Across the country, both patients and doctors are migrating to direct primary care – an innovative and relatively recent healthcare model in which patients pay a flat fee for unlimited in-person and virtual visits with their primary care physician.
This article explores how direct primary care (DPC) works, the advantages of the model, and why thousands of patients and doctors are switching to primary care.
I’ll also discuss why DPC isn’t designed to stand on its own. It’s not a substitute for a full-fledged health plan that covers catastrophic medical incidents, hospitalizations, chemotherapy and radiation treatments, ER services, and visits with specialists.
Instead, DPC should be combined with a good healthsharing or traditional health insurance policy, so that the full spectrum of possible medical needs is addressed for every covered individual.
How Direct Primary Care Works
Direct primary care – commonly called “DPC,” is a relatively recent innovation in delivering healthcare at the primary care level. Instead of accessing care through an insurance company middleman, direct primary care has patients or employers contract directly with a dedicated primary care practice.
They pay a set, predictable monthly subscription fee like a health club membership. And in return, patients can see their primary care doctor as often as they like. With unlimited virtual and in-person appointments, DPC patients can receive all the medical services people traditionally get from their neighborhood primary care and family medicine doctors:
- Checkups/annual wellness visits
- Preventative medicine
- Well baby visits
- Routine screenings
- Work excuse notes
- Medication monitoring and updating
- Treatment of minor injuries
- Colds and flus
- Referrals to specialists
What Direct Primary Care Does NOT Cover
Direct primary care does not address major medical incidents, such as hospitalizations, surgeries, ER visits, cancer treatments, specialist treatments, or MRIs and other advanced imaging.
While the need for these types of high-ticket services is hopefully very infrequent, care at this level is extremely expensive.
Patients should not rely on DPC alone. The vast majority of people need some other form of protection in place to help them pay for significant and catastrophic medical events.
The simplest and most cost-effective solution: Healthsharing.
Healthsharing Picks Up Where DPC Leaves Off
Just as thousands of patients are flocking to DPC practices, they are also migrating from traditional health insurance plans to alternative healthsharing plans. These are non-profit voluntary associations of like minded individuals who agree to share one another’s medical bills.
They are extremely effective at helping individuals and families pay large and catastrophic, unexpected medical bills. And they do so at up to 50% less than the cost of an unsubsidized Affordable Care Act-qualified health insurance plan.
Compare Pricing on the Best Healthshare Plans Available
Healthsharing Vs. Health Insurance
|Run by non-profit healthsharing ministry organizations||Usually run by for-profit insurance corporations|
|Up to 50% less expensive (absent ACA subsidy)||Up to 100% more expensive (absent ACA subsidy)|
|You can use healthharing benefits with any provider. Choose your own doctor||HMO, PPO and EPOs restrict non-emergency care to narrow care networks|
|Waiting periods on pre-existing conditions||Pre-existing conditions are covered from Day One|
|Members pay a “member responsibility amount or annual household portion before bills are shareable.||Members must pay deductibles before plan pays benefits|
|Generally 100% covered after member responsibility amount.||Most plans require coinsurance payments of 40% (bronze), 30% (silver) , 20% (gold) or 10% (platinum).|
|Does not include primary/preventative care. If you join a DPC plan, you only pay for primary care once.||Plans must by law include primary/preventative care. So DPC patients must effectively pay twice for the same primary care coverage.|
|No open enrollment periods. Sign up any time||You must sign up during the ACA open enrollment period, unless you qualify for a special enrollment period.|
|Plans have flexibility to exclude services members don’t need or want.||ACA requires health insurance plans to include ten minimum essential coverages (MEC)|
|Does not qualify for Affordable Care Act subsidy (but is often cheaper, even without the subsidy!)||Qualifies for Affordable Care Act subsidy|
Eliminating Redundancy – Don’t Pay Twice for Direct Primary Care
One common problem DPC patients have with health insurance and some other healthcare plan is having to pay twice for the same level of care.
For a health insurance plan to qualify as ACA-compliant, they must include, at a minimum, the ten minimum essential coverages mandated by the Affordable Care Act.
Among these minimum essential coverages are primary care medicine and preventative medicine – both of which are included in your DPC plan.
But the health insurance plan must by law include these benefits, even if you don’t use them. This forces insurance premiums upward, even though the DPC member receives no benefit, since they would use their DPC practice to receive primary care services at no cost.
In effect, using a traditional ACA-qualified health insurance plan means paying twice for the same primary care benefits, once in the form of a DPC subscription, and once in the form of health insurance premiums.
