Some abandoning health insurance for monthly medical care memberships

Posted at 10:18 AM, Nov 13, 2020

With health care costs on the rise, a growing number of Americans are throwing out the old way of seeing a doctor and turning to a membership model. A monthly or annual fee gets you direct access to a doctor, no insurance needed.

Twenty years into her career, bogged down by red tape, too many patients and long days, Dr. Shaila Pai-Verma was looking for a better way to practice medicine.

“I was just miserable,” she said. “The joy of medicine is gone and then you're just doing paperwork.”

So, a year ago, she started a new primary care practice with a new business model.

“The patient basically has a direct contract with the physician and they take insurance companies out of it,” she explained.

Patients pay a flat monthly or yearly fee. In exchange, they receive a broad range of primary care services and quick, unlimited access to their doctor via in-person office visits, phone or by text.

“Everyone wants everything immediate. And so, I think this is it. It's good, especially in this time for people to have access,” said Pai-Verma.

Membership fees range from about $125 to $200 per month on average – about $250 less than having typical health insurance. Most patients still carry catastrophic coverage for emergency treatments and hospitalizations, but that insurance is usually only $50-100 a month, so patients still save money.

For Bonnie Micheli and her family, it was all about access.

“With this, it's just so much easier to just know that I can contact directly here within a few hours for any issues that I'm having,” said Micheli.

In late September, a bipartisan proposal was introduced in Congress that would expand access to the model and allow people to use their health savings account for direct primary care (DPC).

Because they see fewer patients than traditional practices, some critics say the model could worsen the shortage of primary care physicians, a trend that’s already driven by burnout.

But according to a recent study, DPC members had 25% lower hospital admissions and the cost of emergency room claims was reduced by 54%.

“There's less ER visits and you know, better health care for the patient,” said Pai-Verma.

While there is still debate, for a growing number of Americans, like Micheli, it’s becoming a simplified health insurance alternative.

“Honestly, it’s just so nice to know what I'm paying every month or if you do the annual, what you're getting for that money, and you know exactly who to go to when you have a problem.”