Let us preface this article with the fact that there are 25 million Americans who have no health insurance as of 2023, thus making the conversation on affordability and access to care for uninsured patients just as important and as urgent as it was a decade ago.
Gaining access to reliable yet affordable direct primary care options healthcare has become such a complicated and obscenely expensive privilege that is not available to many. This is why more and more patients are exploring different alternatives to traditional, insurance-based health care.
In this article, we address frequently asked questions regarding direct primary care for uninsured patients. Is it possible? Is it advisable? Is it a myth? Let us settle the score between direct primary care vs. health insurance and how patients can maximize both arrangements in order to receive the level of care and medical attention they deserve.
For patients who are unable to afford insurance or for those who are not willing to join Medicaid for social reasons, direct patient care plans are the best fit. In fact, direct primary care (DPC) can serve as a viable precaution if a patient is not protected by health insurance. The rule of thumb is direct primary care is for reliable, preventive care while your health insurance can provide additional coverage for specialist services, as well as in-patient costs.
Because DPC practices do not operate under third parties, like health insurance, a patient is not required to have a health savings account (HSA) or a high-deductible health plan (HDHP) to avail of any direct primary care service.
Should the patient have no insurance, all DPC expenses incurred are to be paid out-of-pocket by the patient, without the intervention of third parties like health insurance.
With a monthly cost of $55 to $110, patients are able to receive best-in-class preventative care, thereby helping them stay in good health, and prevent hospitalization and adverse health outcomes at a later date.
If down the line, the patient enlists to a HSA or HDHP, he/she should not encounter any trouble with having both health care arrangements, especially with the Medicaid Primary Care Improvement Act in place.
This November 2024, Congress passed H.R. 3836, also known as the Medicaid Primary Care Improvement Act. This bipartisan bill clarifies that Medicaid and DPC can coexist, with patients not being required to secure a federal waiver from the Centers for Medicare & Medicaid Services (CMS).
This is a monumental change within the healthcare industry because it removes friction between insurance-based and direct pay models. Once the new bill undergoes further implementation, this will simplify DPC arrangements for Medicaid patients and provide more affordable direct primary care options
For DPC arrangements, patients pay a monthly retainer fee that ranges between $55 to $110. This fee already covers a set of basic services, such as unlimited consultations and direct, 24/7 contact with your primary care physician. Some subscriptions also come with additional services, like vaccines or annual physical exams.
Dr. Jon Izbicki paints a clear picture of what benefits a patient receives from his DPC practice. “[We] charge $780 per year for unlimited primary care, payable as $65 monthly or annually with a discount. Visits are as long as needed and are usually [booked] within the same or the next day. [We] have developed contracts with clinical laboratories for highly discounted testing and radiology. [We] purchase generic drugs at wholesale prices and sell them to [our] patients at the same price. For many patients, especially those with multiple chronic illnesses who are taking 5 to 7 prescription medications, this can save as much or more than the annual membership fee.”
Gone are the days when DPC and concierge medicine subscriptions were dubbed as ‘for the rich’. These days, it is very easy to find a direct primary care subscription that fits every kind of budget and caters to all kinds of health requirements.
When searching the market for a DPC provider that fits your needs, it is best to practice due diligence and research on the following:
When it comes to better quality primary care, retainer medicine arrangements are deemed a better alternative and can replace the subpar primary care services offered by the traditional, insurance-based health care model.
DPC and concierge medicine practices offer a slew of priceless benefits such as:
Read more about: What is Direct Primary Care (DPC)?
On the flip side, it is essential to note that DPC subscriptions do not cover hospitalization, specialized procedures, and other in-patient services. DPC arrangements are not able to substitute health insurance in these respects. For these reasons, it is recommended that DPC plans should be supplemented with some type of catastrophic coverage health insurance plan (High deductible plans) or health share plans.
In hindsight, DPC reduces a patient’s dependence on traditional health insurance. Concierge medicine for low-income patients takes care of all primary care requirements, however patients still need some sort of safety net coverage (such as health share plans or high deductible plans) to pay for hospitalizations and consultant visits. Dr. Rob Lamberts, MD, a concierge doctor, explains that patients who are not covered by insurance are “at constant risk of developing conditions that could quickly bankrupt them”.
Moreover, he details that there is an added level of pressure on the side of the physician when it comes to direct primary care for uninsured patients. “The job of the primary care physician, who has to manage the care in such a way to minimize the need for specialists and hospital care, becomes critical to both the health and financial well-being of the patient.”
The cost of DPC subscription plus catastrophic coverage is less than that of traditional health insurance. Patients can reduce their insurance plans to cover hospitalization expenses and catastrophic health care only.
Comstock’s Magazine notes that the average cost of traditional insurance plans in America amounts to $328 a month, compared to $150 a month for DPC retainer fees plus a bare-bone premium for a high-deductible health plan at about $110.
Although we can conclude that direct primary care for uninsured patients is indeed possible and even advisable, it can still be considered a risk to go about life with no catastrophic health insurance. Should there be any untoward accidents that happen or there is a need for emergency services at any given time, having a catastrophic insurance plan / health share plan in your arsenal can be a life saver. This way, outrageous out-of-pocket expenses can also be avoided.
As per Dr. Rob Lamberts, “People are more than just physical bodies, and should be considered on all levels, including economic.”
Given that 7-8%of the U.S. population are left uninsured at any point in time, addressing health disparities through direct primary care could not have come at a better time. Uninsured patient care models are breaking down barriers to care for low-income individuals. Thanks to affordable direct primary care options, patients can receive best-in-class preventive primary care by spending $55-110 per month.
Innovative care models for uninsured patients are definitely blessings, in a way that DPC keeps them healthy and reduces the long-term healthcare dollars spent (in billions) on future hospitalizations and complications.
