It’s almost Open Enrollment season for the Marketplace, and it’s the time of year where we can get confused about health insurance. I am writing a series of articles to answer general questions about why Direct Primary Care works so well with certain kinds of health insurance. This first article is about Direct Primary Care and high deductible health insurance. (Of note, people with employer based health insurance typically have fewer plan choices, so it’s not quite as overwhelming, though this information is still relevant.)
What is the deductible?
The “deductible” is the amount of money that you have to pay before your insurance will start paying for your care. This can be confusing because your insurance HAS to pay for certain things (your annual exam, your mammogram, your screening colonoscopy, most immunizations) so you don’t have to deal with your deductible for those services. However, if your mammogram or colonoscopy shows something suspicious and you need a biopsy, now you have to think about your deductible because you have to pay for the biopsy. Additionally, if you see your primary care physician for a cough or for back pain, you may have to pay for the entire visit AND any labs or imaging that might be needed. You won’t even know how much you pay until weeks later, which is an aggravating aspect of the health care system.
Is my healthcare free after I pay my deductible?
After you pay your deductible, your insurance will start paying more for the care you receive that year, though you probably still have “co-insurance” to pay, which is often 20% of whatever you are charged. It means that your insurance is picking up most of the charge (after you paid your deductible) but that you still can expect a bill. You will probably also still have your co-pay on your office visits (generally $20-40 per visit depending on whether you’re seeing your primary care doctor or a specialist).
What is a high deductible versus a low deductible?
Deductibles can vary widely. Looking on the cost estimator site for PPO plans at Healthcare.gov for a family of 4, a deductible ranges from $14000 for the Blue Cross Premier PPO Bronze HSA to only $1500 for the Blue Cross Premier PPO Gold. Of course, the monthly cost for these plans is quite different, and the high deductible plan is $1130/month cheaper than the low-deductible plan. Your actual monthly cost for these plans varies with your income, age, tobacco use history and household size, so I am just showing the difference in the monthly costs for discussion purposes. (Of note, I wrote a separate article about PPO vs HMO plans).
High Deductible Plans are cheaper because you take on more of the risk for your health care costs in a given year. Depending on your income, you might be able to get a Bronze high deductible plan for no/low monthly cost off the Marketplace. You can then use a fraction of that money that you are saving to pay for a membership at NorthCountry Health Direct Primary Care!
How does NorthCountry Health Direct Primary Care work well with a high deductible plan?
NorthCountry Health DPC is not an insurance plan. However, a membership at NorthCountry Health Direct Primary Care can work well for patients with the high deductible plans because you can count on getting your primary care (and likely most of your urgent care needs) for a low, fixed monthly cost. At NorthCountry Health, there are no co-pays, no co-insurance and no surprises. We offer other ways to save you money because we offer cash-pay prices on labs and cash-pay prices on common generic medications. We have the time to look into cheaper options for imaging studies that might work for you. We can even help you find cash-based surgery centers in the Midwest! You can still use your insurance for labs, medications, imaging and specialist procedures if you want to, but you’ll have the opportunity to do the math and figure out what will be the best deal for you.
If you have further questions about Direct Primary Care and how it might work for you and your family, please reach out and set up a free meet and greet with Dr. Ryan Brang.