Should I Get Health Insurance if I Join a Direct Primary Care Practice?

As a direct primary care practice, Progressive Health Primary Care will never bill your insurance company. That’s because nearly all of your healthcare services with Progressive Health will be covered by your monthly membership fee. As a result, it’s your doctor–not your insurance company–who guides your care.

But does that mean you don’t need any health insurance? Not necessarily. In fact, we typically recommend that members also maintain some level of health insurance. Thankfully, being a member of a direct primary care (or DPC) clinic means that you won’t have to rely on your insurance quite as heavily or nearly as often.

What You Need to Know About Direct Primary Care

By making the patient the center of its healthcare model, direct primary care is at once a revolutionary and old fashioned way of delivering medicine. DPC models bypass the hassle of insurance networks, co-pays and deductibles.

Instead, patients make a direct, monthly membership payment to the practice and receive access to a suite of healthcare procedures, screenings, and treatments. Progressive Health Primary Care is a DPC clinic, though we put a few of our own twists on the model.

Generally, the direct primary care model is popular for two reasons:

  • Patients receive more attention: Direct primary care clinics are able to keep their patient counts low. This means that doctors are able to spend more quality time with patients, answering questions and going over care. In a DPC setting, a doctor has the time to become deeply invested in your care.
  • Primary care becomes central: Because of your relationship with the direct primary care clinic, the vast majority of your healthcare will be overseen by a single physician you trust–a doctor who becomes an expert on your health. Even when you need to see a specialist outside your DPC, the results and treatment plans will be monitored by your primary care doctor to ensure the totality of your health improves.

There are supplemental benefits that DPCs offer as well. For example, your primary healthcare is no longer tied to your employer, so if you switch jobs you don’t have to change doctors. Likewise, if you lose your job, you won’t have to go through the hassle and expense of COBRA to keep your doctor. If you’re paying for your own health insurance, you can keep your primary care doctor no matter what changes the insurance carrier makes. In our practice we dispense prescription medications to our patients at discounts that are usually lower than the co-pay at most pharmacies, which brings additional savings to our patients.

Do I Still Need Health Insurance?

As a member of a DPC clinic, the vast majority of your routine care will be included in your membership package (depending on your membership level). But any care you require outside of the Primary Care setting will not be covered. So we still recommend that members consider carrying insurance.

For most DPC members, however, additional health insurance will not need to be as comprehensive as you might expect. In general, we find that many patients consider one of the following options:

  • Catastrophic Insurance: Some health insurance plans are designed primarily to cover catastrophic care. In the event of a car accident or cancer diagnosis, for example, you would be covered for the vast majority of emergency care. These plans usually have a low monthly cost but carry a considerable deductible. That makes catastrophic insurance impractical for everyday care, but ideal to keep in your back pocket for emergency services.
  • Health Savings Accounts (HSAs): Many employers offer a Health Savings Account, which is a special type of pre-tax savings account that can be deployed for medical expenses. HSAs can be used to pay for a variety of medical services, so they are often a good way for DPC members to handle any supplemental costs that occur due to emergency needs or specialist visits.
  • Flexible Savings Accounts (FSAs): In addition to an HSA, employers may also offer what’s called a Flexible Savings Account, or FSA. An FSA is a dedicated, pre-income-tax savings account for medical expenses, and in that way it’s very similar to an HSA. But there’s an important difference. The money in your FSA will not roll over from year to year, which means you can lose any funds that you have not spent. That makes an FSA a good option for anyone with predictable and routine medical expenses.
  • Other Insurance: If you require a significant amount of specialist care, you may want to look into a more robust insurance plan to augment your DPC membership.

It’s also important to note that just because you have health insurance doesn’t necessarily mean you need to use it. Even if you already have health insurance, you can still join a DPC clinic for your primary care. Doing that saves you deductibles and copays, which could make direct primary care a more affordable option in the long run. Likewise, you can always pay cash for your medical services–and DPCs often free patients up to do precisely that.

The vast majority of our members’ medical needs are met by their DPC clinic. When your primary care is secure, health insurance goes back to being exactly that: insurance–something to keep in your back pocket for a rainy day.

Making Healthcare Personal

Choosing insurance is always going to be a rather personal decision. So you can receive the very best personalized advice for your situation, we recommend that our members sit down with a highly qualified health insurance broker.

If you have questions about Progressive Health Primary Care, contact us to schedule an appointment with a member of our team.