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How Does Direct Primary Care Work With Medicare

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April 29, 2022

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Direct primary care (DPC) has become the most common and preferred alternative to conventional medical services. The fee-for-service payment model enables practitioners to focus on the business, with a clear pricing structure. As more doctors and patients opt to follow DPC models instead of traditional models of practice, there will be questions concerning insurance plans. With direct primary care, a patient is required to pay membership fees in addition to being charged for services provided by a physician. Generally, medical practices charge for services in an effort to meet statutory requirements.

Concierge medicine is becoming more popular

Concierge medical services also increased from 1990 to today. MD Value of Prevention (MDVIP) has an extensive national medical network covering nearly 15,000 primary care physicians serving nearly 260,000 patients. Concierge Medicine Today estimates that around 122,000 doctor practices concierge medicine today. Those figures are derived from interviews, and they don't appear in the Federal Register of Public Records.

Tell me the best way to keep Medicare?

Most people under Medicare have concerns that they can't afford to see a doctor. The membership charge for a DPC will not be reimbursed by Medicare. This is a big issue because most people feel frustrated about keeping plans. Medicare may remain extremely useful, especially in the event of unplanned medical services. Medicare also covers other medical services that are not directly offered by your primary caregiver.

Reasons Medicare and DPC models work well together

Although DPC providers do not pay or receive reimbursement from insurance companies, you can still have a Medicare plan in effect. Tell me the reason you should consider this:

It's the law

In order to abide by Federal Law, every person must also have medical coverage for their medical needs. Generally, they choose a high deductible plan for medical care, a major medical plan, and a plan that includes health savings account for medical care. Medicare is a federally funded program that provides for the protection of the public's health as a whole.

Last April, the Centers for Medicare and Medicaid Service (CMS) unveiled several new payment models designed to help transform primary care by reimbursing providers for health outcomes rather than the services administered.

Medicare may cover additional services

Because a direct primary care doctor provides the first treatment, the patient may also need a second. This is how Medicare can come about. If the doctor is required to do lab tests, x-rays, or prescription medication, they are able to provide the services.

Standard Medicare which includes Medicare part A (Hospital Insurance) and Medicare part B (Medical Insurance) and usually covers 80% of the cost associated with these medical services. Most of our Medicare patients at our practice have this as their coverage for outpatient services.

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This is a group that would benefit from high-quality primary care, but Medicare is still built on the insurance-based fee-for-service model of payment, which creates barriers to frequent communication and access between patients and their physicians.

High-quality primary care

While DCP is growing rapidly, it is being held back by some outdated federal regulations. In particular, the rules governing the use of Health Savings Accounts (HSAs) need to be amended to allow account holders to use their balances to pay DPC monthly fees.

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If you have further questions regarding Medicare and how it works alongside a direct primary care model, our team at Century Medicare offers excellent resources.

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