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Why is it that something so obvious and desired can be right under our nose, yet is not common knowledge? Although millions of us have discovered a simpler and more affordable healthcare solution, there are still so many who have no idea that it even exists as a choice for their healthcare needs. Much like health insurance itself, one of the main problems is that for most it is a frustrating element of life to plan each year. Purchasing healthcare is expensive, time consuming, and when we go to use it we are confused every step of the way. We simply do not want to spend the time or go down that rabbit hole of something we do not understand. The good news is that this affordable solution will also alleviate many of these areas we all find problematic.

2 Step Solution

Although this is not a one-size-fits-all plan, there are two basic steps to all of this.  Step one will involve selecting a direct primary care provider (DPC) and step two will involve selecting either a high deductible health insurance plan or a medical cost sharing plan. 

Breaking it down in such a way will simplify the process even further and hopefully shed some light on an approach that is unique and not discussed often in the mainstream.  It is important to know what all of this means and the pros and cons of your selections as they will apply to your individual needs.

Step 1

Planning the first step is through electing a direct primary care (DPC) (sometimes referred to as a direct care provider (DCP)). This service is best summed up by those complaints that so many of us have after our annual primary care visit. We go in for our visit, wait too long to see our doctor, and then our doctor sits behind a computer screen typing while asking a series of questions that are not relevant to our health and what we would like to discuss. At the end of our 15 minute visit we feel scurried out of the office and are overall unsatisfied with our visit. This or some version of this is common place for our doctors visits in today’s world. We know that this is not the doctor’s fault and due to insurance company and hospital group requirements they have to see patients in this fast paced manner. This is exactly why the direct primary care movement is happening right now across the country. Not only are we as patients tired of this process, but so are our doctors!

Direct Primary Care

Although these practices each function differently I will summarize DPC practices in a broad sense. These are either individual physicians, or more typically groups of physicians that have broken away from the world of networks and insurance companies. They charge a monthly membership (usually quite affordable) for access to their services as needed. This certainly brings back the positive relationship between the PCP and patient that has dwindled over the years in our current system. In return, we as members will get access to that DPC’s services on an as needed basis, without paying further costs or copays. There are services beyond the scope of those membership costs such as labs, prescriptions, and services performed at an out-patient facility. A DPC will most often offer discounts and suggest preferred vendors to use to help minimize the out-of-pocket costs for services of this nature. What works so well is that a DPC is now genuinely vested in their patient and there to help with important patient decisions. Surprising to most is that these Direct Primary Care practices are available everywhere across the country, many of which even offer naturalistic and homeopathic options. Now that you have heard of this concept, I urge you to conduct your own Google search to learn more about the local DPC practices available in your area.

Step 2:

While DPC’s solve a healthcare need at a low cost, they do not provide everything that we need for our complete healthcare planning. You are probably asking yourself what you might do about catastrophic claims that a DPC would not perform such as an emergency visit. That takes us to step 2 in the planning process. There are two solutions to this problem and each individual needs to evaluate what works best for them.

DPC + High Deductible Health Insurance

One answer is a high deductible health insurance plan also known as a Bronze plans. If you are receiving financial assistance through a subsidy then this could be a perfect solution. If your income is too high to be eligible, this solution of DPC membership + high deductible health insurance plan may be too expensive for you. This is especially true since this high deductible health insurance plan will have a $7,900 out-of-pocket maximum each year. This approach, combining the two plans, will not yield very much savings in the end, but does give many of you access to a direct primary care membership.

DPC + Medical Cost Sharing 

What you will likely find to be the most cost effective way to access your own direct care provider is through the combination with medical cost sharing.  Again, if this concept is new to you I recommend a Google search to learn more than I can include in this blog. The combination of DPC + medical cost sharing will save most of us about 40-60% on monthly costs versus a traditional health insurance plan (with no subsidy). With that monthly savings, you will lower your out-of-pocket costs from $7,900 with a health insurance plan to around $1,000-$2,500 for a catastrophic claim. Yes, by having access to your own personal doctor and lowering your out-of-pocket exposure to a catastrophic claim you can pay about half on a monthly basis. This approach is not for everyone and is recommended for healthier individuals due to the restrictions or pre-existing conditions with medical cost sharing. This also helps to explain the much lower cost and those with serious pre-existing conditions should carry a traditional health insurance plan. It is important to know that medical cost sharing is not insurance and will work differently. There are quite a few of these medical cost sharing communities and they can work very differently from one another. We find the simplest and best designed one that pairs with DPC practices to be ZionHealth.org. There are also many others out there and they will all help save significant money as it compares to health insurance.

 

How Much Can You Save?

This should now be captivating to you and is an obvious reason why this revolution in healthcare is happening right now. I want to give a quick example of the costs and how to plan DPS + medical cost sharing and you can compare on your own how much the health insurance costs would be in your area. As a quick note, an IUA is medical cost sharing lingo for initial unsharable amount and will work similar to a deductible and out-of-pocket maximum. Its important to learn these and other differences when exploring medical cost sharing.

A 45 year old couple will pay about $100 per month for a DPC membership on average. This could be higher or lower based on the particular practice and the services offered. If this couple combines that DPC coverage with Zion Health’s $2,500 IUA plan for $250 a month, they will have a monthly healthcare cost of $350 which is about half of what they would pay for a Bronze health insurance plan in most areas. They also have have now eliminated their physician copays and their exposure to a large catastrophic claim is only $2,500.

Anyone who has planned their health insurance will clearly see the the potential annual savings in their healthcare costs. I can not say it enough, we need to make this more common knowledge for all!

 

Advantages of DPC + Medical Cost Sharing with ZionHealth.org

  • Average 40-60% savings
  • No network restrictions
  • Lower-out-of pocket exposure for catastrophic claims
  • Relationship with Primary Care Physician
  • End of life planning allowance $10,000
  • Combined billing with many DPC practices
  • No annual caps
  • No separate bank account needed
  • No religious requirements
  • Pre-existing condition coverage phased in after 1 year
  • World wide coverage
  • Encouraged healthy living
  • Coverage available for alternative treatments not covered by traditional insurance
  • Simplified need (claims) processing
  • No open enrollment deadlines, apply all year long!

 

Helpful Links

https://zionhealth.org/

https://www.mgma.com/data/data-stories/advantages-and-limitations-of-the-direct-primary-c

https://www.dpcare.org/