Direct Primary Care: How It Works

Direct Primary Care: How It Works

April 10, 2024

 

Direct primary care is a business model that allows physicians to offer services directly to their patients in exchange for a monthly or annual membership fee. The DPC membership fee allows patients to receive a wide variety of treatments and services with no additional fees. The DPC contract can replace traditional fee-for-service billing with third-party insurance plans because it provides regular, recurring monthly revenue to practices. The income from direct primary care memberships can sustain a practice’s finances, allowing the physicians and office staff to focus on the health and satisfaction of the patient rather than billing and coding. Patients benefit from the direct primary care model because it covers most primary care services in the contract. A DPC membership plan can be more affordable and provide greater customer satisfaction than traditional medical insurance in primary care. In this article, you’ll learn how direct primary care memberships can be beneficial to you.

The Benefits of DPC Membership

More Time for Patient Care

Cutting out the middleman of health insurance, physicians working with direct primary care memberships spend less time dealing with paperwork and bureaucracy than traditional health insurance deals with. Because physicians and their staff can spend less time on administrative tasks, they have more time to spend with their patients. When a physician has more time to spend with their patients, it leads to an improved and more trustworthy doctor-patient relationship.

Less Costs

Patients pay one monthly or annual fee for a DPC membership. There are no additional fees or copays for each treatment or service. The membership fee pays for all primary care services, making it less likely for patients to avoid seeking care or treatment due to costs. Allowing physicians and their staff to help patients as soon as a problem arises.

More Convenient

Most DPC memberships will cover telehealth services, allowing patients to receive care via phone, email, or video chat. All of these telehealth services can be a more efficient and convenient way to receive primary care than in-person consultations, depending on the situation.

 

Photo by National Cancer Institute on Unsplash

How Much Does A DPC Membership Cost?

Direct primary care memberships typically cost between $50 to $150 a month. DPC memberships are typically lower for children and higher for adults and families. The members themselves can pay fees, or employers can also offer DPC memberships, typically alongside a self-insured major medical health plan

 

Patients will pay no additional costs for care and treatment that are fully covered under the DPC membership plan. That’s why it is important to understand the terms of what’s covered and what isn’t covered in your membership plan. Some memberships cover more treatments than others. Prescription medications and lab work services may require additional fees to be paid depending on the membership plan. However, DPC memberships can be structured so that patients are able to pay wholesale costs instead of retail costs.

 

Photo by National Cancer Institute on Unsplash

DPC Memberships Can’t Replace Traditional Health Care Insurance

Medical services beyond primary care, like surgery and specialist treatment, most likely won’t be covered in your direct primary care membership. Since surgeries, specialist treatments, and prescription medications can be unaffordable, direct primary care programs typically suggest their members also have a form of major medical health insurance coverage. Although the direct primary care membership structure can’t provide coverage for major medical treatments, a DPC membership provides physicians who focus on the overall well-being of their patients so that they can potentially avoid major medical treatments.

Regulation of Direct Primary Care Plans

The Affordable Care Act allows ACA-compliant health insurance plans to provide primary care through a DPC membership. But, most DPC memberships are stand-alone plans, separate from major medical health insurance. Before 2019, the ACA required all Americans to hold a health insurance plan unless they had exemptions, and a DPC membership didn’t fulfill this requirement. But now, some states have changed their stance on DPC memberships and how they can be regulated. If you are considering a direct primary care plan, you should contact your state’s insurance department to find out how DPC memberships are regulated in your state.

 

Photo by CDC on Unsplash

Overview

Direct primary care memberships are growing increasingly popular in the United States. The DPC structure is a great way for patients to receive primary care services for a monthly or annual fee with no additional fees. Remember that if you are considering a DPC membership, you most likely still need to have major medical health insurance to cover treatments outside of primary care. Traditional health insurance can be expensive and cause families to forgo some primary care services when they really need them. This is where a DPC membership comes in; the benefits of being able to pay an affordable monthly or annual fee let patients get the primary care they need whenever something comes up. Telehealth, through phone calls, email, and video chat, also provides a convenient way for patients to receive primary care. If you are considering a direct primary care membership, make sure to read the terms and conditions of your plan, understand your state’s regulations, and talk to your primary care provider before signing up for a membership.

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