Firstly, you get the benefits of a close, personal relationship with a primary care and family physician at an affordable price.
Additionally, you also get the massive purchasing power of a health sharing plan for specialist care, surgeries, ER visits, hospitalizations, and catastrophic injuries and illnesses.
Essentially, you receive comprehensive medical benefits much less than you would pay for similar benefits via a traditional health insurance policy without an Obamacare subsidy.
In this piece, we’ll discuss what direct primary care is, what health sharing is, the advantages and disadvantages of each, and how they work together to help provide many people with the same or better healthcare at a more affordable price – especially for those who don’t receive an Affordable Care Act subsidy.
What is Direct Primary Care (DPC)?
Direct Primary Care is a healthcare model focused on providing general primary care services for a monthly or quarterly subscription.
Essentially, a DPC doctor or practice charges like a health club: You pay a predictable monthly subscription. In return, you get unlimited visits with your physician, including routine check-ups, basic lab tests, screenings, vaccinations, “sick note” verifications, and consultations.
Basically, anything normally done in a family doctor’s office is done through your DPC physician.
And aside from your monthly subscription, you pay nothing extra. There’s no deductibles, no copays, and no coinsurance.
All you pay is a monthly subscription for yourself and your family.
This can save quite a bit of money compared to going through a traditional insurance plan – especially if you visit your doctor often.
Direct primary care practices typically emphasize telemedicine, which helps control costs, and make it much easier to get an appointment.
DPC Helps Get Overpriced Insurance Companies Out Of Your Primary Care
DPC physicians do not take traditional insurance. For years, primary care physicians have found dealing with traditional health insurance companies to be a struggle.
Traditional primary care doctors have to generate a mountain of documentation on each patient, which cuts into available face time with patients, and decreases the quality of care.
They also have to employ a small army of billing specialists just to keep up with insurance company correspondence so they can earn a living. Which also adds cost to every visit.
Who pays for those billing specialists? You do!
You pay In the form of increased co-pays and co-insurance, and in the form of reduced face time with your doctor – who has to spend as much time taking notes for the insurance company as he or she does actively listening to your concerns and actually providing care.
Insurance isn’t designed for low-cost, high-frequency events like routine primary care visits. Insurance is designed for high-cost, catastrophic, low-frequency events.
After all, you don’t insure your car against predictable oil and coolant changes. You insure against unpredictable car wrecks, car thieves, and natural disasters.
So it is with health insurance: When it comes to primary care visits, traditional insurance companies rarely add value. Insurance companies don’t add value. They don’t help at all for people who don’t meet their deductibles for the year.
They just add costs.
With DPC memberships, you essentially drop the insurance intermediary and contract with your doctor and his or her practice directly.
You pay less money for access to your primary care doctor. Your doctor pays less money in administrative staff, extra office space, and overhead. Your doctor enjoys a lower case load, and has more time to spend with you, the patient.
- Personalized Care: DPC doctors typically have fewer patients, allowing them to spend much more time with each individual. Where traditional PCP doctor visits typically average around 10-15 minutes, visits with DPC doctors average 45 minutes. Your DPC doctor simply has more time for diagnosis, counseling, and treatment.
- Transparent Pricing: Fixed monthly fees make healthcare costs predictable and easy to manage. No more surprise billing, copays, tracking deductibles, or co-insurance amounts to worry about.
- Limited Scope: DPC mainly covers primary care and doesn’t provide coverage for specialized treatments, surgeries, or catastrophic events. Don’t just use DPC by itself. DPC should always be combined with a catastrophic health plan, a health sharing plan, or a high-deductible health plan. You can also combine DPC with a traditional health insurance plan, though this approach is less cost-efficient.
- Additional Costs: While you will no longer have copays or deductibles to pay for primary care visits, your monthly DPC subscription comes in addition to any health sharing contributions or traditional health insurance premiums you may need to pay each month.
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What is Health Sharing?
Health sharing plans are non-profit associations of like-minded people who band together to help share one another’s medical expenses.
Each member contributes a predetermined amount to a shared pool, which is then used to pay for members’ medical costs.
Health sharing plans are not health insurance. Instead, they are a much more affordable alternative approach compared to the unsubsidized cost of a traditional Marketplace health insurance policy.
Health sharing plans typically run up to 50% less than an Obamacare-type policy before accounting for subsidies. They are particularly cost-effective for people who don’t qualify for premium tax credits or cost-sharing reductions under the Affordable Care Act.
The primary disadvantage of health sharing plans is that they don’t share costs related to treating pre-existing conditions right away. Instead, they impose waiting periods on most pre-existing conditions.
