HOUSTON – Health insurance can be costly for families and employers. But did you know you have other options to get covered and avoid paying a tax penalty? There’s concierge medicine, which can give you exclusive access to your primary care doctor, a real VIP service. And there’s direct primary care, which is all the special treatment, at a more affordable cost.
We first told you about direct primary care in 2021. Since then, it’s grown; a simple search online finds many options in Houston.
Here are just a few:
Some doctors choose this route because they want to really get to know their patients. Dr. Bhavana Rao told us in traditional family medicine it’s not always possible.
“If you have a 15-minute visit, and you have five issues to discuss. It’s hard for anyone you know,” said Dr. Rao.
That’s why she liked the idea of direct primary care, A.K.A. a monthly subscription to doctors. You pay monthly subscriptions for all kinds of services, so why not use them for your doctor?
How much does direct medical care really cost?
“Direct primary care practices don’t submit any bills or invoices for consultations, two insurances. And it is much more affordable,” said Dr. Rao.
With direct primary care, you pay an annual or monthly fee and can get benefits such as same-day appointments, calls, and/or text messages with your doctor. This can be any time of the day or night.
“Yeah, the only doctor that I’ve ever had or know of that will text, like she will text make sure we’re okay. Or if we have a question. We’ll send her a text. And she’ll get back to us like, within short, I mean, within a half an hour for sure,” said patient Jeff Newkirk.
What about healthcare for the kids?
The Newkirk family has used this type of medical care for years. Their kids can also use the service and they don’t even live here!
“We have three college kids. And whenever they have an issue, they can just you know, they’ll call me up and say, ‘Hey, mom, I feel this way.’ And I’ll say well, contact, Dr. Rao. And they do and she takes care of everything virtually,” said Diane Newkirk.
The Newkirk family says they now don’t need traditional health insurance. It might be a scary thought, but Sunil says it could work for a lot of families.
“We know that car insurance is for accidents, homeowners insurance, we know if it’s something we can pay out of pocket and fix it. We’re not going to go to insurance. But health insurance in this country is framed so the way it’s framed is it’s something that you have to use for everything. And insurance is not built for that insurance is built for something that is rare,” said Sunil Vashsist.
How does direct care compare with traditional insurance?
Let’s break this down. According to the Kaiser Family Foundation, the average person pays $7,470 for health insurance every year. Plus copays, prescriptions, and whatever it takes to meet your deductible. The average annual cost for a whole family is $21,342.
What’s the monthly membership fee?
“It’s $75 an adult and we have discounted rates for kids, for children below 21 years of age, and that’s $15 per child,” said Dr. Rao.
We checked around and $75 is about average for a direct primary care service. Some direct access cost a little more or a little less but most are in this ballpark. If you pay $75 a month for a year. A family of four at Meridian Springs Primary Care would pay about $2,160. That’s without any insurance for an emergency hospital stay or surgery.
Newkirk says his family won’t consider going back to the old premium way of doing health insurance.
“No way. No, because this is so it’s stressful. You know, the old way is stressful. You never know what specialist you can go to what’s covered here. You know, you know, Dr. Rao is going to be there. She’s accessible. She knows you as a person and a patient because she cares and she takes time. There’s no way you can replace that,” said Newkirk.
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What if you need a specialist?
If you are someone who needs speciality care like dialysis, cancer patients, or someone with an autoimmune disease, chances are this type of medicine won’t work for you. But if you’re in the large majority that just needs primary care and generic prescription drugs, this might save you money. Many direct primary care doctors network with one another to find specialists that will either offer a discount for patients paying out of pocket. Newkirk says when the family has needed specialty care, Dr. Rao points them in the right direction.
“She has doctors that she’ll put you in contact with, or places that, will offer some sort of discount for somebody who doesn’t have like the insurance that, you know, the general public does. And you know, saves you money in that way,” said Diane Newkirk.
RELATED: Affordable healthcare for those in need
How do you cover the cost of prescriptions?
Surprisingly, many prescriptions might already be cheaper without insurance. Dr. Rao encourages patients to use GoodRX.com to find coupons for low-cost drugs. If you qualify for Medicare, can also purchase insurance plans specifically to cover prescription drugs.
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