Not sure how direct primary care works? Need more information about the role that a healthshare plan like DPC Direct will play in handling your healthcare needs outside your DPC? In this post, I’ll share important information that will help you make informed decisions that protect your health and your finances. Don’t get caught unaware!
What Is Direct Primary Care?
Direct primary care is something of a throwback to the way that healthcare used to work before insurers came to dominate the industry. Once upon a time, patients and doctors had a personal relationship.
Often, the entire family saw the same doctor for decades. The medical professional was familiar with their health concerns, their lifestyles and goals, their pain points, and more. It was like being treated by an old family friend.
Direct primary care helps recreate something of that old system. It’s about allowing physicians to focus on caring for their patients, and ensuring that patients can build strong, lasting relationships with their doctors.
In this situation, you (the patient) make a financial agreement with a healthcare provider (your doctor). This is a direct arrangement, with no middleman (the insurer). That means there are no health insurance claims to file and no labyrinthine rules to wade through before getting the care you need. You also don’t have to pay a monthly premium or a copay.
Instead, you’ll pay a monthly fee to your healthcare provider. In exchange, you get full access to that professional’s services throughout the month. There are usually no caps, either. If you need multiple follow-up visits, it’s fine. Each physician (or group of physicians in some cases) sets their own monthly fee and determines what’s offered, but most patients save time, money, and (best of all) their sanity.
You’re probably wondering what the catch is. There is one, and it’s something that you’ll need to understand – you will still need health insurance to access care that’s not provided by your doctor. If you need surgery, to see a specialist, or to deal with a catastrophic health situation, you will need some type of protection. You can purchase a high-deductible health plan, or you can go with a healthshare plan like DPC Direct.
Where Can I Find A DPC Practitioner?
Use the map below to find a DPC practice in your area. Note that some may not be accepting new patients at this time.
The drop pins that are Blue are DPC offices with whom we have a personal relationship, and that are currently accepting new patients. (Attention doctors and patients: if you do not see your DPC clinic on the map, please click here to add your clinic.)
Pros and Cons of the Direct Primary Care Model
Direct primary care offers quite a few advantages. However, it’s not perfect. There are some drawbacks that you’ll need to be aware of before deciding to go this route. In this section, I’ll lay out some of the most important pros and cons to balance so you can make the best decision for your health (and wealth).
Pros of the DPC Model
In this section, I’ll list the benefits that DPCs can offer. I think you’ll agree that they’re pretty substantial.
- Time with Your Physician – One of the most important advantages of a DPC over the conventional health insurance arrangement is that you get more time with your doctor. You might not be aware of it, but physicians spend a great deal of time filling out forms and completing insurance paperwork. With a DPC, all that time can be spent with you, the patient. Direct primary care practices also often see fewer patients per day than practices that accept insurance, which means even more time to focus on your health.
- Build a Relationship with Your Doctor – When was the last time you really felt that your doctor knew you? Chances are good it’s been a very, very long time. It might even be your pediatrician from decades ago. As insurance has become more complicated, doctors can get to know their patients less, meaning that this relationship that should be strong and resilient is almost nonexistent. With a DPC, your doctor has the time to get to know you, your health history and story, your goals, and more, and then deliver personalized care that fits perfectly.
- Upfront Pricing – With health insurance, you rarely know upfront what your insurer will cover and what they won’t. There’s a great deal of ambiguity and that leads to a lot of stress and tension. With a DPC model, you don’t deal with that situation. You’ll always know what you’re being charged. It eliminates confusion and ambiguity because you pay a known monthly fee and then a flat office fee (in some cases).
- Appointments That Work for You – When was the last time you were able to make an appointment with a physician that wasn’t at least three weeks or a month out? Some patients must schedule their appointments even farther out. With a DPC, that’s not the case. In fact, you can usually schedule your appointments the very next day if you like, and some practices offer same-day appointments. Imagine being able to get the care you need in a timely manner instead of having to wait and wait some more.
