It’s no secret that the cost of healthcare in the United States has been rising at an alarming rate. As any healthcare provider will tell you, healthcare in America has become increasingly unaffordable over the past several decades. What may not be as well known is that there are alternatives to traditional insurance that can help reduce the cost of your medical care while also giving you more freedom to choose where and when you seek treatment.
There are a number of reasons people might not be comfortable with the traditional health care model. Here are some of the most common reasons people seek alternatives to health insurance:
Finding the right medical team might be the most important factor in your health care. Unfortunately, when you have a traditional health insurance plan, things don’t always stay the same. For example, your doctor may not be in-network. Your plan might require that you see a primary care physician to get a referral to a specialist. Or you might quit your job and suddenly find yourself out of a doctor, too.
These programs give the health insurance provider a lot of control over who you see and under what circumstances. That can make it difficult to reach the support you need when you want it.
The relationship between doctors and insurance companies affects the relationship between doctors and their patients. Most doctors would love to have more time with their patients, but time simply doesn’t allow it. Much of that has to do with regulations and payment practices put in place by the insurance company. Because of that, you may not even know how to reach your doctor when you have questions or need support.
If you want more time with your doctor, you’ll likely need to have a payment arrangement that works for both of you. While this means out-of-pocket costs, it also means that you get more time and more personalized care. Ironically, although the costs are out-of-pocket, they’re often overall much lower than what would be billed through an insurance company — particularly in the direct care model.
Even the simplest health insurance plan isn’t exactly simple. You may know what to expect when it comes to routine care and co-pays — until, of course, a “surprise bill” comes in the mail.
With programs outside of the outdated health insurance model, there aren’t any surprises. Costs for both preventive care and other medical services are clear and worked out in advance. And since the finances are between you and the doctor, it’s much easier to communicate if you need an alternative solution.
Photo by Laura James
Technically, health insurance is no longer required at the federal level. However, going uninsured is a pretty risky endeavor. Murphy’s Law tends to kick in right when you have a lapse in coverage. But while it’s a good idea to have something in place, it doesn’t necessarily mean that you have to buy a marketplace health plan.
In general, there are four basic ways to pay for medical expenses: managed care, direct care, fee-for-service, and high-deductible plans.
Managed care plans are designed to help members limit costs. The members pay a monthly premium, and in exchange, covered medical expenses are paid by the plan. These plans are the most commonly offered type of medical coverage in the United States. However, the premiums can be high — especially when covering a family or a member with pre-existing conditions. Managed care plans include PPOs, HMOs, and EPOs.
With direct primary care, you pay a monthly fee that covers all of your medical costs. This means that you don’t have to worry about rising health care costs or paying for unexpected medical bills. As long as your doctor accepts payments with this type of subscription model, you can see any doctor or specialist that you want without having to get a referral. You won’t be charged more just because you need prescription medication, hospitalization, or mental health treatment. Additional services will incur additional costs, but the cost of your subscription won’t change based on these factors.
This type of plan is a great option for those who previously had a hard time affording medical coverage — whether due to pre-existing conditions or changes in employment. The direct care model also gives you total control over which doctors you see. Essentially, you’re building your own care network.
Photo by Anna Shvets
In a fee-for-service model, doctors get paid per service, directly from the patient’s pockets. This type of arrangement bypasses traditional health insurance altogether. While this gives doctors and patients a lot of control over their finances, some patients may feel that costs are unpredictable. Critics have also argued that this model incentivizes doctors to suggest more services to the patient.
Also known as HDHPs, high-deductible plans have been gaining popularity in recent years for their low insurance premiums. They’re generally offered alongside HSAs (health savings account), where you can save funds to cover the higher deductibles and costs associated with an HDHP. These plans can supplement direct care coverage, providing a backup in the case of emergency medical needs.
The best alternative to traditional insurance may be direct care insurance. Direct care offers a way for individuals and families to save money on medical bills without sacrificing quality care. With direct care, patients pay a monthly fee in exchange for unlimited access to medical providers who accept that plan’s network. There are no deductibles, so you can see any doctor anytime without having to worry about how much it will cost you out-of-pocket.
Ready to explore the direct care model? Reach out to Higher Ground Women’s Health to see if it makes sense for you.
While we hope you’ve found this helpful, we can’t give you any medical advice without knowing your situation. Please reach out to a healthcare provider if you have specific questions or concerns. Nothing on this site is intended to diagnose or treat any illness, and no statement is intended or should be construed as medical or legal advice. Please utilize your best judgement and the support of your doctor when making any decisions about your health.