Even with a DPC membership in place, you should still have an additional medical plan to help you pay for all those things that your DPC doesn’t provide.
For example, your DPC membership typically won’t include these critical healthcare services:
- specialist care
- surgeries
- ER services
- hospitalization costs
- prescription drugs (except for a few generics your DPC doctor may stock in his or her inventory)
- lab costs and imaging (in most cases)
- durable medical equipment
Without additional protection, you could easily face a healthcare bill of hundreds of thousands of dollars—and potentially be unable to access the care you need.
That said, your additional protection doesn’t necessarily need to be a traditional health insurance plan. For many people, a health sharing plan can be a more affordable and cost-effective companion to your DPC membership.
Health sharing plans can still help you handle major medical expenses and even catastrophic healthcare costs, but at a fraction of the monthly cost of an unsubsidized traditional health insurance premium.
Direct primary care is a terrific option whether you pair it with a traditional health insurance policy or with a health sharing plan. The important takeaway is that you have one or the other in place to handle major and catastrophic medical expenses, along with your DPC membership.
This article will explore what DPC does well, what it doesn’t cover, and how you can best protect yourself against potentially devastating healthcare costs, while still getting superior primary care from your personal physician.
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Why the Shift Towards Direct Primary Care?
Under the direct primary care model, doctors don’t bother with accepting traditional medical insurance at all.
Instead, their patients contract directly with them, paying an affordable monthly membership fee, usually between $70 and $150 per month. By dropping insurance, DPC doctors also eliminate massive administration, overhead, and billing costs. They can therefore lower their patient headcounts substantially.
The lower caseload, in turn, allows doctors to spend much more time with each patient, so they have a deeper understanding of their health needs and concerns.This contrasts sharply with the traditional healthcare model, which often leaves doctors overwhelmed by paperwork and back-to-back appointments, compromising the quality of care.
The ability for DPC doctors to engage in meaningful consultations without the rush translates into better disease prevention, diagnosis, and management.
The DPC model removes Big Pharma, Big Insurance, and Big Government from your relationship with your primary care doctor. This cultivates a level of trust and confidence between doctors and patients rarely seen in conventional settings.
Patients and physicians value this more patient-centered care model highly, leading to a more personalized and effective experience.
The Value of Health Insurance with DPC
Even as a member of a Direct Primary Care (DPC) practice, securing additional protection via a health insurance plan or joining a health sharing plan is crucial. Here’s why:
Protection Against High-Cost Events
- Emergency Room Visits: No matter how comprehensive your DPC membership is, it doesn’t cover emergencies that require an ER visit. An unexpected trip to the emergency room can be financially staggering without insurance.
- Hospital Stays and Surgery: DPC focuses on primary care and preventive measures but doesn’t cover inpatient hospital stays or surgeries. These can incur substantial costs, running into tens or hundreds of thousands of dollars for serious conditions or procedures.
- Specialist Consultations: While DPC provides excellent primary care, you may need specialist care for specific conditions. Health insurance or healthshare plans can help cover the costs of seeing specialists, from cardiologists to oncologists, without breaking the bank.
Health Insurance vs. Healthshare Plans
Choosing between health insurance and a healthshare plan depends on your personal and financial preferences.
Health sharing plans offer more flexibility and much lower monthly costs compared to unsubsidized traditional health insurance products. They also allow much more freedom for you to choose your own doctor compared to traditional insurance HMO and PPO plans.
Health sharing plans are an excellent, money-saving alternative for many. Especially if you don’t get a subsidy under the ACA for a Marketplace plan.
But they typically limit sharing benefits for pre-existing conditions for the first several years of enrollment. So they may not be the best solution for some, depending on their medical history.
Why Health Sharing Complements Direct Primary Care
- Aligned Philosophies. Both DPC and health sharing plans prioritize direct relationships and transparency. DPC practices offer a transparent pricing model for primary care services, while health sharing plans provide a clear outline of how medical expenses are shared within the community. This transparency ensures that members are not blindsided by hidden costs or complex billing structures.
- Lower Costs. For individuals with high deductible health insurance plans, monthly premiums can be exorbitant, with additional out-of-pocket expenses before coverage even begins. Health sharing plans have much lower monthly costs compared to unsubsidized traditional health insurance premiums. They routinely save hundreds of dollars every month compared to Marketplace plans without subsidy, which is more than enough to offset the cost of a direct primary care membership.
- Preventive Care Focus. DPC practices emphasize preventive care. They want to keep patients healthy and avoid costly medical interventions. Health sharing plans also emphasize prevention, but they are also there to help you pay for unexpected large and even catastrophic expenses when prevention fails.
- Community Support. Health sharing plans are made up of like-minded people who share key values. Membership in these communities often foster a sense of belonging and mutual support among members, echoing the personalized care and attention provided by DPC practices.
How To Combine Health Sharing with an HSA
If you’re a business owner, independent contractor, or self-employed, it’s now possible to combine the cost savings and flexibility of health sharing with the tax advantages of a health savings account.
If you are a business owner or contractor, you can use HSA MEC to make yourself eligible to make tax-free contributions to an HSA!
You can also look into HSA Secure, which is also designed to preserve your eligibility to make pretax contributions to HSAs.
With both HSA Secure and HSA MEC, you must be a business owner or have verifiable independent contractor or self-employed income to participate.
DPCs and High-Deductible Health Insurance Plans (HDHPs)
High-deductible health insurance plans (HDHPs) offer lower monthly premiums in exchange for a higher deductible—the amount you pay out-of-pocket before your insurance coverage fully kicks in.
This cost structure makes HDHPs an excellent complement to your Direct Primary Care membership. If you don’t want to enroll in a health sharing plan for whatever reason, an HDHP, combined with tax-free HSA contributions, may also be a good solution.
However, under current law, joining a DPC makes you ineligible to make new contributions to a health savings account.
Learn More: Escape From Healthcare Narrow Networks: How You Can Finally Choose Your Own Doctor!
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Conclusion
The DPC model offers a more personalized, efficient, and cost-effective approach to delivering routine, basic healthcare services.
It empowers patients to take control of their health without the fear of unexpected costs, all while fostering a strong patient-doctor relationship.
Remember, it’s important to complement DPC with health insurance or health sharing so you are protected against the financial impact of major health emergencies.
Making an appointment for a consultation is easy and free! Just click here, and pick an appointment time.
For Further Reading: What is a High Deductible Health Plan? [HDHP FAQ] | How Health Sharing Can Expand Healthcare Freedom | How to Get the Most Out of Your Health Savings Account
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Wiley is President of HSA for America. He believes that consumers should have choice and price transparency, so they can make the best healthcare decisions for their needs. Read more about Wiley on his Bio page.
