By Peter D. Holt
Even with the Affordable Care Act, millions are still uninsured, and health insurance rates continue to climb for millions more. In response, many consumers opt for high-deductible plans with lower premiums that actually cost more to use. In 2014, we saw the largest ever one-year enrollment increase in such high-deductible plans, from 18 percent to 23 percent of all employees with health insurance, according to Mercer’s National Survey of Employer-Sponsored Health Plans.
While high-deductible plans pick up most of the tab for hospitalizations or other forms of acute care, they leave enrollees to cover the full cost of nonemergency but still important medical procedures and checkups. This encourages enrollees to put off nonemergency care, an unintended consequence that runs counter to the original intent of the Affordable Care Act.
The good news is that self-pay, noninsurance models can fill in the gaps left by traditional insurance. One increasingly popular alternative is called direct primary care. Supported by a growing number of physicians across the country, this model combines a monthly membership fee for expanded primary care services with high-deductible catastrophic coverage for heart attacks, cancer care and other acute or long-term illnesses.
Such practices already operate in most states, according to the Direct Primary Care Coalition. For a monthly fee that varies according to age, direct primary care gives consumers access to doctor’s office visits and includes in-office X-rays, 24/7 email and phone contact with their doctor and more.
Another similar model, personalized telehealth services, has ushered in perhaps the most affordable private-pay model of all. In one popular plan, individuals can remotely access doctors via their mobile devices or PCs for $11 per month, while an entire family can subscribe to the plan for $15 per month. While this does not address emergency care needs, it greatly complements a high-deductible plan at a fee affordable to practically everyone.
Indeed, direct primary care is often provided as a voluntary alternative within the health benefit plans of employers such as Expedia and Comcast. Doctors in direct primary care practices love the model because it lets them practice the kind of old-fashioned, hands-on medicine that drew them to the profession, minus the onerous requirements of traditional insurance.
As the direct primary care model indicates, consumers may be better off paying for some of their healthcare services via a cash/credit, private-pay model instead of insurance premiums. For example, patients at the chiropractic clinics run by The Joint Corp. save money by not using their insurance.
According to a 2014 survey from The Physicians Foundation, 17 percent of physicians 45 or younger indicate they are planning to convert to a direct-pay practice in the near future. Direct primary care and other private-pay alternatives to traditional health insurance put the practice of medicine back into doctors’ hands, at prices their patients can afford.