Direct Primary Care meets primary care needs – how to pay for other needs outside of insurance…
Did you decide that you could’t afford to continue with your health insurance and are looking for another way to help pay for catastrophic health issues? Unfortunately, you are not alone. While Direct Primary Care is an excellent way to get your primary care needs met – it doesn’t provide help with paying for catastrophic health problems where you may need to be hospitalized or have surgery. Many people will opt for a high deductible plan and pair it with DPC – but even those plans prices have risen out of many people’s reach. Joining a health cost-sharing plan is a solution that can help pay for serious medical issues.
What are Cost Sharing Health Plans?
Cost Sharing Health Plans may be either faith-based or not faith-based. Some of the faith-based ones (also called Health Sharing Ministries) have been around for many years, and people who had them were exempt from paying the penalty for not having ACA compliant health insurance. Newer plans, like Sedera, were not grandfathered in and do not exempt people from paying the penalty – although this is a moot point now for individuals. Some plans, like Sedera, can be provided by employers to help care for their employees and can be paired with another insurance product – called a MEC plan (minimal essential coverage plan) as well as direct primary care.
Limitations/ Considerations on Cost Sharing Health Plans
Since these plans are not insurance, they are not required to cover all the same things that ACA plans do. Pre-existing conditions may not be included – or only partially covered for several years, people with specific health problems may not be accepted, mental health coverage is unfortunately poor, and some of the plans require participants to sign a statement of faith. However, for many people the price difference, as well as a different philosophy, make it a desirable alternative. There are different levels of coverage available. A membership for a family with $1,000,000 coverage is generally under $500/mo with most of these plans – instead of well over $1600/mo with the plans that are found on the marketplace. There are programs with less coverage, but I would be hesitant to suggest people consider them.
Another DPC physician I know put together a chart that lists some of the major Cost Sharing plans and wrote a recent blog post. Click HERE to link to his chart/blog. PLEASE read the plan specific sites well and ask questions before signing up – they are not right for everyone – but for many people is a great way to get help when you need it. These plans are based on principle’s of individual responsibility and helping others who are in need. These are member to member payments – either directly or indirectly – to help each other – instead of paying a large corporation whose motives may or may not be aligned with the patients’. Also, as I said earlier – this is not insurance – but a great alternative to investigate.
Health Sharing Plans and DPC
Some Health Sharing Plans may partially reimburse or discount monthly sharing amounts for people participating in a direct primary care practice. Sedera is only available for individuals at this time who are affiliated with a direct primary care practice. That is why there is an enrollment link on my sign-up page – not that I am endorsing them over any other plan. They are simply the only group that has reached out to the Direct Primary Care community to make it easier for patients to enroll and and include it in their monthly bill from DPC Practices. You can sign up after you join, and it is definitely not required.
If you are a patient of mine and are interested in learning more about health sharing plans and whether or not they would possibly meet your needs, please contact me to talk about this further.
***Note *** This post, like all my other posts, is for general information only and is not to be taken as direct advice. Please consult your personal physician, insurance agent, or financial advisor for more information.