Concierge Medicine, Direct Primary Care, or Health Insurance?

Concierge Medicine, Direct Primary Care, or Health Insurance?

Photo of five medical professionals with an african american doctor in the front for information on Raleigh concierge medicine and direct primary care, from Hunt 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?

Photo of a pros and cons chalk board for Raleigh health insurance, concierge medicine, direct primary care information from Hunt Insurance.
Weigh the pros and cons

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.

Affordable Care Act – Obama Care Enrollment Deadline

The Affordable Care Act (ACA / Obama Care) enrollment deadline date is January 15, 2016 at 11:59 Pacific Time.  The broader deadline to avoid paying a fine for not having health insurance is January 31, 2016. Although you’re not required to sign up, if you don’t, you’re subject to a fine. Depending on your circumstances and income, penalties can range from several hundred dollars to more than $1000.

If you’ve already enrolled, and you’ve done so before December 17, 2015, your coverage is effective January 1, 2016.

Having Trouble Deciding Which Healthcare Plan to Choose?

Picture of a man working on a laptop for Raleigh ACA Obama Care health insurance help from Hunt Insurance.If you’re like many people, you have put off enrolling in health insurance because you’re not sure what to choose or how to work your way through the website. We can help.

Remember, the website is for people who don’t have medical insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source. This means that you are able to explore your options through an insurance carrier or an insurance agent.

The assistance of an experienced professional can simplify the process for you. You will be able to compare plans, costs, and decide which plan is best for you and your family.

Health Insurance – Some Factors to Consider

  • What does the plan cover? – Find out if the plan covers services such as doctor’s visits, hospitalization, prescriptions, physical therapy, emergency care, orthopedic services, and other care you need or expect to need.
  • Which providers can you see? – Many plans require you to go certain doctors or hospitals. If you go to a medical provider outside of the plan’s network of doctors, you will have greater out-of-pocket costs. Or you may be responsible for the entire costs.
  • What are your co-pays and deductibles? – Determine how much you will have to pay for doctors visits, prescriptions, and other care. Will you have to pay a certain amount of medical expenses on your own before the plan starts to provide benefits?
  • What about out-of-state care? – If you travel out of the state or out of the country, find out what your plan will pay if you need medical care.

There is a lot to consider, but an insurance professional can help you understand your options. Get assistance now to avoid ACA/Obama Care penalties for failure to enroll.

This post is sponsored by Hunt Insurance of Raleigh, NC.

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