Direct Pay Health Care Part 2

When people think of “direct pay health care”, they think of the 1% paying cash. But direct pay health care is available to everyone, and you don’t have to be “rich” to use it, either. In this article, we’ll focus on one common type of direct pay health care that is often viewed as for the rich only–concierge care.

Concierge Health Care

In “concierge care” the patient pays an annual “retainer”, which can be as low as 100.00 a month for an individual. This retainer gives you the services of a group of doctors and specialists, on an unlimited basis, for a small co-pay when you schedule appointments. The average concierge medical network will also include inpatient and outpatient medical care for surgeries, and emergency room services and even ambulance/transport services at a discount.

As concierge physicians focus on wellness–keeping you healthy–the average plan will include basic health services annually in the retainer fee, and also offer a wide range of alternative medical treatments, from acupuncture and chiropractors to massage therapy, yoga, and even Tai Chi. Many plans also allow you to add ancillary services like dental and optical to a standard package, and arrange to keep accounts similar to HSAs, so you can have some money set aside for unexpected medical expenses within the practice itself.

Many concierge plans also offer house calls, and 24/7 on call nurses for general questions in addition to 24/7 access to your primary doctors, and some also offer telemedicine, online visits with your doctor. The advantage of a good concierge plan over insurance at comparable rates is simple–you not only get more for your money, the good concierge plans often have reciprocating services with medical teams in dozens of states and cities. Some plans have nationwide coverage, so your medical care and records go wherever you go, and there are also international plans available.

Is A Concierge Plan For Me?

Concierge plans are the best choice for young, healthy people who don’t need to see doctors often at all. The savings over insurance premiums can be substantial on an annual basis, and if you choose a large network, your health care is very portable. It is also a good choice for older patients with stable, chronic conditions, as many concierge plans offer reduced rates for seniors as well as offering some pro bono care.

For those with families and young children, the financial benefit may be small, but the benefit of your child being able to develop a long term relationship with one group of doctors more than outweighs the financial angle, just as it does for adults. Concierge doctors have smaller patient loads, and because they have the same patients for years and in some cases decades, they know their patients, and can often spot changes in a patient that other doctors would miss.

Choosing A Concierge Plan

Concierge plans range from simple to complex, from as little as 100.00 a month to 1000.000 a month or more, for the luxury, worldwide programs. All of them tend to focus on promoting wellness proactively, as such you’ll find an emphasis on diet, exercise, and a holistic approach to being healthy that is an important part of the system. As an example of one of the best ones for “boomers”, you can check out MDVIP, one that is a popular choice and has been in operation since the very early 2000’s. I highly recommend subscribing to the newsletter.

Another good resource is American Academy of Private Physicians , and in certain states, you can also check out Concierge Choice Physicians. Contacting your state’s Medical Board, or local hospitals, can also be a good place to start.

Important Things To Keep In Mind

It’s not only OK to “shop around”–it’s highly advisable. You’re paying for a service, not just “insurance”, so finding the right doctor or team is worth the time it can take. Also keep in mind that it’s a good idea to still have basic catastrophic coverage–and some concierge plans require you to have insurance available in case something big comes up.

Also, if you have an HSA option available at work, you can typically use HSA funds to pay for your concierge service retainer fees, and in many cases your concierge related medical costs will be tax deductible–so whether you go a standard “direct pay” route and just pay your doctors cash or you go the concierge route, you’ll want to keep all your receipts and take the extra few minutes to figure out whether filing an itemized tax return is “worth it”.

While Medicare  doesn’t cover concierge costs in most states (California has exceptions to this), if you have to be hospitalized or require diagnostic services you can typically arrange to have those billed through your Medicare, at the standard rates. And in some states, a concierge plan that covers all that is required by obamacare is accepted as being on obamacare.

If the idea of a full concierge plan doesn’t work for you financially or otherwise–then shop around for direct pay doctors outside of concierge networks. Most people don’t realize that just about every doctor will take cash–and that many doctors will also negotiate their fees with you, as will hospitals and in some cases diagnostic testing centers.

We’ll be covering other ways to lower your medical bills in the next several articles, including barter. But it never hurts to call your current doctor and ask them what their cash fees are if you don’t file an insurance claim–the answer might surprise you.

As we said before–concierge medicine isn’t for “everyone”. But if you’re someone with chronic conditions, someone who is a believer in proactive wellness, or someone who rarely needs more than the typical annual checkup, a reasonably priced concierge plan can make a difference financially, especially if you take the money you would have been shelling out for insurance and either invest it prudently, or buy precious metals.



2 thoughts on “Direct Pay Health Care Part 2

  1. This does sound like a good deal. I’m trying to figure out Medicare choices. I’m probably going with HealthNet, since there’s no cost and it should work with my insurance through work. My husband may sign up with Kaiser. I will likely go with them whenever I manage to retire. I can’t believe how complicated they have made health care. You really have to sit down and study all the plans.

    Liked by 1 person

    • Absolutely. That’s why a lot of my senior friends here in Tucson are going full on concierge plans. Quite a few of the local docs give seniors deep discounts on the stuff they’d be paying for anyway under medicare, and they get hospital services billed through medicare.

      It’s worth looking around your area and talking to your current docs of choice about cash/direct pay alternatives. You might well find yourself very pleasantly surprised at the kinds of deals you can make with docs.

      I have 4 neurology visits, 2 pulmos, and a cardio on account as my Doc Squad bartered visits for handyman services and artwork for their offices and homes :-).

      I also recently had 2 teeth pulled under laughing gas, in exchange for my other half painting the dental offices.

      One of the big drivers down here is since our governor expanded Medicaid and we’re armpit deep in illegals, the medical system is totally overwhelmed. There simply aren’t enough docs, especially specialists, to handle the patient load.

      One of my lib neighbors who was all for obamacare changed her tune real quick when she lost her docs, lost her meds, and then she started getting the infamous “reverse death panel” letters from her insurance:

      “Due to the critical shortage of pain management specialists in our network, your primary physician’s referral request has been denied at this time.

      We are sure you understand that providing the limited resources to the patients most in need is the first priority….”

      So she started yelling *at me*, because I see mine once a month, so I was somehow “stealing” HER appointment. I pointed out that *I pay cash, therefore I NEVER have to wait more than a week to see any of my docs*.

      She also blamed me for being one of the people who are making sure obamacare doesn’t work, because I won’t play. But she also believes that all doctors should be required by law to accept obamacare, no matter what the conditions are. Some people are just too ignorant….


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