Open Enrollment - Understand your health coverage and alternative options.

Wow, I can’t believe it is already December…..almost halfway through the open enrollment season.  Over the years, open enrollment typically starts from Nov 1 – Dec 15th. However, for this year, open enrollment will run until Jan 15, 2022.

What exactly is open enrollment? Open enrollment is a period of time set aside by health insurance companies where they allow anyone to purchase health insurance. Unfortunately, those who do not obtain insurance during open enrollment time frame typically are unable to obtain insurance until the following year unless there are certain qualifying life events to allow you to enroll outside the typical period, ex. Marriage, divorce, childbirth etc.

As family physician and an owner of a subscription-based family practice which does not participate in the health insurance market, one of my most asked questions is,…

Do I need health insurance? My answer is unambiguously, YES.

I recommend to all my patients’ catastrophic health coverage. This can be in the form of traditional health insurance or as member of a health sharing group etc. Catastrophic health coverage is important. This is the coverage you need for care in the emergency room, hospitalizations, surgery, cancer treatments, major accidents.

I do however want to mention that Health Insurance, DOES NOT equal affordable Healthcare

For the young and relatively healthy adults who only use outpatient services, health insurance can present a problem. Is it affordable? Do I really need it? Will it cover my outpatient visits?

Unfortunately, outpatient services are not always adequately covered with catastrophic health insurance, which results in high co-pays for office visits, and high cost for medications and imaging studies.

Here is a quick exam of a new member who enrolled in my clinic last week:

26-year-old relatively healthy young male, has health insurance and has been seen twice in the past 6 weeks with an ongoing cough. Here is a breakdown of his costs

Traditional Fee for Service Clinic

Co-pay for 1st visit $60

Medication for Cough $13.50

Medication (Albuterol) $55.00

Follow up Visit Co-pay $60

Chest X-ray (2view) $115

Antibiotic x 10 days $15.15

Prednisone x 5 days $4.00

TOTAL COST: $322.65

Direct Primary Care Subscription Model

Co-pay for 1st visit $0

Medication for Cough $3.03

Medication (Albuterol) $23.00

Follow up Visit Co-pay $0

Chest X-ray (2-view) $64

Antibiotic x 10 days $5.58

Prednisone x 5 days $1.40

TOTAL COST: $97.01 (+monthly fee $172.01)

Yes, he has insurance, but he still paid over $300 for an acute concern. What is the problem,….his health insurance does not provide adequate coverage for outpatient services. This is what I mean when I say: Health insurance does not equal affordable health care.

My practice is a direct primary care model. We do not use the traditional insurance or fee for service concept. We use an affordable subscription model. For a fixed monthly fee starting at $75/month, my patients have access to me for all their office visits as well as after hours and weekend virtual care. We do not charge you for each visit because all your visits, whether you need 1 or 5 a month, are all covered under the same monthly fee. Primary care physicians can handle about 80-90% of your health care needs and being easily accessible to my patients through same or next day appointments, I am able to keep them out of the urgent care or emergency room for acute primary care concerns.

Yes, most of my patients have health insurance or are a member of a health sharing group for catastrophic care, however this does not interfere with their primary care services in our clinic. I am able to provide primary care directly to my patient who have direct access to me through call, text, email even after hours, on holidays and on weekends.

We do not have an open enrollment period. New members can enroll anytime, therefore, we are able to address the difficulty of finding easy access affordable care outside the open enrollment period, especially for those who do not meet special requirements for enrollment outside of the usual open enrollment time frame.

The goal to a better healthcare system is to have access to your primary care doctor that is affordable and easily accessible while still carrying catastrophic coverage that will cover those unexpected life moments*. (I am not an insurance agent so please discuss with your agent or benefits advisor on what plan works best for you.)

Please contact us if you are interested in becoming a member or have any questions about membership (welcome@onedpc.com/828-360-8359).

You can also become a patient and schedule an appointment online by CLICKING HERE.

Thank you for reading and have a great week!

-Dr. Elsie Osei @ One Health DPC