As such, they may not be appropriate for those who have pre-existing conditions, or who anticipate needing surgery shortly after joining a health sharing plan.
Health Sharing Picks Up Where DPC Leaves Off
DPC plans aren’t meant to be a stand-alone solution for protecting you against high medical costs.
While DPC plans are fantastic when it comes to routine and preventive healthcare, they are not designed to pay for specialist care or face a catastrophic health event, like surgery or cancer treatment.
This is where a health sharing plan can come in.
Here’s how they can work together:
Your DPC membership allows you unlimited access to a primary care doctor. You use your DPC for routine blood tests, seasonal flu shots, minor infection treatments, and basic screenings.
Suppose you have a routine blood test that comes back abnormal. Your DPC doctor has some tests run, and it turns out you have acute leukemia.
Your doctor hands you a referral to an oncologist. This visit and all your oncology care, including chemotherapy and surgery costs related to treating your leukemia are not included in your DPC plan.
But this is where your health sharing plan can kick in like a champ.
You’ll be responsible for a few thousand dollars in initial unshareable amounts (sometimes called member responsibility amounts) which function similarly to a health insurance deductible.
Your health sharing plan covers most or all of the rest, depending on your plan.
Combining Health Sharing and DCP Eliminates Redundancy
Combining a DCP membership with health sharing is more cost efficient than using a traditional health insurance plan – especially if you don’t receive an Obamacare subsidy.
There are multiple reasons for this:
- Healthshare costs are typically just a fraction of the cost of an unsubsidized Affordable Care Act-style health insurance policy.
- When you combine DPC with a traditional health insurance policy, you essentially pay twice for the same primary care coverage.
But since most health sharing plans don’t share costs for routine primary care services – at least until you spend a few thousand dollars out of your own resources – you only need to pay for primary care services once: via your DPC subscription.
Choose Your Own Specialists, Clinics, and Hospitals
The freedom to choose is another area where health sharing plans have a big advantage over most traditional health insurance plans sold via the Marketplaces.
Most of today’s affordable health insurance policies that qualify for subsidies over the Exchanges are HMOs and PPOs. These plans restrict your ability to see doctors or use clinics or hospitals of your choice.
You must get all your emergency care from doctors, clinics, and hospitals on your plan’s list of approved providers.
These may not be the best available.
If you use a health share plan, in contrast, you can normally use your benefits with any willing provider you choose.
This can make an immense difference – especially if your medical situation is complex or difficult.
Introducing The DPC DIRECT Health Sharing Plan
While DPC memberships can be combined with any health sharing plan, some health sharing plans, like the DPC DIRECT Health Sharing Plan, are designed explicitly to complement a DPC membership.
DPC DIRECT’s sharing benefits are more carefully tailored to pick up right where most direct primary care membership benefits leave off.
The advantage: a smoother transition from DPC care to specialist, hospital, surgical, and outpatient care, and care from other service providers. There is more continuity of care, and less potential for surprise bills or confusion because of services that fall through the cracks between the two types of plans.
Combining DPC Membership with Health Savings Accounts
If you are a business owner or you have verifiable income from self-employment, you can also consider combining DPC with the powerful HSA SECURE health sharing plan.
HSA SECURE is one of the only health sharing plans currently available that maintains your eligibility to make tax deductible contributions to a Health Savings Account.
This is because HSA SECURE was designed to meet the federal government’s standards for minimum essential coverages, and therefore meets the criteria to qualify as a high-deductible health plan, or HDHP.
Health savings accounts are one of the most powerful tax tools available to individual taxpayers in the U.S. Tax Code. They provide: F
- Pre-tax contributions
- Tax-deferred growth
- Tax-free withdrawals for qualified health expenses.
Effectively, HSAs allow you to pay qualified medical expenses with tax-free dollars. So you can save thousands in taxes over time, by taking full advantage of your HSA.
Meanwhile, HSA SECURE monthly contributions are typically 35% to 50% less than the unsubsidized cost of a traditional health insurance policy.
So you can save money in multiple ways: On your monthly health plan costs, and on your federal and state income taxes.*
There’s a 20% penalty if you make withdrawals for non-medical expenses.
But when you turn 65, those penalties go away. You can then use your HSA money to supplement your retirement savings – or for anything else you want, penalty-free. You just pay taxes on the withdrawal, just as you would with a traditional IRA or 401(k) plan.
HSAs are a great way to save on income taxes, healthcare expenses, and supplement your retirement nest egg.
And the lower monthly contributions in HSA SECURE as compared to an unsubsidized traditional health insurance policy should help free up plenty of cash to start funding your HSA.
The catch: To enroll in HSA SECURE, you must have an ownership interest in a business, or be able to show income from self-employment.
