Direct Primary Care vs. Insurance
Is it really cheaper than insurance?
In most cases, YES.
It’s easy to forget just how much you are spending on insurance because most of the time it’s taken as a deduction on your paycheck. But let’s run a comparison scenario for a 40 year old single individual and see how just the real cost measures up.
As you can see below, the base rates of Remedy Direct Primary Care are clearly better than the Healthcare Exchange options and they are competitive with employer-offered plans… until you consider the additional costs. Then you have to consider, can you afford to not have a membership?
With traditional insurance plans you have to not only pay your copays with each visit, but also your insurance will only cover a portion of each bill until you meet your deductible. Remedy Direct Primary Care has NO copays and NO deductibles. And while you still have to pay for labs, medications, and imaging, these are at often significantly reduced rates (see estimates below).
| 40 year old | BCBS | BCBS+DPC | Zion Health + DPC |
|---|---|---|---|
| Annual Premium | $1,512.00 | $2,112.00 | $2,040.00 |
| Meds | $293.40 | $84.05 | $84.05 |
| Labs | $60.00 | $10.05 | $10.05 |
| Imaging Specialists Urgent Care ER Procedures |
$1,920.35 | $482.63 | $482.63 |
| Total Yearly Costs for Expected Use |
$4,469.15 | $2,758.02 | $2,686.02 |
Pricing Comparison with a 40 year old, single individual (non smoker)
| 55 year old | BCBS | BCBS+DPC | Zion Health + DPC |
|---|---|---|---|
| Annual Premium | $1,512.00 | $2,352.00 | $3,240.00 |
| Meds | $598.24 | $144.64 | $144.64 |
| Labs | $120.00 | $18.75 | $18.75 |
| Imaging Specialists Urgent Care ER Procedures |
$2,238.91 | $482.63 | $482.63 |
| Total Yearly Costs for Expected Use |
$4,469.15 | $2,998.02 | $3,886.02 |
Pricing Comparison with a 55 year old, single individual (non smoker)
We ran the numbers for Blue Cross Blue Shield of Arizona based on the average employee premium ($126 per month) & average employee deductible ($4,300).
We assumed a $20 coverage on labs by insurance, but the real costs could be hundreds more.
The imaging cost was calculated based on a 30% risk (multiplied by the negotiated cost) of a single CT or MRI at Flagstaff Medical Center for BCBS rates.
The average American goes to 4 doctor visits per year, 2 of those are primary care, so we assumed 2 specialist visits for age 55+ and 1 per year for age 40+.
The average American has a 30% chance of urgent care visit and 40% chance of ER visit. The average ER visit charge in Arizona is $2300. For urgent care, we assumed a $150 charge.
Procedure charges were based on the Healthcare Bluebook rates in Flagstaff.
If one were to go to the healthcare marketplace exchange, you can add $200 per month in premiums to the employee contribution example above ($2,400 more per year).
References: rate.com (PPO and HMO rates), CDC.gov (healthcare use data), ehealthinsurance.com, zionhealth.org, carepricer.nthrive.com/?clientId=13007&facid=4906 (FMC rates), helioshealth-az.com/answers.html, kff.org (Avg Marketplace premiums)
Learn more about Zion Health, medical cost sharing insurance