Direct Primary Care: the Pros & the Cons

Direct primary care is sometimes referred to as concierge health care.  It’s grown in popularity since the mid 2000’s as a response to dissatisfaction with traditional health insurance. Because it’s not traditional health insurance, it’s exceptionally important to understand exactly what you’re getting yourself into before you make the leap. 


What is Direct Primary Care?

Direct primary care is an agreement made between patient and healthcare provider, usually your primary care physician.  As opposed to paying your insurance carrier monthly premiums, you pay a fee directly to your provider.  Usually this fee is around $100 per month for an individual with discounts available for families.  

Often this is the only fee will have to pay.  Your basic preventative care including lab work will be covered.  Although, some physicians will charge an additional flat fee per visit, but that’s not as common. In most direct primary care agreements, you’ll have access to your doctor in person, for telehealth and also via email and phone.  For this reason, many consider it to be a simpler, more personalized approach to health care.   When you remove premiums, copays, coinsurance, and deductibles, it certainly can be much simpler to understand your bill!


What’s the Catch?

Direct primary care is not a perfect solution.  There are many services not covered such as specialist visits, urgent care, hospital procedures, and prescription drug coverage.  And, let’s be honest, those are the most expensive health care costs!

Another drawback is that these arrangements are not available everywhere and, of course, your doctor may not be willing to participate in such an arrangement.  If you have a PCP that you like you can discuss it directly with them or check out the direct primary care coalition at dpcare.org to find a provider near you.  



How Can I Make Direct Primary Care Work for Me?

You definitely do not want to be without coverage should you need a major procedure.  For this reason, most people supplement their direct primary care coverage with some type of high deductible health plan or catastrophic coverage.  A high deductible health plan will offer lower monthly premiums when compared to other health insurance, but will still provide coverage if you need to see a specialist or fill a prescription.  It will also impose an out of pocket maximum in case you wind up in the hospital.  You can purchase a HDHP on or off the marketplace.

Some people may also be eligible for catastrophic coverage.  These plans can be available on the marketplace or off.  You can also purchase catastrophic coverage in the form of a short term medical plan which is a little more customizable and usually pretty inexpensive.  These will limit your financial exposure in case of medical emergency.  

You may find that when you add your monthly fee to some type of basic plan to cover your additional healthcare needs, that there isn’t much of a savings.  Additionally, it may simply not be feasible in your area.  If that’s the case, there are still plenty of options to save money on health insurance.  You may want to look into a HDHP with HSA. You can also try a short term medical plan or even a marketplace plan.  Just make sure you can lower your MAGI to make yourself eligible for those premium tax credits.  

Healthcare is ever evolving, so feel free to give us a call at iHealthBrokers with any questions.  You can reach us at 888-918-0518 or schedule a call today!


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Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.

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