You’re at the end of the line already: considering Direct Primary Care (DPC), but you’re not really sure how it fits with your health insurance.
Well, you’re not alone.
It’s a common question: Can DPC really cover everything? Will you be left uncovered when it comes to emergencies?
Can DPC completely replace insurance?
The short answer is no. While DPC offers comprehensive primary care, it isn’t designed to cover other major medical expenses like hospital stays or surgeries.
But that’s not a bad thing. In fact, combining both DPC with insurance can actually give you the best of both worlds: everyday care that’s simple and predictable, with the addition of coverage for the unexpected.
Let’s break down how DPC and insurance work together and why having both can keep you covered without overspending.
What Direct Primary Care Covers
Direct Primary Care (DPC) keeps everyday healthcare simple, accessible, and predictable. Instead of paying per visit or dealing with insurance claims, you pay a flat monthly fee that covers a range of essential services.
At Craft Concierge, DPC includes:
Routine Visits and Checkups
Members can schedule same-day or next-day appointments without worrying about copays or hidden fees. This includes annual physicals, follow-up visits, and general wellness checkups.
Lab Work and Diagnostic Imaging
Routine lab tests like cholesterol panels and diabetes screenings cost $5, far less than the typical $128. Advanced imaging, such as MRIs and CT scans, is also available at significantly reduced rates.
Chronic Condition Management
Patients managing conditions like diabetes or hypertension receive ongoing support, personalized care plans, and regular check-ins to keep symptoms under control.
24/7 Messaging and Virtual Care
Members can reach out to their care team anytime, day or night, through secure messaging so minor concerns can be addressed promptly, preventing more serious issues.
What DPC Does Not Cover
DPC takes care of everyday health needs, but it doesn’t replace health insurance. Major medical expenses still require coverage beyond primary care. Here’s what DPC doesn’t cover:
Emergency Room Visits
If you end up in the ER after a serious accident or unexpected illness, those costs won’t be covered under DPC. Insurance steps in here to manage hospital bills and emergency care.
Hospitalizations and Surgeries
DPC focuses on preventive care and routine visits, but it doesn’t cover the high costs associated with hospital stays, surgical procedures, or intensive care.
Specialist Care Outside the DPC Network
If you need to see a cardiologist, neurologist, or other specialist outside the DPC network, insurance will handle those expenses. DPC may refer you to specialists, but won’t cover those visits.
Prescription Drugs Requiring Insurance Coverage
While some medications may be included in the DPC membership, more expensive or specialized prescriptions typically require insurance coverage.
How DPC and Insurance Work Together
When you use DPC and insurance together, they can cover all bases without driving up costs. Here’s how the two work hand-in-hand:
- DPC manages routine visits, lab work, and diagnostic tests under a flat monthly fee, making everyday care predictable and easy to budget.
- Insurance takes over for emergencies, hospitalizations, and specialist care that fall outside of DPC’s scope.
- Pairing DPC with a high-deductible health plan (HDHP) keeps premiums lower while still providing coverage for serious medical events.
- With fewer routine claims filed through insurance, premiums may stay more manageable over time.
- DPC provides consistent access to primary care, preventing small health issues from escalating into costly emergencies that insurance would need to cover.
How to Choose the Right Combination for Your Health Needs
Finding the right balance between DPC and insurance depends on factors like health status, family size, and budget.
Here’s a quick guide on how to decide:
- Those managing chronic conditions can use DPC for regular monitoring, routine checkups, and follow-ups, while insurance covers hospitalizations and specialist visits.
- Families with young children can lean on DPC for primary care and urgent visits, reserving insurance for more serious health issues.
- Healthy adults may choose a lower-cost insurance plan for emergencies while using DPC for affordable, everyday care.
- Craft Concierge helps patients identify the best plan combination, ensuring comprehensive coverage without unnecessary expenses.
Protect Your Health Without Breaking the Bank
DPC makes everyday care simple and predictable, but it’s not a substitute for health insurance. The best strategy? Combine both. With Craft Concierge, you get affordable primary care for routine visits and ongoing support, while insurance covers emergencies and major medical expenses.
Ready to find the right balance?
Contact Craft Concierge today to learn how our membership plans can work alongside your insurance to keep you covered from every angle.
