What is Direct Primary Care?
The direct primary care (DPC) model gives physicians an alternative to fee-for-service insurance billing, typically by charging patients a monthly fee. This fee includes most primary care services, including clinical services, care coordination, and comprehensive care management. It removes insurance companies and large health systems from dictating how care should be delivered and how much things should cost and the mysterious pricing and billing that happens behind closed doors. Basically it’s an attempt to return to the days of a simple exchange of goods and services.
Frequently Asked Questions
We do not replace insurance. To be compliant with ACA mandate and to ensure you have care in case of hospitalization and need for specialist we recommend having insurance too.
Do you take insurance? No we do not contract with insurance. This is how we keep care simple and transparent, but we acknowledge this means an upfront cost.
Can DPC and traditional health insurance work together?
Yes, many people choose to combine DPC with a high-deductible insurance plan. This combination allows them to use DPC for primary care services, while the high-deductible plan provides coverage for emergencies or high-cost medical events. This combination can potentially offer the benefits of both the DPC and traditional insurance models. Another option is to explore healthshare programs which is community based resource sharing. Some companies to explore are : Altrua, DPC Direct, HSA Secure, Medi-Share, netWell Healthshare, JHS Community, Liberty, OneShare Health, Prosper, Sedera, Samaritan, Universal Healthshare, and United Refuah.
It is important to note that a DPC membership alone does not meet the minimum essential coverage requirements under the ACA. Therefore, unless the individual is otherwise exempt, they could still face a tax penalty for not having a comprehensive health insurance plan. The penalty for not having minimum essential coverage has been reduced to zero at the federal level starting from the 2019 plan year, but some states have their own individual health insurance mandate and penalties. Oregon does not currently have a penalty. We still recommend having some coverage in the event of major medical events.
Can DPC cover major medical events?
No, DPC membership does not cover major medical events such as surgeries or emergencies. For this reason, individuals using DPC are advised to maintain a high-deductible emergency plan, traditional health insurance or a healthshare service for this comprehensive emergency coverage.
How will it improve my care?
DPC allows you to access your doctor as much as you need for a monthly fee. Same-day or next-day appointments are available in person or via telehealth. Overall, accessing health care is simpler and more convenient. The majority of doctors opening DPC clinics have cited wanting to improve care as the reason for their shifting away from more traditional fee for service structured clinics. The average panel size (number of patients) for a doctor is 400 in a DPC compared to 2000 in a traditional practice.
Will it save me money?
It may or may not. DPC membership has been shown to save some people money on their overall healthcare costs by reducing utilization of higher cost services (65% fewer ER visits, 66% fewer specialist visits, and 82% fewer surgeries). There are no co-pays, deductibles or hidden fees making costs predictable and potentially lower. There is no meeting your deductible before you can have that wart frozen off or avoiding visits to problem solve why your diabetes is out of control due to mounting copays. One ER visit in Portland can be over $1500 so if you have a high deductible insurance plan or no insurance most likely we will save you money. Our intention with this clinic is to lower the cost of care for you personally as well as the overall cost of healthcare on a community level. We also can coordinate lower prices on your regular medications, which can help you save some money.
Who should opt for a DPC?
Young adults, active older adults, people with minor non-emergency health issues or accidents or individuals with chronic conditions that can be managed with regular primary care may find DPC to be a good option for cost savings. Those people who anticipate needing extensive medical procedures, specialist visits and meet their deductible each year may not see reduced cost from a DPC. Other reasons to consider a DPC are the personalized care and quick and reliable access to a doctor.
Can I use my HSA for DPC membership costs?
No apparently not yet. There is legislation being put forward to allow for this. You can use the HSA for labs, imaging, medications which are costs not included in the membership.
Can I use my FSA for DPC membership costs?
Yes. You can use FSA funds for the membership fees.
How does payment work?
Payment is expected at the start of services, whether membership fees or non member urgent care visits.
Can I cancel membership?
Yes. You can cancel anytime but there is no prorated refunds. If you decide to reenroll after 90 days you will be charged the enrollment fee again.