Does Direct Primary Care Count As Insurance?

Jun 25, 2021

Direct Primary Care (DPC) is an innovative, patient-centered model of healthcare that’s gaining popularity as a wonderful alternative to traditional fee-for-service or insurance based models of care, and it’s not difficult to see why! The DPC setup offers significant benefits to both patients and providers while getting the focus back where it should be…on the patient.

With that being said, there’s still a lot of confusion out there about what Direct Primary Care really is, how it differs from traditional healthcare models, and whether DPC counts as insurance. We’re here to answer those questions!

What Makes DPC Different?

Instead of charging a separate fee for each service (such as a co-pay for every office visit and then a bill for any services rendered), DPC practices simplify the billing process by operating on a membership basis! Patients pay an affordable, fixed monthly membership fee and, in return, gain access to a huge suite of primary health care services, including preventive care, urgent care, chronic disease management, in-office testing and procedures, and generic prescription medications from the office formulary – all included within the cost of that membership. For anything that’s not covered within the monthly membership fee (such as lab reading fees or an x-ray), patients pay negotiated out of pocket prices that are comparable or, in many cases, lower than what those same services would cost through insurance.

Do I Still Need Insurance If I’m A Patient At A DPC Practice?

While DPC is incredibly comprehensive, it’s important to remember that it is not the same thing as insurance. Because DPC does not involve any transfer of risk, it is not considered to be “insurance” in the traditional sense, nor is it regulated by state insurance commissioners. That’s why DPC members are often encouraged to purchase a supplemental wrap-around insurance policy to cover services that do not fall under the “primary health care umbrella,” such as emergency care, hospitalizations, and specialty care for complex illnesses and injuries.

DPC doesn’t replace insurance completely, but it does serve as a complementary form of healthcare that alleviates much of the patient’s financial burden while freeing the provider from the bureaucratic red tape present in insurance-based healthcare models that, in many cases, impedes their ability to provide quick treatment to patients.

The Bottom Line

As a form of risk management intended to protect you from financial loss, insurance can play an important role in covering the costs associated with life-threatening emergencies, hospitalizations, and specialist care for complex illnesses and injuries. However, using insurance to pay for primary health care services, which are frequently needed and relatively predictable, just doesn’t make sense. DPC is a practical alternative that ultimately allows physicians to practice medicine more effectively by having the time to listen to, empathize with, and care about their patients.

At Optimum Direct Care, our goal is to provide health care that is in your best interest, regardless of whether it fits within the cost-control constraints mandated by an insurance company. By providing you with convenient access to a physician you know and trust at a predictable cost, we’ll allow you to take better control of your health and ultimately inspire you to learn and maintain healthy habits over your lifetime.

If you’re ready to start on the path toward optimum health and wellness throughout your life, contact our team today!

“Dr. Muzzi knows me. She knows what I do for work, where I travel, sports and activities, our pets, what I wear to Burning Man and even knows my Dad (who approves!). Taken at face value, this may seem like a cute note to show that we’re friendly. But this depth of knowledge is organically woven into the care she provides every time we speak and my health is better for it. ”