DPC Direct Healthshare
Designed To Work With Your Direct Primary Care (DPC) Membership
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By Wiley Long III, President – HSA for America
Reviewed by Lou Spatafore – Fact checked by Misty Berryman – Updated 12/4/2023
If you’re enrolled in Direct Primary Care membership, you can now enroll in a Health Sharing program tailored exclusively to DPC members. Our DPC Direct option gives you access to low-cost medical cost sharing to protect you from emergency hospitals.
Meanwhile, your DPC doctor will provide all the routine and preventive services you need.
Pairing DPC with health sharing is a simplified way to build a more comprehensive healthcare strategy, while still paying considerably less than you would with traditional insurance.
Plan Overview: DPC Direct
As long as you’re currently enrolled in a direct primary care program, you can enroll in DPC Direct right away.
As a member of the DIRECT health sharing community, you’ll have access to:
- Medical cost sharing for emergency or unexpected medical bills
- A monthly cost as low as $190 / month for individuals
- Unlimited 24/7 telemedicine services with $0 fees for just $5 extra per month
- Optional access to the RX Share prescription discount program (with generic prescriptions as low as $5)
How Does DPC Direct Work?
DPC Healthshare is a more simplified model of healthcare cost sharing.
Here’s how it works:
- Enroll in a DPC membership. (Don’t have DPC? Check the Map below to find a Direct Primary Care provider in your area.)
- Make an appointment with your Personal Benefits Manager to enroll in DPC Direct. Unlike other health sharing ministries (MediShare, Covenant, etc.) this program is open to all people, regardless of faith or religious affiliation.
- Choose an Initial Unshared Amount (IUA). This is the dollar amount that you will need to pay out-of-pocket before you can access cost sharing, similar to a deductible. (IUA options include $1,000, $2,500, or $5,000).
- When you incur a medical bill, simply submit a cost-sharing request. As long as your IUA has been met, and it’s an eligible medical need, the DIRECT Healthshare community will cover the rest of your bill.
- Continue to work with your Personal Benefits Manager year after year to keep your healthcare strategy optimized and up to date. Your PBMs services are 100% free to you, for as long as you have your plan. Read more details in the DPC Direct brochure (pdf).
How Much Does DPC Direct Cost?
If you’re an individual, membership in DPC Direct can be as low as $170 per month. However, your actual cost will depend on your age, your IUA option, and which additional options you choose to add to your membership.
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For members of Zion HealthShare, the out-of-pocket costs associated with seeing a primary care provider (PCP), specialist, hospital inpatient admission, and urgent care can vary based on several factors, including the type of service and the member’s chosen Initial Unshareable Amount (IUA).
Here’s a breakdown of the potential costs:
1. Primary Care Provider (PCP) Visits:
- Direct Primary Care (DPC) Membership: If the member has a DPC membership, visits to the PCP are typically included in the monthly DPC membership fee. There are no additional visit fees, deductibles, or copays for seeing a PCP within the DPC network.
2. Specialist Visits
- Out-of-Pocket Costs: Members may need to pay the full cost of specialist visits up to their IUA. After meeting the IUA, eligible medical expenses can be shared with the community.
3. Hospital Inpatient Admission
- Initial Unshareable Amount (IUA): Members are responsible for paying their IUA before any inpatient hospital costs become shareable. The IUA options are typically $1,000, $2,500, or $5,000.
- Additional Costs: After the IUA is met, additional eligible expenses related to the hospital stay are shareable according to the member guidelines.
Surgeries
Cataract surgery is treated as a pre-membership medical condition and is subject to a one-year waiting period before it is shareable.
Expenses related to cosmetic surgery are shareable only for disfiguration due to a shareable injury or illness.
Maternity Benefits
DPC Direct has specific guidelines and limitations regarding maternity and childbirth coverage. Here are the key points:
1. Waiting Period. Maternity expenses are shareable only if the pregnancy commences after at least 60 days from the membership effective date.
2. Initial Unshareable Amounts (IUAs). Two initial unshareable amounts are applied to maternity needs. For example, if the IUA is $1,000, the member must pay the first $2,000 of maternity-related costs before these expenses become shareable.
3. Separate Needs for Children. Any pre-birth or post-birth needs of the child are considered separate from the mother’s maternity care. This means that the costs associated with the child after birth are handled independently and require separate sharing requests.
4. Exclusions and Limitations. Certain services related to maternity and childbirth are not shareable. These include:
- 3D and 4D ultrasounds.
- Most immunizations (such as flu shots) during prenatal care.
- Non-prescription supplements.
- Genetic testing/counseling, including services like amniocentesis and NIPT testing.
- Doula services, birthing tubs, and placenta encapsulations during delivery.
- Breast pumps and lactation consultant services postnatally.
Initial Unshareable Amount Requirements
For maternity needs, two initial unshareable amounts (IUAs) are applied. This means if the IUA is $1,000, then the first $2,000 of maternity-related costs must be paid by the member before the costs become shareable with the community. Additionally, any pre-birth or post-birth needs of the child are considered separate from the mother’s maternity care.
