Concierge Medicine, Direct Primary Care, or Health Insurance?

An increasing number of doctors are exploring opportunities to offer concierge medicine or direct primary care. Instead of using your health insurance for basic healthcare, you join the doctor’s health plan—either through a concierge company or the doctor’s in-office plan—and pay an annual fee. These plans are not health insurance. Most patients use their health insurance to cover emergencies, more costly medical expenses, and hospitalization.

Concierge Medicine

According to Concierge Medicine Today, there are about 12,000 concierge doctors throughout the U.S. There are concierge medicine companies, and doctors can join them to and become part of the network. Patients join the plan and pay an annual fee. The average cost per patient is about $138 per month. Some costs are lower, and some are significantly higher. In return for the annual fee, doctors promise personalized primary care. Depending on the medical practice, doctor’s visits may or may not be included in the annual fee, and your insurance company is billed for the visit. If your doctor is offering this option, speak with him or her about the details of the plan.

Direct Primary Care

Direct primary care is modeled after concierge medicine. In contrast, fees are assessed directly by the practice. Unlike concierge plans, the physician has not enrolled with a concierge medicine network. As a result, monthly membership costs are lower. Primary care, preventive care, urgent care, and chronic disease management are included in membership. Insurance is usually not accepted by these practices, and for more costly medical expenses, patients pay out of pocket. In turn, medical claims are submitted by the patient to the insurance company. Speak with your doctor about the details, if this plan is being offered to you.

How does the patient benefit? When doctors don’t have to file insurance claims, their costs can be cut by as much as 40%. Doctor’s fees are lower, and the savings are passed on to the patient.

Is Concierge Medicine or Direct Primary Care for You?

That depends. Patients with health insurance plans that have high of out-of-pocket costs for lab work, x-rays, vaccines, and the like may benefit from concierge medicine or direct primary care. Concierge or direct care physicians often negotiate lab fees to offer patients lower rates than they would through health insurance plans. Also, patients with high-deductible plans (out-of-pocket costs for you before the plan starts providing coverage) may benefit by using one of these options and saving on the cost of primary medical care, and reserving the high deductible for specialty care and emergencies.

If you have an insurance plan with low deductibles and co-pays, concierge medicine or direct primary care may not be for you. Although it may be offered to you, weigh the pros and cons. Remember that these plans usually cost at least $1000 per year, in addition to your health insurance premiums. If your doctor switches to a concierge or direct care plan, and you don’t want or cannot afford it, you may have to switch doctors, or your case may be transferred to a physician’s assistant or nurse practitioner in the office.

Alternatives to health insurance aren’t affordable for everyone. If you already have health insurance, it may be all you want or need. If you don’t have health insurance, discuss your plan options with a trusted agent. In an emergency, it’s better to have limited coverage for emergencies or critical illness than no coverage at all. If you are presented with the opportunity for concierge or direct primary care, carefully weigh the costs, what the plan includes and excludes, and your projected medical expenses.