For most patients, there’s no getting around the fact that cost is a significant factor when weighing healthcare choices. That’s one of the reasons that membership-based primary care options have become quite popular.
Direct primary care and concierge medicine are often lumped together because they both operate under that kind of membership-oriented structure. And on the surface, direct primary care costs and concierge medicine costs might seem similar. But there are some significant differences between the two when it comes to what you pay–and the care you receive.
Typical Direct Primary Care Costs
Direct primary care (or DPC) is still relatively new, and there are plenty of people who aren’t familiar with how it works. In a DPC setting, you pay a single monthly fee to your primary healthcare provider. That fee then covers all or nearly all of the primary care services you receive at that clinic. Visits tend to be longer, more thorough, and–often–more productive. Best of all, in a DPC setting your health insurance company is not billed, nor are they involved in any of your primary health decisions.
As a result, the out-of-pocket costs you’re responsible for under a direct primary care system usually fall into two categories:
- Monthly membership dues: The cost of your membership to a direct primary care clinic will vary from provider to provider. In general, however, you’ll have the option to pay annually, semi-annually, or monthly.
- Occasional out of pocket expenses: Your monthly membership will cover the vast majority of care at DPC clinic. But there are rare specialized procedures, diagnostics, or immunizations which may require additional payment because of increased costs of raw materials. However, patients will always know exactly how much these additional payments will be before the procedure is performed.
While health insurance is not a direct component of the cost structure at direct primary care clinics, many patients will keep coverage of some kind (the type of coverage you require will depend on your unique situation). So it’s important to factor that in when thinking about direct primary care costs.
Typical Concierge Medicine Costs
At first glance, concierge medicine costs have a lot in common with direct primary care models. However, concierge medicine developed as a way to offer luxury medical services. The idea was to build on existing insurance-based coverage rather than remove insurance from the equation. As a result, your insurance company is still very much involved with concierge care.
The cost of concierge medicine usually breaks down like this:
- Monthly membership dues: Concierge clinics use monthly dues to ensure that their physician-to-patient ratio stays low. Membership provides you with access to the clinic, but not necessarily to the services offered. These dues usually run at least a couple hundred dollars per month (often more).
- Costs of procedures: Every concierge clinic is different. Some standard and preventative procedures may be covered by your monthly dues. You may be charged more for additional care–blood work or women’s health exams, for example. How much extra you pay will depend on your insurance coverage and the specific clinic where you’re a member.
- Health insurance: Many concierge clinics require that you continue to carry health insurance and will, in fact, bill your insurance companies for your procedures and care. This means you’ll still be responsible for health insurance premiums, deductibles, and copays. Your health insurance company may also be able to veto certain procedures (or, at least, refuse to pay for those procedures).
That concierge clinics retain their dependence on health insurance makes it even more challenging to predict the costs involved. When you’re a member at a concierge clinic, it’s possible you’ll find a surprise bill from your insurance company–or find that you haven’t paid enough of your deductible to avoid out of pocket expenses.
Comparing Concierge Medicine and Direct Primary Care Costs
To compare concierge medicine and direct primary care in terms of costs, let’s look at what they have in common and what makes them each different.
What DPC and Concierge Medicine Have in Common
- Monthly fee: The most obvious element that both DPC and Concierge medicine has in common is that they both charge monthly membership fees.
- Access: Once you become a member of a DPC or a Concierge clinic, you’re granted certain benefits. It’s also true that at both DPC and Concierge clinics, one of the things you’re paying for is increased access to your physician. Appointments tend to be more thorough and less rushed.
Where Concierge Medicine and DPC Clinics are Different
- Coverage: DPC clinics will cover virtually all of the healthcare you receive within their walls under the banner of primary care. This includes preventive checkups as well as treatments for routine illnesses and more. That’s not necessarily true at a concierge clinic, where you could incur extra costs for treatments, often through your insurance company.
- Insurance: Concierge clinics still bill your insurance company. That means you’re still responsible for copays, deductibles, and more. Obviously, this can become quite confusing. A DPC clinic, on the other hand, will never bill your insurance company. All healthcare performed at a DPC is handled through that clinic. Your insurance never gets involved.
Where Progressive Health Primary Care Offers More
There may be other differences, especially on a clinic by clinic basis. At Progressive Health Primary Care, for example, there are specific services we offer that are either free or heavily discounted. Some of those services include the following:
- Covid-19 testing: Progressive Health Primary Care offers our members both PCR and rapid antigen Covid-19 testing. The PCR test is more accurate, but it can take several days to see your results. Antigen tests are slightly less accurate (they can sometimes provide false negatives), but results are visible within fifteen minutes. That’s why we recommend that most members undergo both types of tests.
- Pharmacogenetic Testing for Mental Health: Historically, finding the right prescription for mental health treatment has required a trial and error approach. Patients would try one medication to see if it worked. If the trial medication did not provide positive outcomes, another would be prescribed. This can be a time consuming and frustrating process. Genetic testing can help take that guesswork out of finding the right mental health treatment. Genetic tests will give your physician a good indication of what medications are likely to work (and which are best to avoid). Over the past 7 years, Dr. Liu has helped over 100 patients find excellent mental health medications thanks to this genetic testing.
- Discounts Prescription Medications: Prescription medication is a critical part of your overall medical care. At Progressive Health Primary Care, we make many prescriptions available in our office at a highly reduced cost. A full price prescription Icould cost you hundreds of dollars; even with insurance, you could still pay $50-$100 out of pocket, depending on your plan. At Progressive Health, this same prescription could cost you much less. With price transparency, you’ll always know what you’ll pay for a prescription well before you reach the pharmacy checkout counter.
- Medical Cannabis Consultation: In 2019, the Illinois Medical Cannabis Patient Program became a permanent institution. In order to participate in this program, patients need to go through a consultation process with a physician. Progressive Health offers these consultations for some specific patients, including those with PTSD or various types of cancers. These consultations are free to members of our practice, and include counseling and information regarding the safe, healthy, and responsible use of medical cannabis.
What’s Best For You?
Direct primary care has become popular because it offers a lot of benefits for a reasonable monthly membership due. Whether a DPC clinic is the best option for you will depend on your unique situation. Knowing the differences between concierge medicine costs and direct primary care costs can help you make an informed and thoughtful choice about the future of your primary care.
To find out more about direct primary care, contact our clinic to schedule an appointment with one of our physicians.