- Better Communication – How easy is it to communicate with your doctor? Chances are good that it’s not particularly easy. In some cases, you may not even communicate with your doctor at your appointment. With DPC agreements, most practices offer streamlined, direct communications that allow you to get in touch with your doctor in person, by phone, email, or even text message. Video chat may also be available.
Cons of the DPC Model
Okay, with the pros out of the way, we need to turn our attention to the cons. While there aren’t many, they do bear discussing because these will affect your situation.
- You Still Need Insurance or a Healthshare Plan – As I mentioned previously, you can’t get away without having any type of health insurance at all. Your DPC will only give you access to the services your doctor (or group) can offer. Specialist care, emergency services, and the like will all need to come from elsewhere, and you’ll need insurance to secure that. Many patients choose to go with a high deductible health plan (HDHP) in this instance. You may also want to consider a healthshare plan like DPC Direct.
- Payments Don’t Count Toward Your Deductible – With traditional health insurance, payments often count toward your annual deductible. With a DPC agreement, that’s not the case. According to the IRS, direct primary care is a “health plan”, and the payments you make go only to the practice in question. You will still need to meet your insurance deductible.
- Not Available Everywhere – While most patients will have access to some type of direct primary care agreement, DPC plans aren’t available everywhere and you may find that your physician does not offer one.
As you can see, DPCs offer a lot of value and utility. However, you must go into the situation aware that things might not be perfect.
Healthshare Plan or High Deductible Health Plan?
We’ve touched on the fact that your DPC agreement will cover most of your regular medical visits, but you’ll need a solution for seeing specialists, access to urgent care, and the like. That means having either a high deductible health plan or joining a healthshare plan. These are not the same, and you’ll need to make sure that you can choose the right path forward.
What Is a High Deductible Health Plan?
An HDHP is exactly what it sounds like. Sometimes, they’re referred to as catastrophic health plans. These plans are specifically designed for people who hope not to use them but need the protection they offer in case of emergencies or catastrophic health situations that their DPC agreement can’t help with.
Many HDHPs don’t have copays. You’ll pay the full cost of your care/appointment until the deductible is met. That makes these very high cost, although if you use them for emergency/catastrophic situations, you will still reach your deductible fairly quickly (since your care isn’t discounted via copays).
It’s right there in the name – the deductible is higher with these types of plans than with traditional insurance, but the goal is not to use the plan in the first place since you’ll be getting your regular care covered through a direct primary care arrangement with your physician.
The tradeoff between HDHPs and conventional health insurance is that you’re able to save money on your monthly premiums. When you combine an HDHP with a DPC agreement, you’re able to realize the same benefit. The money that would otherwise have gone to your monthly premiums instead goes to your doctor (at least a portion of it, since DPCs are much more affordable than even the cheapest health insurance).
What Is a Healthshare?
Healthsharing plans have become more and more popular as insurance has grown increasingly confusing and costly. Many of these programs are faith-based, as well, which allows families to work with others who share their beliefs. How do they work, though?
A healthsharing plan is precisely what it sounds like – a group of families comes together to pool their resources. Usually, you’ll pay somewhere between $300 and $500 per month. In addition, healthshares come with other benefits, like lower deductibles (note that healthshares call these initial unshared amounts, or IUAs, rather than deductibles) and limited out-of-pocket costs, which can help to make getting the care that you need more affordable.
Yes, healthsharing programs do resemble conventional insurance, but they are very different. For instance, they are not regulated by the government, and there is no contract between you and an insurer.
Healthsharing plans can offer a lot of benefits, but there are a few things to consider before joining. For instance, because many of these plans are faith-based, they may not pay for expenses that don’t follow Biblical beliefs, such as injuries sustained in a drunk driving accident, or the costs of a pregnancy outside of marriage. Other potential considerations to think about include the following:
- Pre-existing Conditions – While insurers are now required by the US government to cover pre-existing conditions, healthsharing plans are not. So, if you have a pre-existing condition, it may not be covered by the agreement, or you may not be eligible to join a healthsharing plan.
- Chronic Conditions – If you take medication to treat a chronic condition, such as blood pressure medication or insulin for diabetes, there is a chance that the healthsharing plan won’t cover your medication for the duration of your life. They may be covered initially, but eventually you will be responsible for paying for them out of your own pocket.
