What Is Direct Primary Care, and How Does it Affect My HealthShare Membership?

Direct primary care (DPC) is another response to the skyrocketing costs of traditional health insurance. DPC providers are tired of cutting their time with patients short to fill out insurance paperwork, so they created a new model. Instead of accepting insurance, these doctors ask patients to pay a flat-rate, monthly fee (this fee appears to be about $100, depending on the location). In exchange, patients have unlimited access to primary care.

DPC Providers can spend much more time with their patients with no insurance paperwork to worry about, and appointments can be an hour long. Patients can see a doctor whenever they need and can also have consultations by text or over the phone. This arrangement makes it easy to get checkups, vaccines, blood tests, and other simple, routine care—and it has become increasingly popular since 2009. The Direct Primary Care Coalition claims “today, about 1,200 DPC practices in 48 states provide peerless access to great primary care to over 300,000 American patients.” As insurance costs continue to rise, it seems likely that the DPC idea will continue to spread.

So, if you already belong to a HealthShare and are interested in DPC, how might that affect you and your HealthShare membership? Well, it depends on a few things.

Does your HealthShare encourage direct primary care?

Does your HealthShare recommend using direct primary care? A few HealthShares do! Several are trying to improve their plan options by offering more help with preventive care, and an easy solution for that is to allow sharing for DPC membership costs. If your HealthShare’s member guidelines mention DPC, congratulations, you don’t need to read the rest of this blog.

Does your program include preventive care?

Does your specific plan allow sharing for preventive care? Most HealthShares offer at least one program that only shares costs for major medical bills, such as hospital visits. In this case, adding a DPC membership for your preventive care can be a great idea! But if your membership already includes sharing for some preventive services, you may have everything you need with only a HealthShare membership. Some HealthShares, however, like Zion Health and Sedera, will incentivize members with exclusive rates or different membership types that are made to pair specifically with direct primary care. For example, Zion Health memberships usually include some preventive care services and telemedicine, but they can access a lower membership rate without these features if they enroll in a DPC practice.

The good news is that nearly all HealthShares allow members to change their membership at least once, so if you are on a basic plan and want to switch to one that will help share costs of preventive care, you probably can.

Need more information? Just Ask.

When in doubt, the best thing you can do is ask. It’s great that healthcare is evolving to include new options, new ideas, and new ways to pay its bills. It really looks like we’re heading toward a better place with so many people trying to think of new ways to approach how we take care of ourselves. But the flip side of all this change is that things can get confusing. If the guidelines for your HealthShare membership aren’t clear about DPC membership, call and ask. You might be pleasantly surprised.


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