It depends. If you’re an individual, no. If you’re a business owner with fewer than 50 full-time employees, no. If you’re a business owner with 50 or more full-time employees, yes. Congress repealed the individual mandate tax when they passed the latest tax legislation. As of 2019, there is no penalty for individuals not having health insurance. However, for businesses with 50 or more full-time employees, it’s still legally required to offer health insurance to full-time employees.

Unless you offer a low deductible plan (for example, $1,000 deductible), direct primary care can actually be very complementary to a health insurance plan because it allows your employees to take advantage of services included in a DPC membership at no cost and severely discounted labs, medications, and services. This reduces their out of pocket costs, like co-pays and deductibles.

Plus, there may be employees who don't want traditional health insurance, in which case direct primary care may be a better fit for their needs and will likely save you money because it's cheaper than paying for insurance premiums.

For the most part, no. That’s the beauty of the model and what allows them to offer such dramatically discounted services, medications, and tests. When doctors bill insurance, your services become more expensive due to all the administrative fees the insurance company adds. A simple blood test that would cost $114 if you used insurance actually only costs $9. It makes a lot more sense to just pay cash for this and most other primary care needs.

Yes, direct primary care can likely help. While it’ll depend on the medications your employees take and their specific issues, DPC doctors often offer deeply discounted medications. Additionally, DPC doctors are treating more and more otherwise-specialized ailments like rheumatoid arthritis. You can see an example list of medications from a couple DPC doctors here and here.

DPC doctors will refer a patient to a specialist if necessary, but often at discounted rates, too. DPC doctors also often leverage eSpecialist companies like Rubicon, which is kind of like Uber for specialists, to help become more of a one-stop shop. Patient care is the ultimate priority and they’ll do what’s right for your employee.

Direct primary care is not for high acuity issues like those. While DPC doctors can often serve as a medical sherpa, of sorts, to help you navigate traumatic situations like this, we — and DPC doctors — HIGHLY recommend having some form of health insurance, such as a high deductible, low premium plan. Patients often lean on direct primary care for 80-90% of their routine, non-catastrophic needs and only use their health insurance for things like hospital visits, surgery, etc.

Think of it like your auto insurance: every time you get an oil change or a tire rotation, you don’t need to file an insurance claim, but when something major happens, it’s good to have. If you’d like to chat through this, just contact us at [email protected] and we’d be happy to help you.

Yes! Nearly all DPC doctors provide a family plan, and most specialize in family medicine. Prices vary, but typically look like $50-75/month for the first adult, a discount for the second adult, and $10-25/month for each child. A family of four can have a DPC family membership for $118/month with some providers.

You'll be billed monthly for the cost of your employees' DPC memberships, but never more than the monthly payment cap that you set. We want you to be in full control of your budget, so you will never have any surprises or extra fees. You'll receive an itemized invoice every month with each employee. If a DPC provider bills any given employee more than your monthly cap, then that employee's credit card will be charged to cover the remainder. This ensures that your costs will be predictable and your employees maintain some skin in the game to not let costs spiral out of control.

We will never charge you unless an employee enrolls in a direct primary care membership. You only pay for the employees that actually use the benefit.

We charge a low service fee per employee so we can keep automating your direct primary care benefit administration. If you sign up, but none of your employees ever visit or enroll with a DPC doctor, then you will not be charged.

Your monthly invoice will be itemized in detail. We don’t like opaque pricing and cost structures (hello, healthcare!).

We use your payroll and time tracking integration (for example, ADP, Tsheets/Quickbooks, Xero, Homeshare, etc.) to check for new, qualifying employees every day. If an employee is newly qualified, then we notify them, help them sign up, choose a doctor, and enroll in a membership. If they enroll, they’ll show up on your next monthly invoice. You don’t need to do anything, although we’ll send you a report showing how many employees will qualify next month so there are no surprises.

Don’t use any of the above systems for payroll or time tracking? Let us know!

Just like above, we use your payroll and time tracking integration to check every single day to ensure we have all qualifying employees and to ensure we know when an employee no longer qualifies or works at your business.

If an employee no longer qualifies, we will notify you and notify them with details about when their Equal benefit expires and when they will be charged next per their subscription. Because they set up their account with their credit cards, there is no disruption in their direct primary care membership, unless they decide to cancel.