Monday, December 03, 2018

Case Study: DPC & ACA

So, working on an interesting, perhaps one-of-a-kind case:

Sally, 62 years young, has a very limited income, a few meds, and a need for health insurance. Fortunately, she qualifies for a substantial subsidy: so substantial, in fact, that one of the plans would cost her $0 in premiums [ed: Hi, Jeff!]. On the other hand, that plan has a substantial out-of-pocket liability of its own, to the tune of $7900, which represents a rather significant portion of her income were she to encounter a major, catastrophic expense.

And speaking of catastrophic expenses, one of the problems with the Direct Primary Care model has been the lack of plans to provide coverage for major claims (eg heart attacks and cancer treatment). On the other hand, it does offer affordable primary care (of course), and often includes deeply discounted prescription drug costs.

Well, it turns out that we may have our first legitimate "you got my DPC in my ACA" case:

We checked DPC Frontiers, and it turns out there are a couple of practices located near Sally, and with affordable rates (about $100/month). Coupled with that "free" ACA plan to act as the DPC "wrap," it looks like we have a winner:

Catastrophic coverage in case she gets hit by a bus, or cancer
Not defined by or limited to in-network doc's (other than, perhaps, specialists), and so not deterred by narrow networks
Perhaps my biggest DPC bugaboo is unnecessary (and costly) duplication of coverage, which this basically resolves
From what I have gathered, DPC doc's also have access to low(er) cost prescription meds, which obviates the need to ACA-plan rx coverage
Seems like a win-win to me.

Unfortunately, of course, this will continue to be the exception, rather than the rule, until we get true catastrophic plans back.

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