By Anna Wilde Mathews
More Americans are dropping health coverage because they can't afford it. David Contorno is uninsured by choice.
Contorno is one of a small cohort of people who opt to buy healthcare largely on a cash basis. His family of six hasn't had conventional insurance in eight years. He is keeping his bills down using services that he promotes to others through his business as a health-benefits consultant.
Among his secrets: He pays a monthly membership fee for constant access to a primary-care doctor, scores cheap prescriptions by using discounts and manufacturers' coupons, and negotiates with hospitals and doctors' offices for deals.
After back surgery a few years ago, Contorno was billed at around $20,000. "I just called up and said, 'I'm willing to pay today. What can you do for me?'" His payment dropped to around $4,000.
In the opaque and expensive U.S. healthcare system, where costs are rapidly rising, people are increasingly landing in the nascent DIY healthcare shopping economy. Millions are expected to lose Affordable Care Act plans or Medicaid over the next few years. Many others with employer or ACA insurance are switching to cheaper plans with high-deductible coverage that kicks in only after they have spent thousands out of pocket.
If you are one of these people, there are still ways to save money on healthcare.
Primary care
Contorno, 49, and some other cash-paying patients use direct primary-care practices. You typically pay membership fees to get unlimited visits and off-hours support, often by text.
Another healthcare benefits consultant who doesn't maintain conventional insurance, Cristy Gupton, 52, sliced the skin on the tip of her pinkie finger while cooking at her parents' house in 2024. She sent a video of the bloody cut to her primary-care doctor, and he told her how to dress it and avoid infection. She managed to avoid a costly trip to the emergency room.
Gupton pays $70 a month for her primary-care membership and an additional $25 a month for each of her two sons. Contorno's family of six spends $180 a month. Gupton and Contorno said the cost makes sense financially because they save on off-hours trips to urgent-care clinics, get better preventive care and don't need as many referrals to specialists.
You can find local direct primary-care options here or here.
There are also free and discounted clinics around the country that might charge nothing or offer fees on a sliding scale based on income. Check here or here to find one. And you can compare among a growing array of virtual options for one-off visits at a cash price.
Try shopping
Experienced cash-pay patients said it isn't easy to pinpoint prices. Often, a good first start is a google search or query to an artificial-intelligence chatbot about who in your area lists cash prices. You can also call and ask a healthcare provider for a cash price.
A growing array of websites promise shoppable cash prices on certain procedures, including Green Imaging, MDsave, ColonoscopyAssist, RadiologyAssist and UberDoc.
Don't forget to vet the providers for quality, to the extent possible. Medicare is a place to go for ratings.
Hospitals are required to make some pricing public through their own websites, including 300 "shoppable" services. Turquoise Health has aggregated a lot of the hospital listings. "None of these cash prices are like take it to the bank," said Turquoise Chief Executive Chris Severn. Patients should be careful and not assume the listed prices are assured.
If you are paying cash for a planned procedure, healthcare providers including hospitals are required to offer you a "good faith estimate" of cost beforehand. Even if you have private insurance, you should be able to opt to pay cash and get an estimate. Here is information about how it works.
For prescriptions, cash-pay veterans suggest comparing options such as GoodRx, the billionaire Mark Cuban's Cost Plus Drug Co., and the cash prices at nearby pharmacies. Drug manufacturers' discounts can help both insured and uninsured patients. Contorno said he got the price of one sleep drug down to $25 a month from $600 by combining a discount card and a manufacturer's coupon.
After the fact
If you are going to an emergency room, the hospital has to at least stabilize you regardless of your ability to pay, and you can try to cut a deal after the fact. You might be in a better position if you cross out parts of the hospital's consent form that require you to promise payment before you sign, and then take a picture of it.
Your first step should be to check if you are eligible for financial assistance. Nonprofit hospitals are required to post such plans publicly. Other providers often have them as well.
The nonprofit Dollar For has aggregated policies from around the country and offers counseling and support. The rules vary widely, and hospitals often make you jump through hoops, but some do offer aid even to people who qualify as middle-class.
"It can be way more generous than people think," said Jared Walker, executive director at Dollar For. "It's always worth checking.
You can also try nonprofits that help with medical bills, such as the Patient Advocate Foundation, or a search tool that helps connect you with possible support.
Limited backstops
If you can't obtain conventional insurance, there are some other options that typically cost less -- but they come with warnings. Contorno, for instance, uses a medical-cost-sharing membership service, which costs him $630 a month for his family and picks up big bills such as a recent hospital stay. It has worked well, he said, and he doesn't feel it is riskier than traditional insurance.
Cost-sharing setups don't offer the same guarantees as insurance. They might not cover pre-existing conditions, for instance, and can leave out certain types of care, such as drugs. They also aren't typically overseen by insurance regulators.
Conventional insurance offers more predictability and protection, and health-policy experts caution against going without it. "Alternative options will fall short if you have a serious illness," said Cynthia Cox, senior vice president at the health-research nonprofit KFF.
Other health-coverage products, such as short-term medical plans, can have gaps. Offerings known as indemnity plans might pay only a set amount toward a medical service, leaving you on the hook for the rest of the cost. Buyer beware.
Write to Anna Wilde Mathews at Anna.Mathews@wsj.com
(END) Dow Jones Newswires
April 18, 2026 12:00 ET (16:00 GMT)
Copyright (c) 2026 Dow Jones & Company, Inc.
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