Dec 31, 2024
As U.S. health care costs continue to climb, frustration is mounting among both patients and doctors, who increasingly feel that the system prioritizes profits over quality care. And now, some doctors are challenging the status quo by opting out of traditional insurance models altogether.
For Dr. Chris McCarthy and Dr. Jerome Aya-Ay, co-founders of Palmetto Proactive in Spartanburg, South Carolina, this means embracing Direct Primary Care (DPC) — a health care approach to bypass insurance altogether.
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“It’s kind of like Netflix,” McCarthy told Fox Carolina. “You can watch as many shows as you want or no shows. So you can come to the office as often as you need and there is no barrier.”
In this model, patients pay physicians directly through predictable monthly or annual fees, eliminating the administrative and financial hurdles associated with insurance.
By cutting out the middlemen, patients pay physicians directly through monthly or annual fees. Patients can then enjoy benefits like unlimited doctors visits, routine exams, urgent care and more — without overhead that often inflates traditional healthcare costs.
While DPC offers a promising alternative, it may not be the ultimate solution to all of America’s health care woes.
Is Direct Primary Care the future of health care?
With health care spending averaging $13,493 spent per person annually, many Americans are feeling the pinch more than ever. Despite high costs, patients often leave their appointments dissatisfied.
As Dr. Shane Purcell, family physician and founding member of the Direct Primary Care Alliance told Fox, the true cost can often be an unwelcome surprise: “A few weeks later you’re like, how is this possible? I got two minutes with a doctor and my bill is $300 or my insurance didn’t pay for it.
“There are a lot of insurance issues.”
Direct Primary Care (DPC) aims to disrupt this status quo by eliminating insurance altogether, offering a subscription-based model that promises a better experience. Under DPC, patients pay a flat monthly fee, typically between $50 and $150, giving them unlimited access to their primary doctor without copays or deductibles. The model, according to the AAFP, aims to lower financial barriers for Americans accessing routine care and, ideally, facilitate better relationships between patients and health care providers.
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And it’s working great for some Americans. As Mark and Whitney, a couple with two children, shared with Ark Family Health, DPC has been a game changer for their family. Before it, they were spending $350 a month on a high-deductible plan that left them paying 20% out of pocket after meeting the deductible.
When faced with a $1,200 premium at Mark’s new job, they opted for DPC at $265 per month. Now, they have unlimited access to their primary doctor — making it easy to budget without any unexpected fees.
Some businesses, like Hub City Hospitality in Spartanburg, are turning to DPC as an affordable health plan for their workers. By covering 50% of the DPC fee, employees are left on the hook for just $28 a month for coverage, according to John Trone, Hub City’s Vice President of Human Resources.
Health coverage remains a crucial topic for Americans, as a 2022 study by the Kaiser Family Foundation revealed that over 100 million American adults, or roughly 4-in-10, are burdened with debt stemming from medical or dental bills.
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A small fix for a big problem
While DPC offers a promising alternative to the traditional insurance-driven system, it remains a small fix for a much larger problem. Though it can ease the financial burden for some, most Americans are still reliant on insurance, and DPC alone won’t cover major expenses like surgeries or emergency care.
And, as HealthInsurance.org notes, what you’ll have covered depends on the office you’re signed up with. Since DPC doesn’t typically cover lab work, imaging or procedures, most experts recommend pairing your plan with a traditional health insurance plan, typically a high-deductible plan.
So although DPC can be more affordable than the traditional approach, it’s far from comprehensive. That being said, there are practical ways to manage health care costs short of abandoning insurance plans.
For example, embracing a preventive care approach — including setting up regular screenings, vaccinations and maintaining a healthy lifestyle — can keep health care costs low by getting in front of concerns that can get expensive down the line. Many insurance plans cover preventive services at low to no cost, helping stave off more severe (and costly) issues. Comparing prescription prices is another tactic to help save. Some pharmacies offer discount programs or price-matching. Also, consider using a Health Saving Account (HSA). An HSA is a tax-advantage account that allows individuals to set aside funds specifically for qualified medical expenses, including medical, dental, vision care and prescription drugs. This can be a valuable tool for covering out-of-pocket expenses while also providing tax benefits.
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Victoria Vesovski is a Toronto-based Staff Reporter at Moneywise, where she covers the intersection of personal finance, lifestyle and trending news. She holds an Honours Bachelor of Arts from the University of Toronto, a postgraduate certificate in Publishing from Toronto Metropolitan University and a Master’s degree in American Journalism from New York University’s Arthur L. Carter Journalism Institute. Her work has been featured in publications including Apple News, Yahoo Finance, MSN Money, Her Campus Media and The Click.
