My divorce was final last year, and I lost my health and dental insurance. I know that I need a mammogram once each year. I'm over 40, and I have fibrocystic breasts. The problem is that I cannot afford the test or the doctor's fees. Do you have any suggestions?

R.

Several studies in recent years have tried to demonstrate a link between insurance and the quality of health care. The results indicate that people without insurance do not seek out medical care and do not seek access to preventive care. One of the problems is the premise that health care and health insurance are synonymous. They are not. The other problem is the assumption that the cost of routine or preventive care is prohibitive. This may not be the case. These misunderstandings have led us to the point where many people are overinsured and pay far more for insurance than the value they receive from it. People who have coverage for routine and preventive care may be paying more for that particular part of their coverage than they receive in benefits.
Certainly, it is important to insure yourself and your family against the catastrophic cost of major illness and hospitalization. Depending on a family's circumstances, however, it may actually be less expensive to pay for preventive care with your own funds. A doctor may give a discounted rate to a person paying with his or her own money. It is to the doctor's advantage to accept a cash payment than to spend funds to seek reimbursement from an insurance company and wait several weeks for payment. On the other hand, there are affordable insurance plans that include annual exams and some preventive care benefits, such as a periodic mammogram.

Several Internet web sites offer insurance options and quotes. You can contact a local insurance broker for affordable insurance options as well. Uninsured people who seek to purchase coverage sometimes find that pre-existing conditions are excluded from coverage for a limited period of time. This may be the case for fibrocystic breast disease. The mere presence of fibrocystic breast disease will probably not disqualify you from obtaining insurance if you are otherwise healthy.

Some states have options for people who are uninsured, such as guaranteed availability of insurance either in the private market or through a public insurance pool. An insurance broker or your state's insurance department will have information on such options.

It is in your best interest to seek affordable insurance and to find options that will offer you the preventive care that you need. You may discover that the care you need is more affordable than you think. Weigh the cost differential between paying for insurance coverage for routine care and paying for the same routine items out of pocket. Compare the cost of comprehensive coverage with catastrophic (high-deductible) insurance, and take into consideration the projected cost of paying for routine care yourself. Not many people do this, because they assume that insurance coverage is always the best option.