18% of Texans don’t have health insurance despite needing medical care. You may find navigating the healthcare system daunting if you’re among them. But “I don’t have health insurance” is not a phrase that should keep anyone from getting healthcare.
Out-of-pocket medical expenses are impossible for the average Texan to pay. You may wonder if you must have insurance to get medical care. The surprising answer is no — there’s another option.
Direct primary care is a new way to saccess comprehensive care without insurance. In this blog post, we’ll discuss how direct primary care services can help Texans without health insurance get the care they need.
How Does Medical Insurance Work?
Health insurance is the standard way to pay for medical services in the United States of America. However, the healthcare system makes medical services too expensive for most Americans to pay for out-of-pocket. Often, many people get subsidized health insurance through their employers .
Since companies can offer health insurance to many employees, they get cost savings from the insurance company. The company may subsidize or match the employee’s contribution to their health insurance.
Health insurance coverage varies depending on the type of plan you have. Most programs cover routine doctor and emergency room visits. Some plans cover preventive care, like checkups, vaccinations, screenings, and prescription drugs.
The Health Insurance Process
Medical insurance has many complexities that one cannot explain in simple terms. That’s part of why people find it so frustrating. But, at its core, medical insurance works like this:
- Insured party pays dues or premiums
- Insurance company holds money
- Insured party accesses medical care
- Insurance company pays for sometimes all or part of medical care
Other factors like filing claims, out-of-network fees, deductibles, and out-of-pocket maximums add many complex layers to this process. For example, the insurance company may reject your claim for a procedure because they don’t consider it medically necessary. In that case, you’ll need to dispute the claim and try again.
Otherwise, you may have to pay for the procedure out-of-pocket. And for medical care not covered by your claim, that cash does not go toward your out-of-pocket maximum. In short, traditional medical insurance plans can become frustrating very quickly.
Health insurance is expensive if your company doesn’t provide insurance options (or you’re unemployed or self-employed). Depending on how much coverage you need, your health insurance could cost over 20% of your monthly paycheck. Thus, paying for medical insurance becomes almost as burdensome as paying for medical care.
Medical Care Without Insurance
The Traditional American healthcare system demands health insurance to provide care. Yet, millions of Americans repeat over and over again, “I don’t have health insurance.”
According to the Kaiser Family Foundation, 11.4 percent of Americans had no health insurance at the start of 2020. That’s 29 million people without health insurance or health insurance coverage. With no health insurance, these individuals face the challenge of paying for their health care costs out-of-pocket.
These healthcare expenses take priority over other fees. The results can be devastating. Some of the hardships uninsured Americans endure include:
- Delayed medical care due to costs
- Ignoring symptoms and allowing an illness to grow
- Entering medical debt/passing it on to their children
- Taking out a second mortgage/facing homelessness
- Being unable to feed themselves and their children
Fortunately, there are now options for medical care without insurance. Direct primary care is an option that provides an alternative to traditional health insurance plans. It is gaining traction as an affordable and accessible way for people without health insurance to get quality care.
What is Direct Primary Care?
Direct Primary Care (DPC) in Texas is an emerging healthcare model. DPC allows primary care doctors to offer their services directly to their patients without insurance.
Unlike insurance, patients don’t pay per visit or procedure. They pay fixed monthly fees for the care they receive. Think of it as a Netflix subscription for your primary care.
Between 1,000 and 2,000 DPC practices provide care to approximately 500,000 patients in the US. Among them, Salveo Direct Care serves members in Texas.
The DPC model allows doctors to spend more time with each patient, up to 30-60 minutes per visit if needed. DPC memberships also enable patients to access care via phone calls, email, or video chats at no additional cost.
DPC services provide primary care. Think of things like checkups, acute visits, preventive care, chronic disease management, vaccinations, and routine exams. Oftentimes though, your DPC doctor may offer even more benefits or services as part of your membership. One example is a focus on lifestyle medicine. Complex or specialized procedures or surgeries aren’t always available through a DPC.
So, remember that maintaining coverage for scenarios outside the services of your DPC may be necessary. With DPC you can reduce your healthcare costs without losing access to essential services.
What are the Benefits of Direct Primary Care?
Direct Primary Care saves patients money and time. Most DPC services cost less than monthly insurance premiums.
The DPC model also cuts out-of-pocket expenses associated with the standard insurance model. Your monthly fee covers all your primary care. The cost reduction alone makes them favorable compared to the health insurance marketplace.
Another benefit of using DPCs is that they are smaller. DPC practices often accept fewer patients than traditional primary care clinics. So, patients get personalized care from a family medicine doctor who knows them well.
The DPC model also offers faster treatment to patients. It eliminates insurance companies as the middleman. Instead of waiting on claims approvals, denials, and appeals, patients get prompt medical care.
How Much Does Direct Primary Care Cost?
DPC services in Texas vary depending on your location and the practice. Some practices offer more comprehensive services, such as:
- Online video visits
- Lab tests
- Specialist services
- Tests using high-tech equipment
Such practices may charge more than average for their DPC services. Or they may offer different packages at different prices for you to select.
The general figure for the cost of DPC services in Texas is between $50 and $200 per month, depending on your required services. This cost is comparable to or less than their phone plan for many people.
