Uninsured? You're Not Alone.

If you're rejected by insurance companies:

The Maryland Health Insurance Program is an insurer of last resort for the state's adults who have been rejected for an individual policy, who are too young or not disabled enough to qualify for Medicare, and who are too wealthy to qualify for Medicaid. Thirty-three other states have similar programs. (Virginia and the District do not.)

Launched four years ago, MHIP has 11,812 enrollees -- ranging from millionaires to people with incomes below the poverty line, said Richard Popper, the program's executive director. They see physicians and go to hospitals that are part of the CareFirst network.

It is not a panacea, Popper said, acknowledging that premiums, which range from $135 to $500 per month depending on age, income and health, are too high for many. Also, a condition diagnosed in the six months before joining MHIP generally won't be covered for the first two months, though enrollees can pay higher premiums for those two months to get the condition covered.

The District's City Council has been talking to MHIP officials about setting up a similar program for Washington, Popper said.

In Virginia, the not-for-profit CareFirst and Anthem Blue Cross/Blue Shield are required by law to offer a policy to an individual who applies for one, but the insurers can exclude coverage for a preexisting condition for up to a year, and there's no limit on the premium cost.

The Medicaid safety net:

Medicaid is for U.S. citizens and legal immigrants living at or below poverty level.

Eligibility rules vary widely, however. In Maryland, for example, working adults without children can get Medicaid coverage for themselves only if they make less than 38 percent of the federal poverty level -- that is, 38 percent of $10,210, or $3,880 a year.

SCHIP for Children:

In all three local jurisdictions, children who lack coverage may be eligible for the State Children's Health Insurance Program. President Bush recently vetoed a bill to extend the program from the 6 million children nationwide who receive benefits to as many as 4 million more. Maryland's SCHIP currently covers children in families earning up to 300 percent of the federal poverty level, or about $60,000 for a family of four.

Other options:

In Washington, people who don't qualify for Medicaid but still have a low income -- 200 percent of the federal poverty level, or $27,380 for a family of two -- can receive free medical care and prescriptions through the DC HealthCare Alliance. The medical care has to be given by participating physicians and hospitals. And the alliance does not cover mental health or alcohol or substance abuse services.

A free primary care program, Maryland Primary Adult Care Program, serves Maryland adults who meet eligibility criteria; Virginia does not offer any such plans.

A federal program offers free breast and cervical cancer screenings; states set their own eligibility rules, usually based on income.

The Maryland Pharmacy Assistance Program subsidizes the cost of prescription drugs; there is no similar plan in Virginia. Wal-Mart has a program through which most generic drugs can be purchased for $4.

Paying out-of-pocket:

If you must pay for health care out-of-pocket, you should ask about fees before a medical visit or inquire as to whether installment payments or other financing is available.

Lancelot now carries a note in her wallet. Printed on it are words President Bush spoke in July. Americans have access to health care, he said. "After all, you just go to an emergency room."

While emergency departments must treat anyone who walks in, regardless of insurance status or citizenship, the physicians' duty is to stabilize the person, not offer ongoing medical care. And hospitals do expect payment.

Having experienced what it is like for an uninsured person to try to get care for chronic conditions, Lancelot has come to live by a different, unwritten rule: "That any agency or organization you call is guaranteed to do one thing for you -- and that is to give you three more phone numbers to call," she said.

Check out these resources for more information on insurance options.

Alicia Ault is a frequent contributor to the Health section. Comments:health@washpost.com.