Click here to learn more information about how much you can save via an HSA.
*Except California, which currently does not allow state income tax deductions for HSA contributions.
DPC and health sharing plans each have unique advantages and disadvantages.
But they are at their best and most cost-effective when they are paired together, as an alternative to a traditional comprehensive health insurance policy. Especially if you don’t get a significant subsidy under the Affordable Care Act.
The combination of a DPC DIRECT or HSA SECURE health sharing plan results in a well-rounded solution for both routine and specialized healthcare needs.
You can enroll in a health sharing plan online in minutes.
Or, for more personalized attention and a free consultation, reach out and make an appointment with one of our expert Personal Benefits Advisors.
Consultations are always free – but the information you receive can make an immense difference in your overall healthcare experience!Here are some additional articles on healthsharing programs: Is a DPC Plan Right For You? Your 2023 Guide on Direct Primary Care Pros and Cons! | Direct Primary Care: How to Use a DPC and Still Protect Yourself from Major Medical Expenses | Bluegrass Direct Brings DPC to Georgetown Kentucky
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Frequently Asked Questions About DPC and Health Sharing Plans
What is Direct Primary Care (DPC), and how does it work?
Direct Primary Care (DPC) is a healthcare model where patients pay a monthly fee directly to their primary care physician or practice.
In return, patients receive unlimited access to a wide range of primary care services without the need for insurance claims or copayments. Patients typically receive an unlimited number of free appointments with their primary care physician, as needed.
Direct primary care focuses on building strong doctor-patient relationships and providing high-quality primary and preventive care.
What services are typically covered under a DPC membership?
DPC memberships typically cover primary care services such as office visits, preventive care, chronic disease management, vaccinations, minor procedures, and acute care.
Some practices also offer pediatric care.
Specialist care, surgery, outpatient, imagery, and lab services are typically excluded, as is anything that doesn’t happen in the doctors’ office or during a telehealth visit.
Do DPC providers accept health insurance?
DPC providers do not typically accept health insurance for their services. Instead, they rely on a direct financial relationship with patients through monthly membership fees.
How does combining a DPC membership with a health sharing plan work?
Combining a DPC membership with a health sharing plan involves having two separate healthcare arrangements.
DPC covers primary care needs, while a health sharing plan helps with sharing costs for larger medical expenses, including hospitalizations and specialist care.
Can I use my DPC membership to cover medical expenses that a health sharing plan won’t cover?
Yes, you can use your DPC membership for services that a health sharing plan may not cover.
These services may include things like routine check-ups, preventive care, and minor medical procedures.
DPC complements health sharing by addressing primary care needs, while health share plans focus their benefits on specialist care, ER and urgent care visits, surgeries and catastrophic healthcare events.
Can I still use my DPC membership if I have preexisting conditions?
Yes, DPC memberships do not discriminate based on preexisting conditions.
DPC providers offer comprehensive care, including managing preexisting conditions, and they do not deny care based on health history.
However, health sharinghealthsharing plans do typically impose a waiting period before they will fully share costs related to the treatment of pre-existing conditions. If you have pre-existing conditions, or you expect to need surgery in the near future.
As always, check your health sharing plan’s guidelines for specifics regarding their treatment of pre-existing conditions.
Are there DPC practices that specialize in certain medical fields, such as pediatrics or geriatrics?
Yes, some DPC practices specialize in specific medical fields, including pediatrics, geriatrics, and women’s health.
It’s essential to research and find a DPC practice that aligns with your specific healthcare needs.
Can I have a DPC membership and a traditional health insurance plan simultaneously?
Yes, you can have both a DPC membership and a traditional health insurance plan. This arrangement provides comprehensive coverage, with the DPC addressing primary care needs and the insurance plan covering specialist care, hospitalizations, and other medical expenses.
Are DPC memberships portable if I move to a different state or area?
DPC memberships are generally not portable across different states or regions because they are tied to specific DPC practices.
If you move, you will need to find a new DPC provider in your new location.
Are DPC memberships suitable for individuals and families of all ages?
DPC memberships are suitable for individuals and families of all ages. They offer comprehensive primary care services, making them a viable option for children, adults, and seniors.
Some DPC memberships have board-certified pediatricians on staff. Others don’t. Ask your DPC providers in your area for specifics about what pediatric services are included in your membership.
Do DPC practices offer after-hours care or access to urgent care services?
Many DPC practices offer after-hours care, and some provide access to urgent care services.
The availability of after-hours care may vary among DPC providers. Some contract with third-party telehealth vendors to provide round-the-clock access.
As always, ask your local DPC providers in your community for specifics.