It’s that time confusing time of the year again. When you have no idea which health plan to choose from and still can’t understand why there’s a difference of 500 to 800 dollars if you choose a high deductible vs. “better coverage” plan. We will help you breakdown different plans and show how direct primary care can help you get better care while saving you money.
Open enrollment for insurance from the “marketplace” (ie., Obamacare Insurance), runs from Nov 1st to December 15th 2020. After this period, you will not have access to enrolling for insurance through the marketplace.
Insurance plan costs vary widely in price and coverage! It can be confusing. While it may seem that more expensive plans = access to better care, read below to understand why that’s not always true.
Every plan requires a premium, which is the monthly fee you pay just to have insurance. This can range from $350 - $3000! Depending on if you are individual or family, age and some other factors.
The different metal categories, like bronze and silver, cover different amounts of the medical bill. For someone one with a bronze plan, you may pay 50% of a medical bill, and in a gold or platinum plan you may pay only 0-10%.
Each metal category will have options for plans with different deductibles—that is the amount of money you have to pay out-of-pocket before your insurance will even start to cover your medical expenses.
For example, when we had a bronze+high deductible plan several years ago, our deductible was $6,000. That means we had to pay for the first $6,000 dollars of any medical expense before our insurance would start to pay for it. Some things will still have a percent covered outside of a deductible like preventive care.
So for any sick visits, going to the urgent care, seeing a specialist, and even for labs and imaging—we were responsible for any cost up to $6,000. You can imagine we weren’t too happy when we had an emergency room visit that year and got stuck with a $1,200 bill. Keep in mind that you’re still paying a monthly premium while still meeting your deductible.
If you want to read more about the details of difference plans and the associated expenses, you can go to the healthcare.gov and learn more.
So how can direct primary care save you money, and how does it pair with health insurance?
If you have insurance, you may wonder why you should pay extra for a direct primary care doctor. But as you can see, with many types of plans, you will be paying out-of-pocket up to a couple thousand dollars on top of the monthly cost before your insurance starts covering your expenses—especially with high deductible plans.
With direct primary care, we charge an affordable monthly membership that will cost about $1,000 per year (paid monthly as $85/month). Many people will spend money out of pocket meeting their deductible and paying co-insurance in a given year on urgent care visits, the random emergency room visit, and even going to see your doctor or specialist.
With us, all your visits are covered, and you get direct access to us, the Drs. Kahn. We are there for you when you need it most (even after hours) and sometimes can save you a trip to a specialist, urgent care, or emergency room. Most importantly, having a doctor you can access without hesitation gives you peace of mind.
Pairing affordable direct primary care memberships with certain health plans (especially high deductible plans) can can help save you money by addressing the majority of your medical needs, being there when you need it, and making sure you are getting excellent care without adding on unnecessary testing!
Do you need a doctor? Sign up with us today!
A note: DPC may not work well with HMO plans—they require you to have an in-network PCP for referrals or orders for advanced imaging. As long as you don’t have an HMO plan, you can see a Kahn Health doctor for your referrals and prescriptions.
