How to choose between a free clinic, a community health center and a cash-pay doctor

Why you have three choices

If you have no insurance, you might hear about free clinics, community health centers and cash-pay doctors and wonder how they differ. They all help people pay less for care, but they work in different ways. The best one for you depends on your income, where you live and what kind of care you need.

You are not locked in, and many people start with one and move to another as their life changes.

What is a free clinic?

A free clinic is a local clinic that offers care at no cost or very low cost. The National Association of Free and Charitable Clinics (NAFC) describes these clinics as serving people who are uninsured or underinsured. These are people who need free or low-cost health care.

Every free clinic is different. Most serve people with lower incomes, and what they offer changes from place to place. Some give basic checkups and help with long-term conditions, and some also offer extras, such as dental care. Each clinic sets its own hours and rules, so ask who they serve and when they are open.

A free clinic can be a good fit if your income is low, you have no insurance and you need basic care now. Call first to ask who they serve, what they offer and what to bring.

What a community health center is

A community health center is also called a federally qualified health center, or FQHC. It is a clinic that gets federal funding to give primary care to the people in its community. Primary care is the everyday care from a regular doctor.

The Health Resources and Services Administration (HRSA) is the federal agency that supports these centers. It says they adjust their fees based on income and family size, and that they serve everyone, even if they cannot pay. Our guide on community health centers explains how that works. That is called a sliding fee scale. HRSA also reports that about 90 percent of health center patients have incomes less than 200 percent of the federal poverty level.

Many centers offer more than one kind of care, such as checkups and care for long-term illness, and some also offer dental or mental health services. Services differ by center, so ask what is offered. You can find one with HRSA's "Find a Health Center" tool.

What is a cash-pay doctor?

A cash-pay doctor does not bill insurance. You pay the practice directly, and the price is set up front. Some doctors charge per visit. Others offer direct primary care, which is a membership with a flat monthly fee, usually $50 to $200 a month, for everyday care.

These doctors do not spend time on insurance billing, so many can see fewer patients and spend more time with each one. Many also let you reach them by phone, text or video. The tradeoff is that you pay the price yourself, and a membership is not insurance (our guide on whether it counts as insurance explains why). It does not cover hospital stays, surgery or the emergency room. Our direct primary care guide and our guide on direct primary care vs concierge medicine explain more.

A simple way to choose

• If your income is very low and you need basic care now, then start with a free clinic or a community health center.
• If you want one steady clinic that can also see your family and take insurance later, then a community health center is a strong choice.
• If your income is too high for a sliding scale, then look at a cash-pay doctor or a direct primary care practice. The same is true if you want easy access to one doctor.
• If you have a high-deductible plan and want predictable everyday care, then a direct primary care membership may fit.
• If there is no free clinic or health center near you, then a cash-pay doctor may be your closest option. You can search our directory.
• If you are not sure, then call two places and ask the price and who they serve.

No matter which you choose, call 911 or go to the nearest emergency room right away if you think you are having an emergency. Chest pain, trouble breathing, heavy bleeding and signs of a stroke are all emergencies.

What to bring to your first visit

Calling ahead saves you a trip. Ask what the place needs from you, since each one is a little different. These are common items to ask about.

• Bring a photo ID, such as a driver's license.
• Bring proof of where you live, like a bill or a lease.
• Bring proof of income if the place charges by income, such as a pay stub, a tax return or a note from your employer.
• Bring a list of your medicines and the doses, and the name of your pharmacy.
• Bring any old records, test results or papers from other doctors.

If you do not have some of these, say so when you call. Many places will tell you what else they can accept. Writing down your questions before the visit also helps, because it is easy to forget them once you are in the exam room.

What should I ask before I sign up?

Whichever type of place you pick, a few questions help. Ask what the visit costs, what is included, how to get an appointment, and what happens if you need a test or a specialist. Our guide on questions to ask a doctor's office has a longer list, and how to ask for the cash price gives you phone scripts. For the bigger picture, see our guide on what to do with no insurance.