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September 2017  Volume 15, Number 9        

health benefits

Could Direct Primary Care Control Your Health Care Benefit Costs?

Affordable Care Act marketplaces are closing at an alarming rate. Health care benefit costs are soaring. Some Republicans are trying to to repeal and replace the current Affordable Care Act and others in Congress just want to make changes before it implodes. Meanwhile, coverage isn’t getting any cheaper, and many Americans are left wondering what options they have for affordable health care coverage.

A new health care model called direct primary care is being touted as an alternative to traditional health insurance. Combined with supplemental insurance, it’s proving to be an appealing alternative for employers who are looking for reasonably priced benefit plans and great benefits for their employees.

Current Insurance Situation

Automobile, home and life insurance policies typically cover the costs of catastrophic events like accidents. Health insurance is different. Although it was originally designed to cover expensive health issues, such as heart attacks or cancer, it’s now used to help with the cost of routine doctor visits. Primary care has become so expensive, few people can afford it without financial assistance.

What DPC Is and How it Works

Direct Primary Care practitioners don’t accept insurance for routine care. Instead, members of a DPC pay the practice a monthly fee. In return for that fee, they have access to routine physicals, acute care, chronic condition management, prescription refills and basic lab work. The cost is usually less than $90 per month for an individual.

To cover the catastrophic expenses, like a broken leg or a stroke, DPC arrangements often are paired with health insurance. While some insurers might provide a plan that duplicates the primary care coverage, other insurers are now providing coverage that strips out the primary care coverage and just focuses on catastrophic services.

Remember that the Affordable Care Act still requires individuals to have health insurance. If the plan that’s paired with the DPC doesn’t provide the minimum essential benefits, the DPC member might have to pay a penalty to the government.

Experts say that a DPC arrangement can save employers up to 40 percent on health care costs because the practitioner’s practice has less overhead — fewer staff members need to be hired to file insurance claims. Therefore, DPC can save employers double-digits over traditional group plans. Employees save on their out-of-pocket expenses.

More importantly, most DPCs are known for prompt appointments, exceptional care and direct phone and email access because they see fewer patients.

Types of DPC-Based Solutions

If you talk to a broker about setting up a DPC arrangement for your company, they will want to know how much of the cost you plan to cover for your employees. The basic DPC-based solutions include:

  • Stand-Alone Employer-Paid – Employer pays for employees’ health care fully or partially.
  • Stand-Alone Voluntary – Employees pay 100 percent of their costs.
  • Health Allowance – Employers offer a DPC membership, but do not sponsor a group plan. Instead, they provide a health allowance for employees to use to purchase their own health insurance. Employees can choose less expensive health plans because they know that DPC membership will take care of a majority of their health care needs.

Who Is a Good Candidate?

A key issue in determining whether you and your employees would be a good fit for a DPC is whether everyone in the company lives within driving distance of a DPC practitioner. You also must have no plans to move the company in the near future.

Remember that this is a nontraditional type of coverage, and many of your employees might be concerned whether this type of plan is as good as what they are used to.

If you think your company might be a good candidate for direct primary care, please contact us.

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In this issue:

This Just In...

Could Direct Primary Care Control Your Health Care Benefit Costs?

Opioid Addiction in the Workplace: How to Help Employees

Switching to a High-Deductible Health Plan? Here’s How to Explain the Change

Great Reasons to Offer a 529 Savings Plan



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