- Health Savings Accounts – If you have an HSA (health savings account) attached to your insurance, you’ll find that you cannot continue to fund with most healthsharing plan (though we do know of one that qualifies).. For those who’ve been treating their HSA like a 401(k) or IRA, this may come as an unwanted surprise.
Compare Pricing on the Best Healthshare Plans Available
Direct Primary Care Directory
I want to make one more important point – some healthshares are designed specifically to work with DPCs. For instance, DPC Direct is specifically designed for those who want the benefits of a direct primary care agreement and don’t want the hassles and costs involved with a high deductible health plan. Not sure if this is the right path for you? Discuss the situation with your Personal Benefits Manager to learn more.
Exploring DPC Direct
What does DPC Direct bring to the table? Why should you consider this option rather than others?
- It’s designed specifically for people who use a DPC agreement. In fact, you cannot sign up for DPC Direct unless you are already enrolled in a direct primary care program.
- You’re able to share emergency and unexpected medical bills across the entire group, saving you a significant amount of money over what you would pay with a high deductible health plan or even traditional health insurance.
- You get unlimited telemedicine services (accessible 24/7) with $0 fees for an additional $5 per month. This is on top of what your primary care physician may offer, so check with your DPC to see if telemedicine is covered. If it is, there’s no need to sign up for it with DPC Direct, but if it’s not, then you get access for just $5 per month.
- You get optional access to the RX Share prescription discount program. Prescription drugs are not covered by DPCs, which means having access to a discount program is very important. DPC Direct’s plan offers access to generic prescriptions for as little as $5.
- DPC Direct is not a faith-based program, which means that it is open to people from all backgrounds, faiths, and belief systems. You do not need any religious affiliation to join, nor does DPC Direct prevent you from receiving care based on religious beliefs the way some other healthshare plans do, such as Covenant or MediShare.
- DPC Direct offers a wide range of initial unshared amounts (IUAs) to choose from, including $1,000, $2,500, and $5,000 to help ensure that you’re able to find an affordable solution that still offers value. Note that you must meet your IUA before you can submit any cost-sharing requests.
- DPC Direct is one of the most affordable healthshare plans in the United States, with memberships starting as low as $170 per month depending on your chosen IUA. Other factors that affect costs include your age and any additional options that you choose to add to your membership.
Use Our Direct Primary Care Directory to Help Make Your Decision
By this point, you should have plenty of information to help inform your decision-making. Conventional health insurance is expensive, confusing, and puts a wall between you and your healthcare provider. Direct primary care agreements help you change that paradigm. You’re able to work directly with your physician, communicate with them as you need, set appointments when it works for you, and save time, money, and hassle.
However, DPCs do have a couple of drawbacks. The most significant is that they’re not going to help in the case of an emergency or major medical situation. In that case, you’ll need a high deductible health plan or access to a healthshare plan. While high deductible health plans can offer the coverage you need, they’re incredibly expensive and can be very restrictive.
On the other hand, a healthshare plan can offer flexibility, lower costs, and access to the medical care that you need. Of course, not all healthshare plans are created equal. Some are very restrictive, while others limit your access to medical care based on religious beliefs. DPC Direct offers affordable solutions and does not base decisions on religious belief or affiliation. You’ll also find that it offers many other advantages and dovetails perfectly with your DPC agreement. In fact, it’s designed to do so from the ground up!
Interested in learning more? Contact your Personal Benefits Manager to discuss your needs and discover what DPC Direct can do to improve your access to affordable medical care.
Here are some additional articles on DPC programs: Best Health Plan to Pair with Your DPC Membership [Direct Primary Care Explained] | Complete Guide to Direct Primary Care (DPC) – HSA for America | Direct Primary Care: How to Use a DPC and Still Protect Yourself from Major Medical Expenses
Here are some additional pages related to this article: DPC Direct Healthshare – Designed To Work With Your Direct Primary Care Membership | All You Need To Know About Healthshare Plans