Olive View Medical Center in Sylmar and LAC-USC Medical Center in Los Angeles, and one rehabilitation facility, Rancho Los Amigos in Downey. DHS also operates several health clinics dispersed across the county that provide no-cost and affordable services for county residents of all ages, regardless of immigration status. You should be prepared to provide proof of a county address at these facilities. Most of these facilities also have staff who can assist eligible patients with enrolling in insurance.
Urgent care centers
The name “urgent care” is a misnomer, in that generally their services are not urgent. These facilities provide outpatient care for non-life-threatening illnesses and injuries, but when timely care is needed. The centers offer after hours services for the medical needs of people with or without a doctor or insurance.
The average cost of a visit is $100 to $150, but may be more if you need lab tests or X-rays. Some accept insurance or require payment upfront. They don’t generally inquire about immigration status. Many urgent care centers around Los Angeles accept Medi-Cal or Medicare.
Choosing a doctor or other health care provider
There are several approaches to finding a doctor or other health care provider. A practical one is to ask family, friends or neighbors for recommendations.
For people with insurance, a logical first step is to check the rosters of providers given by the insurance company, which are usually posted online. For example, a doctor who accepts Medi-Cal can be found at the Medi-Cal, Find A Provider website.
Another option is to do an internet search but narrow the search by specialty (such as pediatrics for kids), geography, or even traits of the doctor, such as sex, gender or languages spoken.
A very useful site is provided by the Medical Board of California, because it shows the practitioner’s license status and if complaints have been filed.
The internet is loaded with review sites about doctors, which may be useful. OpenMD, a health care search engine, provides a list of review sites.
Most Angelenos, regardless of income, insurance or citizenship, have options for choosing health insurance and their doctor. Navigating the healthcare system is not an easy task, but well worth the trouble, as having regular medical care makes a difference for the health of individuals and the community, a lesson driven home during COVID-19.
Questions to ask when choosing a doctor
Medical providers include physicians, physician assistants and nurse practitioners. Physicians have advanced degrees of Doctor of Medicine (MD) or Doctor of Osteopathic medicine (DO), and their training takes at least 11 years. Physician assistants (PA) have advanced degrees but less training, though their scope of practice is similar to doctors. Nurse practitioners (NP) have advanced nursing degrees plus extra training that allows them to deliver higher levels of care. In California, PAs and NPs have to practice with oversight by a doctor.
So, it’s really important that you trust, and ideally like, your provider. Here are a few important questions to ask the clinic staff, reception or the doctor to see if they’re a good fit, including:
- Are they taking new patients?
- Do they accept your insurance?
- Does the doctor and the staff speak other languages?
- What are their office hours?
- Do they have after-hour appointments for routine or sick visits?
- How long does it usually take to get an appointment with the doctor?
- What hospital does the doctor or clinic use? Is it on your insurance too?
- How many doctors and other providers are in the practice?
- Do they perform lab tests, X-rays or other tests in the office? If not, to what facility do they make referrals and is it in your insurance network?
- Will they take care of you if you’re admitted to the hospital or an extended care facility?
In addition, patients need to be their own advocate to ask for what they need. You may also want to consult this list of your rights as a patient, posted by the California Department of Managed Health Care.
Types of insurance
There are pros and cons to each type of plan, and health experts suggest considering several factors in choosing coverage, including age and health status, pre-existing conditions, number of people to be insured on the plan, location of services and the affordability of the plan.
The types of insurance plans include:
- HMO – Health Maintenance Organization. These plans require that people use the organization’s doctors, health care providers and other services. They provide comprehensive care, including physical, mental and behavioral health, and focus on prevention by encouraging clients to have routine checkups and screening tests such as mammograms.
- PPO – Preferred Provider Organization. The insured person pays less when seeing the doctors and other health care providers who are part of the insurance group, called a network. For an additional cost, insured clients can see health care providers outside of the network and a referral from the doctor typically isn’t needed.
- POS – Point of Service. Similar to PPO, in that the insured client pays less when seeing providers in the network, but if they see a provider out of their network, a referral is usually required.
EPO – Exclusive Provider Organization. The insured can only see doctors and other health care providers and go to hospitals in the managed care network (except in an emergency).