How Does Direct Primary Care Work with Medicare?
Direct primary care (DPC) is quickly becoming a popular alternative to traditional healthcare practices. The fee-for-service payment plan within a private market setting allows for more attention from practitioners and straightforward pricing. With more and more physicians and patients alike choosing the DPC model over the traditional practice model, people are bound to have questions regarding insurance plans, such as Medicare.
With a direct primary care model, patients pay a membership fee instead of getting billed for each service their physician provides. One of the reasons traditional medical practices bill by service is to comply with insurance standards. This is what allows doctors to get paid for their work. DPC bypasses all of that since they do not work with insurance providers and can provide their patients with an upfront billing model. That being said, there is still a likely need for patients to have health insurance, including patients who use or qualify for Medicare.
Why Keep Medicare
Many patients under Medicare wonder why they should keep it if they opt to use a direct primary care physician. Since the membership fee charged by a DPC cannot be submitted to Medicare for reimbursement, it’s no wonder patients feel torn on whether to keep their plan or not. The truth is that Medicare can still be very valuable, especially if there are any unplanned medical services needed. Medicare will still cover costs outside of your direct primary care provider as well.
Reasons Medicare and DPC Models Do Work Well Together
Even though DPC providers do not bill or get reimbursed by insurance companies, there are still plenty of reasons to keep your Medicare insurance. Here are some reasons why you might consider keeping your plan:
Medicare May Cover Extra Services
Since direct primary care providers cover initial medical services, anything “extra” may need additional coverage. That’s where Medicare could come in. For instance, if you need any sort of labs, x-rays, or medications, your DPC provider can work with Medicare to get those things covered.
It’s the Law
To comply with federal law, all patients should carry some sort of medical insurance. Those who decide to use DPC for medical care often will seek out a high-deductible plan, a major medical plan, or a plan with a health savings account. Medicare will allow patients to remain in compliance with federal law.
It May Cover Major or Recurring Medical Expenses
If you are on Medicare but opt to use DPC, you will still receive medical savings through your insurance. Medicare will still cover most of your prescriptions or other medications your DPC provider prescribes to you.
Keeping Medicare is also wise for patients using direct primary care to avoid liability for major medical services, such as hospital charges, surgeries, physical therapy, or if the patient needs to see a specialist.
What Now?
While a direct primary care physician will not bill through your insurance, it is still wise to have an insurance plan – especially as a patient with Medicare. If you have further questions regarding Medicare and how it works alongside a direct primary care model, our team at Elevated Health offers excellent resources. Check out the rest of our FAQs or contact us directly if you would like to speak with someone on our team.
