According to national surveys conducted by the American Academy of Family Physicians Foundation, 89% of Americans value having a relationship with their physician who knows their health background and family and medical history. What’s more, 54 percent of millennials either are or would like to follow their health care professional on social media.
This desire for a more personal doctor-patient relationship makes practice models like direct primary care and concierge medicine attractive. Both of these models prioritize this personal relationship. So what makes them different, and how do you choose between them? Let’s take a closer look at each to help you understand your options.
Direct primary care (DPC)
Direct primary care (DPC) is a membership-based model where patients pay their physician directly through monthly, quarterly, or annual fees rather than paying through an insurance provider. The goal of this model is to give physicians consistent revenue without forcing them to spend time coding and billing like a primary care physician would, freeing them up to spend more time with their patients.
You as the patient, in turn, benefit from DPC because the membership fee covers the cost of all doctor visits and most primary care services that high deductible insurance plans might normally require you to pay entirely out of pocket. This membership fee won’t change no matter how many times you see your doctor or the amount of services you receive.
In addition to the unique payment model, patients can also expect longer visit times than with primary care physicians, quick access to their doctor by phone, text, email, and video chat, same-day or next-day appointments, and in some cases, even house calls.
Now that you understand the basics, let’s break down a few of the pros and cons.
The pros of direct primary care:
- Memberships can be set up on a monthly basis and you can cancel your membership at any time
- Members pay lower membership fees than concierge medicine
- The average membership fee costs $77 per month
- It is accepted by the Affordable Care Act as an acceptable non-insurance option
- That means you won’t pay any state-mandated fees for being uninsured
The cons of direct primary care:
- Physicians won’t accept payment through insurance
- While in some cases paying a membership fee is more affordable than high deductible insurance costs, some services aren’t covered by your membership fees (like a visit to a specialist, urgent care, or the hospital) and those will have to come out of pocket.
- It is considered an out-of-network provider
- This means any membership fees can’t be applied to your deductibles.
Who is direct primary care best for?
Given that DPC physicians don’t accept insurance like Medicare or Medicaid, younger, middle-income patients will typically benefit more from direct primary care than older, low-income patients. Also, DPC practices are more common in rural communities where there are physician shortages, so those in rural areas may especially benefit from the ease of access to physicians through DPC.
Just like with a DPC practice, concierge medicine is a membership-based practice that offers patients easier and faster access to physicians through a variety of virtual and in-house options, as well as longer appointment times than primary care physicians can offer.
However, unlike DPC practices, concierge medicine physicians charge your insurance company for your visit in addition to charging you a membership fee. This allows physicians to have two forms of revenue, while allowing you to get help paying for any services that aren’t covered by your membership fee.
Now let’s check out the pros and cons.
The pros of concierge medicine:
- Physicians accept payment through insurance
- It is considered an in-network provider
- This means any copays or related health costs can be deducted and your concierge medicine physician can serve as a patient advocate to refer you to other specialists, hospitals, or health providers.
The cons of concierge medicine:
- Concierge medicine only comes with annual memberships
- While the annual membership fee can be broken up into smaller monthly payments, the contracts are for a full year, and you can’t cancel midyear.
- It comes with higher membership fees than DPC
- The average membership fee costs $183 per month
- It’s not considered an acceptable non-insurance option by the Affordable Care Act
- If you choose concierge medicine and live in a state that requires health insurance, you’ll need to get an insurance policy in addition to paying your membership fees to avoid penalties.
Who is concierge medicine best for?
In a survey conducted by the Concierge Medicine Research Collective, an increasing share of patients at most concierge practices are people ages 50 and older. The cost of membership fees combined with a high-deductible health plan is oftentimes more affordable than traditional insurance for this age group. Patients who suffer from chronic illness or make multiple doctor visits throughout the year may also benefit from concierge medicine.
How to get reimbursed for out-of-pocket medical expenses
The great news about both DPC and concierge medicine is that many health costs that aren’t covered by your membership fees are reimbursable through your employer with a health reimbursement arrangement (HRA).
An HRA is a tax-free allowance to spend on any qualifying medical costs—so whether DPC, concierge medicine, or even primary care makes sense for your specific health needs, you’ll be able to get it covered.
PeopleKeep offers three HRAs that cater to any company size, budget, or insurance status:
- Qualified small employer HRA (QSEHRA)
- A simple, controlled-cost alternative to group health insurance.
- Individual coverage HRA (ICHRA)
- A flexible health benefit solution that can be used alone or alongside group health insurance.
- Group coverage HRA (GCHRA)
- A group health supplement to help employees with out-of-pocket expenses.
While you’ll often see terms like direct primary care and concierge medicine used interchangeably, you now know the important differences between these two membership-based practices to help you make an informed decision. Whether you like the low costs and monthly membership options offered by DPC practices, or prefer the ability to pay through your insurance with concierge medicine, there are options to help you get the personal care you deserve.