Moreover, with DPC, you don’t need to worry about fluctuating healthcare costs based on your health insurance status. You know what you are paying for each month, and it won’t change based on changes in your health insurance coverage. This makes DPC an excellent option for uninsured people.
I Don’t Have Health Insurance, Is a DPC Right for Me?
Direct Primary Care is almost always a great alternative to traditional healthcare. With DPC, you can receive medical care without worrying about annoying insurance quirks like:
- Out-of-pocket maximums
- Healthcare networks
- Nonmedical professionals determining medical necessity
- Unapproved medications/procedures
- Filing or disputing claims
But everyone is different, and you may need more information to help weigh your options. Start by considering your current health insurance status.
What if you don’t have health insurance, but you’re covered on someone else’s plan? Enrolling with a DPC on your own could help avoid out-of-pocket expenses related to your medical care under their plan.
Take a moment to think about all the times you went to see a doctor in the past year. Also, remember when you would have visited the doctor but didn’t due to out-of-pocket cost with your insurance plan or a lack of insurance.
You can use these instances to determine how often you might use DPC services. On average, if you use your DPC services once a month or once every two months, you’ll save money with a DPC, even if you’re on someone else’s insurance plan.
A DPC is even more beneficial for you if you’re in the “I don’t have insurance camp” and need primary care. Few options on the healthcare marketplace beat Direct Primary Care prices.
You may save on healthcare with a DPC compared to healthcare options from employers. That depends on how much the healthcare offered at your place of employment costs.
Suppose you don’t have insurance because you aren’t taking advantage of your company’s benefits. You can ask your manager for detailed information about the benefits and compare them to a DPC. Many employers are also starting to look at Direct Primary Care as a valuable option for their employees. Ask your employer if they have considered that option.
What if I already have insurance?
Depending on your insurance plan’s out-of-pocket costs, DPC may still be worth it.
Moreover, it’s essential to compare what services you need with DPC’s services offers. A DPC might not be suitable for people with more complex issues as their only healthcare option. But a DPC could be a great option if you’re looking for a way to supplement your healthcare with personalized primary care.
It’s also important to remember that DPC isn’t a replacement for health insurance. DPC practices do not cover hospitalizations, specialist care for complex illnesses or injuries, or other forms of care outside of primary care. If you do decide to join a DPC practice, it is recommended that you buy a low-cost, wraparound insurance plan to cover those extra services.
What Services Can an Uninsured Person Get With DPC?
Direct Primary Care offers comprehensive care to uninsured patients. The scope of primary care may change from practice to practice. However, Salveo Direct Care provides an abundance of services to Texas residents.
In-Person Comprehensive Care
Uninsured Texans can access in-person comprehensive care at DPCs like Salveo Direct Care. These in-person visits include services like:
- Well visits & physicals (checkups)
- Preventive healthcare
- Chronic illness care
- Pediatric wellness care, well child visits
- Nutrition services
- Acute injury treatments (e.g., sprained anklesbroken bones)
- Acute illness treatments (e.g., influenza)
- Women’s health (g., Pap smears, sexual wellness, postpartum care)
The benefit of DPC is that the fees paid for the service are predictable and consistent regardless of health insurance status. So, patients can visit their DPC provider whenever for in-person care usually without extra costs. DPC patients with no health insurance get the same quality of care while paying less.
With fewer members, DPC providers get more acquainted with their patients. This leads to accessible and convenient visits or longer appointments, if needed, that are more meaningful. DPC patients leave their in-person consultations feeling like they mattered.
That doesn’t often happen in traditional healthcare settings. Too often, doctors are too busy, distracted, or unacquainted with patients to provide meaningful care. Instead, patients have to wait for a follow-up or second opinion.
Additionally, direct primary care providers focus on preventive health. They provide personalized wellness plans for each individual’s needs. This can result in long-term savings on health care costs because patients need fewer expensive interventions or treatments down the line.
Telehealth Solutions with Direct Primary Care
In-person care is excellent but may not always be necessary (or convenient). Luckily, many DPCs include telehealth visits in their services.
Telehealth connects you to your doctor via the internet. So, you can still stay healthy with primary care if your concerns don’t involve a detailed physical exam.
While you can get in-person appointments with your DPC provider quickly, telehealth is even quicker. Sometimes, you can even get same-day telehealth appointments through your DPC.
Discounted Labs and Radiology
DPCs often provide discounted lab work and radiology services. This can help members save money on the healthcare costs of getting those services done outside their DPC. Sometimes, these services are up to 90% cheaper than what you would pay for health care through traditional providers, which is a significant win for uninsured Texans.
Access to Specialist Care
DPC providers also provide referrals to specialists to get the care you need when needed. These specialist services include but aren’t limited to:
- Mental health
- Physical therapy
Ultimately, DPC provides members access to comprehensive primary care services that they would not be able to get if they had no health insurance coverage or paid for health care out of pocket. The model has provided both insured and uninsured Texans access to quality and affordable care.
Texas Direct Primary Care Near Me
Finding quality healthcare services can be challenging for Texans without health insurance. But “I don’t have health insurance” is no longer a concern with Direct Primary Care. If you’re an uninsured Texan, you have options.
Salveo Direct Care in Texas provides direct primary care to patients regardless of health insurance status.
We seek to revolutionize how Americans get healthcare by not depending on insurance companies. Schedule a free consultation today if you’re ready to start getting higher quality and accessible primary care with or without insurance.