Adding a Newborn to Your Plan
Newborns whose birth is related to an eligible maternity sharing request must be added to the household membership by the parent within 30 days of birth.
Alternative Medicine
1. Chiropractic Treatments. Chiropractic services are shareable when provided by licensed chiropractors.
These treatments are considered part of therapeutic treatments and are shareable up to a maximum shareable amount of $7,500 or a maximum total of 35 treatments per medical need, whichever is reached first.
2. Acupuncture. Acupuncture falls under alternative and/or integrative therapies. These services are shareable when prescribed and performed by a licensed medical professional and related to an eligible sharing request.
Similar to chiropractic treatments, the sharing is capped at either a maximum shareable amount of $7,500 or a maximum total of 35 treatments per medical need.
3. General Guidelines for Alternative Medicine. Alternative medical treatments may be shared with the Zion Health community with prior written approval from Zion Health. Without prior approval, these treatments may not be shareable. Members are required to demonstrate the proposed value of the alternative treatment and provide necessary documentation such as doctor notes on the current condition and estimated costs
Prescription Drugs
Prescription medications are considered shareable under the following conditions:
- The prescription is related to the treatment of an approved sharing request.
- The prescription is ordered by a licensed provider.
- The prescription is approved by Zion HealthShare.
When these conditions are met, the member will be reimbursed for the cost or given a one-time use credit card for the exact cost of the prescription to take to the pharmacy and pay for their prescription.
Zion HealthShare includes a prescription-sharing program through OptumRx as part of its Direct Membership package. This program allows members to access generic prescriptions for $5, with the option for 90-day refills.
Lab Services
DPC Direct is designed to dovetail well with a direct primary care membership, with a minimum of redundancy.
Since many direct primary care practices do their labs in-house or have arranged for steep discounts at local lab service providers, DPC Direct offers very limited additional lab benefits.
For lab services that are not covered under the DPC membership or for more extensive tests, members can utilize their Zion HealthShare membership to share eligible medical expenses that meet the criteria and the Initial Unshareable Amount (IUA)
Waiting Period for Pre-Existing Conditions
Like all health share plans, DPC Direct imposes waiting periods for pre-existing conditions:
1. One-Year Waiting Period. There is a one-year waiting period from the membership start date before any pre-existing conditions become shareable. During this first year, no costs related to pre-existing conditions are shareable.
2. Phase-In Period for Sharing. After the initial one-year waiting period, the shareable amount for pre-existing conditions increases each year:
- Year Two: Up to $25,000 per sharing request can be shared.
- Year Three: Up to $50,000 per sharing request can be shared.
- Year Four and Beyond: Up to $125,000 per sharing request can be shared in a 12-month rolling period, resetting each membership year
Where Can I Find A DPC Practice?
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. You can also see past issues of our DPC Newsletter that we mail out to our DPC Partners. (Attention doctors and patients: if you do not see your DPC clinic on the map, please click here to add your clinic.)
FAQ: Frequently Asked Questions about Healthshare + DPC
Q: What is a DPC Arrangement?
A: Direct Primary Care, or DPC for short, is a membership-based healthcare model where the patient pays a monthly fee in exchange for ongoing preventive and routine medical care. DPC arrangements can be lower than the cost of your monthly phone bill, and provide unrestricted access to your primary physician to help keep you healthy.
However, DPC arrangements do not cover ER or hospital visits, as well as some specialist visits, lab tests, and more. This is why pairing DPC with health sharing is so effective.
Q: How does DPC + Healthshare work?
A: Pairing a DPC membership with a specialized DPC healthshare plan can reduce your healthcare risk without forcing you to pay for an expensive health insurance plan. DPC Direct, for example, provides access to cost sharing for emergency medical bills, something that is not included in DPC memberships.
Q: Is a DPC Healthshare plan right for me?
A: Both DPC and Health Sharing are viable alternatives for anyone who is looking for a simpler and more affordable health plan. However, if you have a serious health condition or ongoing medical needs, these options might not be best for you.
Consult for Free with a DPC Healthshare Expert
Our Personal Benefits Managers (PBM) are top of their field when it comes to Direct Primary Care and health sharing plans. More than this, they’re experts and finding people better or more affordable health plans that are suited to their individual needs.
Your PBM will provide ongoing no-cost consultations to health you with your healthcare strategy. Click here to schedule a consultation, or call 800-913-0172 to get started.
Become a DPC Expert Yourself
Want to learn more about DPC? Click here to read our comprehensive guide, Everything You Need to Know About Direct Primary Care (DPC), and How it Can Lower Your Cost and Improve Your Healthcare. To learn more about the DPC Direct, open the DPC Direct brochure (pdf).
About Us
Since 2004, HSA for America has led the way in affordable healthcare, crafting innovative cost-saving strategies and providing strong alternatives to expensive traditional health insurance for individuals, families, and small businesses. Read more about us.
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DPC Direct Healthshare Reviews Section
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Good Plan with Small Limitations
The DPC Direct healthshare plan offers excellent primary care. Monthly costs are manageable, and telemedicine is a lifesaver. I’d like to see improved processing times for medical cost-sharing claims.
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