In this article, we will discuss direct primary care alternatives to health insurance and explain how they work, as well as the benefits and drawbacks associated with them. We will also provide examples of some direct care providers and discuss whether they are worth the investment.
What is Direct Primary Care?
Direct primary care gives primary care physicians a way to collect fees from patients without needing to go through a third party first. The billing process with third parties can take a lot of time and requires doctors to see a large number of patients to make a profit. Instead, doctors in direct primary care can charge a monthly, quarterly, or annual fee directly to patients.
These fees cover basic care services such as consultations, lab tests, and other clinical medical services. For any treatments or services outside the scope of basic care, patients can use their own health plans. High-deductible health insurance plans are among the cheapest health insurance plans, and are often used this way to cover emergency expenses and other expenditures not covered by the direct primary care plan.
These models aim to improve patient care and provide comprehensive care. As a result, primary care doctors practicing direct primary care can offer longer appointments and spend more time with each of their patients.
Direct medical care models also reduce overhead costs and simplify the administrative side.
How Does Direct Primary Care Work?
Many people seeking healthcare find value in paying a fixed monthly fee for unlimited access to their doctor. A 2020 study indicated that direct primary care fees can range from about $65 to $85 monthly, depending on the provider and services offered.
You can think of this model as a membership at an exclusive doctor’s office where patients receive personalized care and can spend quality time with their doctors. The average time a patient spends in a typical doctor’s office is around 13 to 16 minutes, while a visit to a direct primary care doctor averages about 40 minutes.
Many direct primary care centers allow other ways to access your doctor, such as phone consultations and texting, the ability to schedule appointments for the same day or the next day, and even home visits in some cases. Medications and imaging services, as well as lab tests, are often available at a discount for patients.
There are about 1,200 direct primary care practices in the United States, and more are expected to open each year.
Advantages and Disadvantages of Direct Primary Care
Direct primary care models offer a lot to patients and doctors. Patients enjoy personalized care, and doctors love practicing medicine as it was before they were forced by the health insurance system into a strict payment structure.
Spending more time with patients allows doctors to focus on the patient’s overall health, including wellness and lifestyle habits. This simple switch alone can improve healthcare for patients and doctors.
Critics have raised concerns about the scalability of direct primary care clinics as a standard healthcare option for most people, as doctors can choose how many patients they see. This system increases the burden on the already low supply of primary care physicians and may limit patients’ access to basic healthcare.
Some also argue that reported savings do not provide an accurate picture of the issue, as individuals using direct primary care are often already in good health, and thus their healthcare costs would be less than those of individuals dealing with chronic illnesses, for example.
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Direct primary care models are not a viable option for those who cannot afford the monthly payment. It is difficult for many types of patients who have much to gain from this type of care to access it, which exacerbates the issue of healthcare inequality across the country.
There are 32 states that have enacted laws aimed at redefining direct healthcare practices as “medical services outside the regulation of state health insurance,” giving direct healthcare practices greater flexibility in how they operate.
One downside to the direct healthcare model is that you cannot use Health Savings Account (HSA) funds to pay direct healthcare fees, as the Internal Revenue Service considers your monthly fees as insurance payments, and you cannot use HSA funds to pay health insurance premiums.
New laws are working to address this issue, including the Primary Care Enhancement Act of 2019. In June 2020, shortly after it was introduced, the Internal Revenue Service proposed new regulations to address direct healthcare payments, which would allow for the coverage of direct healthcare fees through an employer-sponsored health reimbursement arrangement (HRA).
Examples of Direct Healthcare
An example of one of the first direct healthcare providers was Qliance. This direct healthcare practice began in 2007 and received backing from Michael Dell, the founder of Dell Computers, and Jeff Bezos, the founder of Amazon. In June 2017, Qliance closed its doors.
Another example is direct healthcare in Spokane, Washington. There are fees for adults under 39 years old, higher fees for adults under 40 years old, and lower fees for children. It offers lab tests, medications, and imaging at a discount for patients.
It is worth noting that most direct healthcare practices operate at the local level with physicians who have built their own practices.
Is Direct Healthcare Worth It?
As with many things in life, the answer to whether direct healthcare is worth it is: it depends.
On the positive side, you have access to a physician and primary healthcare through a single fee you can predict and plan for. It may still be wise to invest in an additional health plan for services not covered by your direct healthcare practice.
Direct healthcare also has downsides, including a lack of assistance when you need more advanced care or care that is not covered by direct healthcare. Additionally, the direct healthcare model does not help address the issue of access to basic healthcare for those who cannot afford monthly payments.
Whether direct healthcare is right for you depends on your health, financial situation, and how you prefer to receive healthcare.
Source: https://www.thebalancemoney.com/direct-primary-care-alternatives-for-health-insurance-4164823
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