Advantages for Patients
Patients report high satisfaction ratings with direct primary care for several reasons. DPC physicians are able to take on significantly smaller patient loads. This translates into several important benefits for patients:
- They get more quality time with their doctors
- They get shorter waiting lists and longer appointments. So they can get more in-depth, personalized care.
- No surprise medical bills. Once the low, affordable and predictable subscription fee is paid, that’s it. You’ll pay no more co-insurance, co-payments, or deductibles to your PCP. Your monthly subscription covers everything.
- Cost savings: An analysis of 116 DPC practices found that the average monthly membership fee for DPC patients is $77.38. Meanwhile new uninsured patients (and those who have yet to meet their deductibles) pay an average of $160 to traditional fee-for-services practices for a single appointment.
- Perhaps most importantly, DPC effectively removes the cost barrier that causes many patients to put off needed healthcare services until they become much more urgent (and expensive!).
DPC DIRECT – The Healthsharing Plan Designed for Direct Primary Care
You can combine any healthsharing plan on the market with a direct primary care membership to good effect. Each healthsharing plan is different, with a slightly different set of benefits, perks, and different pricing.
However, there is one healthsharing plan that was specifically designed to work with DPC plans: DPC DIRECT.
With DPC DIRECT, all applicants are required to hold a DPC membership, or to join a DPC plan when they apply.
DPC DIRECT is different from most other healthsharing plans, in that it specifically excludes the services you would normally get from your primary care physician.
Again, this is to keep costs low, and effectively prevent you from having to pay twice for the same primary care benefits. DPC DIRECT moves all your primary care services to your DPC practitioner.
Instead, DPC DIRECT’s benefits are tailored to emphasize things like catastrophic care, ER visits, surgery, cancer treatments, cardiac intervention, and other high-cost, low frequency medical needs.
This keeps DPC DIRECT’s monthly costs as low as possible.
The combined costs of DPC DIRECT and a direct primary care membership every month are still routinely much lower than the unsubsidized monthly cost of a full-fledged traditional health insurance policy.
With the average all-in cost of a traditional health insurance policy for a young family of four topping $1,200 per month, the typical family can save thousands of dollars each year.
Where to Learn More
Read our Comprehensive guide, The Complete Guide to Direct Primary Care.
Compare Pricing on the Best Insurance Plans Available
Frequently Asked Questions About Direct Primary Care
Can I pair a Direct Primary Care membership with health insurance instead of a healthsharing plan?
Yes, you can. In fact, you may want to consider this approach if you have a significant pre-existing condition that you need coverage for right away. Healthsharing plans are highly cost-effective. But most of them impose a waiting period before expenses for treating pre-existing conditions become shareable.
In contrast, a traditional health insurance plan cannot exclude pre-existing conditions. So your pre-existing condition would be covered right away, under an ACA-qualified health insurance policy that you can purchase via your state’s health insurance exchange.
You might also consider pairing DPC with a traditional health insurance policy if you qualify for a very significant premium tax credit under the Affordable Care Act.
If neither of these circumstances apply, you should look very carefully at DPC Direct, or at another healthsharing plan, which will provide many of the same advantages.
Can I offer Direct Primary Care plus a healthsharing plan like DPC DIRECT as an employee benefit?
Yes, you can. Furthermore, if you have fewer than 50 full-time equivalents on the payroll, you can skip group health entirely without even having to pay a penalty under the Affordable Care Act.
Your expenses are tax deductible as an employee compensation expense. Benefits may be taxable to employees.
Is this the same thing as “concierge medicine?”
No, though they have some common elements.
Like direct primary care, concierge medicine is a subscription-based practice in which patients get easier and faster access to their doctor.
The main difference is that with concierge medicine, your doctor still retains his or her relationship with the insurance company. They will still bill your insurance company for your visit – and charge you copays and coinsurance on top of that.
In contrast, DPC physicians do not require payment from an insurance company. Memberships are paid for entirely with your monthly subscription fee. You won’t pay additional copays.
Here are some additional articles on direct primary care and health sharing programs: Direct Primary Care for Employers: Pros and Cons Discussed | Why Are Insurance Agents Enrolling More People in Medical Cost Sharing Plans? | How Much Money Can Healthsharing Save?
Here are some additional pages related to this article: DPC Direct Healthshare – Designed To Work With Your Direct Primary Care (DPC) Membership | Complete Guide to Direct Primary Care (DPC) – HSA for America
Whitney Kline is a Personal Benefits Manager (PBM) for HSA for America. As a PBM, she helps individuals and small businesses find money-saving alternatives to traditional health insurance – including HSA plans, health sharing programs, DPC memberships, and other innovative solutions.