How Does DPC Work with Medicare?Apr 26, 2023
Over two-thirds of Medicare beneficiaries have two or more chronic medical conditions. 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. Direct Primary Care gives Medicare beneficiaries convenient access to their own physician to coordinate their care when they need it most—as they age and need more healthcare services. Consistently, data shows that patients in DPC practices have fewer hospital days, ER visits, specialty visits, advanced imaging and unnecessary surgeries. They also spend more time with their doctor and report high levels of satisfaction with their experience in the health care system.
Let's look at another hypothetical patient. Nancy is a 70 year old woman with high blood pressure, high cholesterol, and diabetes--she is just like the majority of my current patients. She goes to see her DPC doctor 4 times a year and has labs drawn before each visit. Because Nancy has Medicare, she can use her insurance to cover the costs of the labs. If she gets sick and needs a chest x-ray, Medicare will cover the chest x-ray fees. She also sees a cardiologist and uses her Medicare insurance to pay for her cardiology visits. Medicare covers anything that is done outside of the DPC office, just as it did before she started going to the DPC doctor. But there are many differences between her previous doctor and her DPC doctor. Nancy can text, call or e-mail her DPC doctor and get a response the same day, sometimes within the hour. She doesn't have to wait for 2 weeks to see her regular doctor for an acute problem. When she sees her doctor, Nancy spends up to an hour with her. By the end of the visit, the doctor heard and answered all of Nancy's questions and concerns. Our goal at Emerald Health DPC is to provide this type of personalized and convenient health care for all of our patients, whether they have Medicare, commercial insurance, or don't have health insurance. Please contact us to get more information if you feel this is the kind of health care that you deserve.
Dr. Anne Gonzalez
Emerald Health Direct Primary Care
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