Direct Primary Care Overview: What It Is & Why It Might Work for You

When was the last time you thought about your health insurance? Like, really thought about it? Many get stuck in a certain way of thinking that it’s either traditional insurance or no insurance, thereby only really having one option. But, have you heard about direct primary care insurance? If you’ve heard of it, do you know what it means and how it differs from what you might be used to? That’s what we’re going to be answering today: is direct primary care worth it?

What Is Direct Primary Care (DPC)? 

DPC models have been around since about the mid-2000s, but have really gained traction recently. The entire purpose is to circumvent the confusing, expensive, and frustrating world of insurance, providing something direct, clear-cut, and affordable. 

The way that happens is by cutting out the middleman (or the third parties). The relationship is 100% between the patient and the provider, erasing the need for insurance claims and waiting periods. Instead of paying monthly premiums and copays, they provide a standard monthly fee directly to the provider. These providers don’t bill insurance companies, so they in turn won’t accept any form on insurance. Yet, that doesn’t mean you should go cold turkey. Instead, many patients opt for a high deductible health plan, just in case they run into larger medical problems that DPC providers can’t adequately treat. 

High Deductible Health Plans

Why would someone choose a high deductible health plan (HDHP) specifically over no insurance or other insurance offerings? Because they’re generally low cost, but allow for protection against emergencies or accidents (though the costs will then be somewhat staggering). 

The website GoodRX provides a wealth of information, including what will be 100% covered prior to meeting your deductible, but for a quick overview, let’s start with these two areas: 

• All sorts of screenings are covered (Depression, Blood Pressure, Cholesterol, Diabetes, Anemia, Breast Cancer, Osteoperosis, Cervical Cancer, Autism, Developmental, & more).

• Common vaccines are covered (Whooping Cough in children, Influenza, and Chickenpox)

HDHPs are especially beneficial for those who are generally regarded as ‘healthy’ with little-to-no large medical events either in their history or on the horizon (like inevitable surgeries) because this type of insurance keeps the month-to-month payment low. If you only see a physician for yearly checkups and seasonal shots, this plan will work as a supplement to DPC providers. 

For more information on HDHPs, visit HealthCare.gov. 

Reasons Why DPC Just Works

The terms, conditions, and fine print found in any insurance contract is enough to give anyone a headache. Direct primary care has eliminated anything that’s typically confusing. Your pricing and out-of-pocket is clear from day one (instead of that awkward period where your insurance was billed, but you don’t really know how much or why). With direct primary care, the patient will receive an explanation of what they’re expected to pay for the visit and why, without hidden fees or charges of any kind. Typically, this will range from $50-$150 depending on the provider and the services offered and performed. Think of it like a membership to a healthcare ‘club’ rather than a billable, behind-the-scenes office visit. 

Next, DPC patients tend to find care more accessible than those using traditional insurance. Instead of having to make yearly checkups months in advance, DPC models allow you to schedule same-day or next-day visits, ranging from 30 to 60 minutes per appointment. Plus, you have 24/7 access to providers via call, text, or video chat for any quick Qs that might come up. This is unheard of with traditional insurance since it’s difficult to charge for a phone call, therefore doctors don’t bother. 

Finally, there’s the side effect of a more 1:1 relationship overall. Sometimes, if you just see any doctor available at a clinic, they have to skim your chart to see the basics about you, and then send you on your merry way. A direct physician doesn’t have to complete loads of paperwork that takes so much time during an appointment, which in turn, gives them more time to spend with you. The in-depth visits and thorough consultations yield a more personal, more authentic relationship between doctor and patient. You don’t have to feel awkward talking about the ins-and-outs of your illnesses or symptoms with someone you’ve never met because through direct primary care, you’ll have access to your doctor rather than just a doctor. 

 Things to Keep in Mind About DPC

Earlier we talked about how it’s a good safety precaution to have some form of ‘traditional’ insurance as well, as DPC hasn’t grown to cover absolutely everything that traditional insurance can. Something else to consider is the fact that the IRS views DPC models and the monthly fees as ‘health plan’ payments, and that tends to make a patient ineligible for health savings accounts while taking advantage of direct primary care and its services. 

Similarly, you can’t use existing funds in a health savings account to pay for ‘membership fees’ at a DPC provider, compared to typical insurance. It simply depends on what insurance you had before direct primary care and what you think will happen if you decide to wean off of the insurance alternative eventually. 

If you have questions about DPC, us, or what we do at Elevated Health, visit our website and reach out. Our FAQ page is especially helpful. We’re here to help you understand all of your options so you know what the best fit for you and your family is.

We Are Elevated Health

Our mission is to restore your belief in medical care. So many have a poor association with healthcare due to the vagueness and cost of traditional insurance plans. We wanted to provide a more personal, more affordable experience with your family doctor without any of the behind-the-scenes work. We are here for you first, and we think you’ll notice a difference from what you’re used to once you make the switch. 

Our doctors are one of a kind because they’re pioneering a return to what they wanted when they set out to be doctors in the first place – that is, to care for as many people as possible. They’re putting you first over themselves, insurance companies, or high-salary low-effort practices in traditional offices. 

For a full list of our pricing schema and the direct primary care services included, check out this page on our site at your earliest convenience. You’ll know exactly what we can do for you and for how much, and that’s almost unheard of.

Let us take better care of you. Join Elevated Health.