Direct Primary Care Refresher: What if I already have insurance?

We routinely get questions about how direct primary care works for people who already have insurance.  Now is a great time to revisit this question, as the February 1st deadline for open enrollment approaches.  Insurance is a good thing.  It covers us when we have major events like accidents, severe illness, and surgery.  It is also currently mandated by law under the Affordable Care Act.  We encourage patients to carry some form of health insurance for the big stuff if they are able.  

On the other hand, what we pay for insurance isn't so good!  In fact, it is outrageous.  We see rate hikes every year in premiums and deductibles.  This is where direct primary care can help.  We as healthcare consumers collectively have been paying much more as the years go by for insurance to do more than it should; to cover our everyday medical care, minor illness and preventive care.  This has driven up the cost of primary care considerably.  We can still do primary care for our patients and families at a much more reasonable cost, with better quality of service than traditional practices that are stuck with the rules of third party payers (insurance companies).  We do this by not involving insurance companies.  

We encourage people to challenge the current status quo.  Look for high deductible insurance options to cover the big stuff and use us for your primary care.  For many, even if you made no change in your current insurance coverage, you would still pay less annually for your primary care using our membership than your current insurance deductible.  Below are some scenarios to illustrate this point using our membership, the best priced local health plan we could find, and a Christian cost-sharing ministry that meets the ACA mandate for insurance:

Single Adult

  • Our membership: $39/mo = $468/yr, no deductible.
  • CoxHealthPlans Bronze: $227/mo = $2724/yr, $6300 deductible, $6300 max out-of-pocket.
  • CoxHealthPlans Silver: $297/mo = $3564/yr, $3000 deductible, $6350 max out-of-pocket.
  • CoxHealthPlans Gold: $370/mo = $4440/yr, $1500 deductible, $5000 max out-of-pocket.

In this scenario, even the plan with the most comprehensive coverage still has a $1500 deductible.  That is over three times the cost of our yearly membership.  Even if you have expensive insurance coverage, you stand to save money by doing our membership if you never hit your deductible for the year.  Now compare that most comprehensive Gold plan to our membership plus the higher deductible bronze plan.  $39/mo + $227/mo = $266/mo compared to $370/mo with the Gold plan, a savings of over $100/mo or $1248 per year!

Family of Four

  • Our membership: $156/mo = $1872/yr, no deductible.
  • CoxHealthPlans Bronze: $666/mo = $7992/yr, $6300 deductible, $6300 max out-of-pocket.
  • CoxHealthPlans Silver: $869/mo = $10,428/yr, $3000 deductible, $6350 max out-of-pocket.
  • CoxHealthPlans Gold: $1085/mo = $13,020/yr, $1500 deductible, $5000 max out-of-pocket.
  • Medi-share high deductible: $265/mo = $3180/yr, $7500 deductible.
  • Medi-share mid deductible: $442/mo = $5304/yr, $3750 deductible.
  • Medi-share low deductible: $683/mo = $8196/yr, $1250 deductible.

Deductibles listed for the insurance options are for one individual.  The deductible for the family will be somewhat higher.  So, once again, our membership is still less than even the smallest deductible from the most expensive, comprehensive insurance plan.  Let's look at the potential savings when you combine our membership with the most affordable insurance option and then with the cost-sharing ministry.

Our membership and the Bronze plan: $156/mo + $666/mo = $822/mo.  Still more affordable than the Silver plan alone and a savings of $263/mo or over $3,000 per year compared to the Gold plan!

Now the cost-sharing ministry + our membership.  Medi-share does not cover preventive services, which pairs well with our membership, since we do!  Our membership + Medi-share high deductible option would be $421/mo, over $200/mo less than even the most affordable Bronze insurance plan.  That's almost $3000 less per year and almost $8000 less per year than the Gold plan!

Now, keep in mind, these are some of the most affordable carriers I could find, so other insurances may be substantially more expensive than what you see above.  And there is some nuance to all of this.  Pricing is going to vary based on age, smoking status, etc.  You have to study up, seek an expert, do your homework.  But it may be time for a change that could bring you substantial savings AND better healthcare!  Give us a call.