Direct Primary Care, how does it work, how much does it cost and what does it cover?  

First off let’s understand that Direct Primary Care is not full health insurance.

Traditionally full health insurance cover’s us for our preventive care services, doctor visits, specialist visits, medications, urgent care, and if we’re lucky enough maybe emergency room coverage.

These services and depending on your health insurance plan  , are covered with a co-pay.

Beyond that, if you require surgery or hospitalization, then your health insurance would cover those medical expenses after you paid for your deductible and co-insurance.

The issue that millions of American’s today are facing is the high cost of a health insurance premium.

Take into consideration you’re primarily paying for your doctor visits and medication either once or twice a year to see your doctor and get a refill on your monthly prescription.   

A majority of Americans’ are using their health insurance plan in this fashion, but it something big were to happen, you have the peace of mind that you are going to be covered.

At what cost does our health insurance premium become such an issue that we cannot even afford it on a per month basis.

According to Kaiser , there are two point eight million people that are currently uninsured.

When we looked at the history of private physician practices traditionally when you sought the need for medical attention, you would pay a cash price for those services. This type of service was going on well before insurance companies started to evolve.

The actual business model of direct primary care itself has only been around since the 21st century.  Direct Primary Care began in the early 1990s and 2000s. Around that time, three doctors opened their practice in the state of Washington.

The idea was to go insurance free and charge a subscription on a per month basis.  What happened is the physicians themselves found they had more time with a patient to understand their ailments and give a proper diagnosis.

Direct primary care physician will see anywhere from 500-1500 patients per year and spend 30 to 60 minutes per patient, according to Business Insider

On average, a primary care physician where a client has insurance with a traditional carrier will spend 13 to 16 minutes with their primary care doctor.

It’s the insurance companies that push physicians to see more patients to do more test, administer more medications without a proper diagnosis.

Imagine handing over your car, and it’s been having some major heating issues and the mechanic giving you a diagnosis under 15 minutes.

Would you question the mechanic’s decision-making process or go for a second opinion, considering you might be spending a lot of money on those expenses?

Why are we spending so much money on a health insurance premium that is going to allow us 15 minutes with a primary care doctor were things could fall easily through the cracks?

Is it time to break up with our group or private insurance carrier and use that coverage for catastrophic needs?

Under our current health insurance plan, the cost of procedures remains a direct result on a patient under the current business model that health insurance carriers offer on the individual and group market. Even doctors don’t have a full understanding of the actual price a patient may pay for a service once they are billed.

As a consumer, this will place us at an enormous disadvantage and subject to the health insurance billing practices and finger-pointing between the health insurance carrier and the facility.  

If this bill does not get paid the facility will be forced to send this bill to collections furthermore, we suffer under these billing practices pushing our medical expenses further down the rabbit debt hole.  

Under Direct Primary Care providers are going to know the cost for the test or a strong ball-park figure that allows the patient to make a solid decision if this is something they can cover financially.

One thing to note since the patient is paying for this service as a cash payment and eliminating the need for insurance 8 out of 10 times the patient is going to receive a lower priced procedure compared to having insurance.

The transparency of price is crystal clear when it comes to a Direct Primary Care Service compared to a health insurance plan through a major medical carrier.

Let’s talk about Premiums for a Second!

 

The average cost of a Direct Primary Care Subscription Fee is anywhere from $50 to $75 per individual compared to the average price for a full insurance plan with limited upfront coverage for a 40 to 50-year-old man or woman could be as high as $200 to $300 per month for individual health insurance.

Those prices do not reflect an ACA plan I am referring to a Short-Term Medical Plan or a Ministry Health Plan.

At the ACA level, those prices could be as high as $400.00 per month on a standard bronze tier plan with a major medical carrier with a deductible of $7000.00 and a co-insurance maximum out of the pocket of $7900.00.

Granted if this scenario were to play out, I would be incredibly happy having the insurance cover my medical expenses if I became hospitalized. If this were to happen and according to the Kaiser foundation the average cost for room and board is $3000.00 per day, and this would not include other services covered such as surgery, doctor visits, medications, nursing, food.

Let’s talk about the coverage you can seek at a Direct Primary Care Office.

Finding this information was a bit of a gray area and a word of advice.”Do some diligent research on the office and physician before making a choice.”

Scouring through the internet, I did come across OneMD Direct, and for $75.00 after a $150.00 application fee, I found some plan options that gave me some clarity to share on what might be covered with a Direct Primary Care Plan for $75.00 a month fee.

Preventive Medicine would include an annual physical, cancer screening, wellness, and nutrition along with weight management.

Health Management would fall into the category of sick or minor injury office visits, anxiety, depression, high blood pressure screening, and diabetes.

Other procedures included simple lacerations, minor burn and wound care, wart removal, abscess drainage, and EKG.

Lab Test would include routine blood work, urinalysis, glucose.

One thing that stood out was the ease of schedule compared to a traditional provider that was taking a health insurance plan. With my current doctor, I’ve had to wait up to 3 weeks to see my physician for my annual physical.

Under a Direct Primary Care plan, it is possible to have next day service if your schedule would be inclined to do so.

While it may be helpful to have next day scheduling if we needed immediate access care to a more common treatment such as food-poisoning most physicians are going to use today’s technology, such as video-chat and accessing patients faster.

Everyone is unique in their own way when it comes to their health insurance and the way it functions for their livelihood but with the resurgence of ministry health plans on the market today and the growing need of financial freedom from the high cost of health insurance premiums.

Direct Primary Care could be a good fit for a lot of Americans that are looking for quality coverage at a price they can afford.

Recommended For You

Leave a Reply

Your email address will not be published. Required fields are marked *