Direct Primary Care concept has been a great success in Colorado – and the new DPC DIRECT healthshare program promises to make it even greater.
DPC DIRECT is the first healthsharing plan specifically designed to dovetail perfectly with a Colorado Direct Primary Care plan. Unlike traditional health insurance plans, which by law must force policyholders who are also DPC members to pay twice for primary care access, DPC DIRECT specifically excludes primary care from its list of shareable healthcare expenses.
So you only have to pay for primary care services once.
And your healthsharing dollars can be focused where they should be: On catastrophic care and specialist services.
About Colorado Direct Primary Care
In Direct Primary Care, patients skip the bloated and inefficient major medical insurance plans. Instead, they contract directly with primary care physicians and their practices.
Instead of insurance premiums, DPC patients pay a flat “subscription” to the practice for primary care services – typically $85 to $110 per month per person, with discounted rates available for families and group sponsors.
In return, they receive unlimited primary care services at no additional charge. No copays, deductibles, or additional fees.
The primary care physician handles routine, predictable services like checkups, medication adjustments,vaccinations, doctors’ notes, scrapes and bruises, stitches, and other minor issues.
Colorado Direct Primary Care is also a natural match for healthsharing: A more affordable alternative to the traditional health insurance plans available on the Colorado Affordable Care Act exchange website – especially where the patient doesn’t qualify for a large subsidy under the Affordable Care Act.
Healthcare plans, including DPC DIRECT, are typically available at less than half of the cost of an unsubsidized traditional ACA-qualified health insurance policy.
Background: How DPC DIRECT Reduces Costs by Eliminating Redundancy
As the name implies, Direct Primary Care only focuses on primary care. It’s not designed or intended to function by itself. It doesn’t include things like ER visits, specialist care, or surgeries. It’s designed to be a complement to a catastrophic health plan, such as a healthsharing plan or a major medical insurance policy.
So in addition to Direct Primary Care, Coloradans need to have a plan that picks up right where their Direct Primary Care plan leaves off.
The challenge, of course is to do so without having to effectively pay twice for primary care access.
That’s one of the many problems with Affordable Care Act-qualified policies: The law requires ACA-qualified plans to provide ten essential coverages – whether the customer needs the coverage or not!
And one of those ten essential coverages is access to primary care.
Meanwhile, the insurance bureaucracy – the massive administrative effort to justify, document, and bill insurance companies for the care provided – represents a huge amount of resources devoted to primary care.
And it provides little benefit to patients!
For routine, frequent, low-cost doctor visits, Direct Primary Care is far more cost efficient. Members pay a low monthly subscription fee for as many visits as they need. And that’s it.
That’s where the DPC DIRECT healthsharing plan comes in.
Colorado Direct Primary Care Directory
Combining Colorado Direct Primary Care & a DPC DIRECT Healthsharing Plan May Save You Thousands Per Year!
As of 2023, the average annual cost of an unsubsidized ACA-qualified “silver” plan for a young family of four in Denver County, Colorado, was more than $12,000, according to data from the Kaiser Family Foundation. It’s even higher for Coloradans who live on the more sparsely populated Western Slopes.
For families with no significant pre-existing conditions, the DPC Health sharing plan can provide similar protections against high unexpected medical costs – for as low as $510 per month for a 40 year-old + family coverage.
Actual costs will depend on the parents’ ages, the initial unshared amount option (which functions like a deductible), and which additional options you choose to add to your membership.
How DPC DIRECT Works
To join DPC DIRECT, you must join or already be enrolled in a Direct Primary Care plan.
The two are designed to work together to provide a broad spectrum of protection for Colorado residents:
For things like routine doctor visits, checkups, screenings, medication adjustments, doctors’ notes, immunizations, and other frequent events, you would use your direct primary care plan. You’d pay a flat, affordable monthly fee, and get all the access you need.
No deductibles, no copays, and no coinsurance.
With most DPC plans, you also get unlimited access to telehealth visits. So you don’t need to take a half day off work for a primary care doctor appointment.
And your doctor can spend more time with you. So they can address the root of the problem instead of just treating symptoms.
For specialist visits, emergencies, surgeries, and catastrophic care, you would use your DPC DIRECT healthsharing plan.
You pick the initial amount you can afford to pay out of pocket in the event of a major medical event. That’s your initial unshared amount.
When you or a family member incurs an eligible medical expense not covered by your DPC membership, you submit the bill to DPC DIRECT for reimbursement.
You pay the initial unshared amount for the year. DPC DIRECT pays the rest.
All for a much more affordable monthly cost compared to an unsubsidized Connect For Health Colorado plan. It’s even more affordable than the “Colorado Option” health insurance plan on the state Marketplace, before accounting for subsidies.
And because DPC DIRECT doesn’t need to share expenses for anything already covered under your DPC plan, the savings compared to other healthshare plans and traditional health insurance can be significant.
What to Know About Healthsharing
- Healthshare organizations are not insurance companies. Instead they are non-profit, tax-exempt 501(c)(3) organizations that facilitate the voluntary sharing of medical expenses among their members.
- Healthshare plans cost about half what you pay for a traditional ACA-qualified health insurance policy.
- Healthshare plans may have waiting periods on pre-existing conditions. They therefore usually work best for those who are still in good health.
- Many health sharing plans are faith-based. But DPC DIRECT has no religious requirement. Anyone in Colorado who is enrolled in a Direct Primary Care plan can join DPC DIRECT.
Additional Benefits of DPC DIRECT
Colorado residents who enroll in DPC DIRECT also receive the following benefits:
- Monthly costs as low as $170 per month for individuals.
- Unlimited access to 24/7 telemedicine services staffed by MDs for just $5 additional per month. No additional fees. Each call is free. (This can also be useful if you plan to travel outside of Colorado: You can access your telehealth benefits from anywhere – quickly and easily.)
- Optional access to the RX Share prescription discount program. This offers access to generic prescription drugs for as low as $5
How To Get A Quote or Sign Up
Find out how much you can save with DPC DIRECT! For a free consultation with one of our Personal Benefit Managers, click here.
Or put your zip code in the box below to get an instant quote.
If you like what you can see, you can enroll in just minutes.
Get an Instant Online Quote!
Who Should Consider DPC DIRECT for Colorado Direct Primary Care?
Any Coloradan who is currently enrolled or considering enrolling in a Direct Primary Care Plan should consider DPC DIRECT as a healthsharing alternative to traditional or Affordable Care Act-qualified insurance.
This is particularly true if:
- You do not qualify for a subsidy for an Affordable Care Act policy, or you only qualify for a small one.
- You want to be able to choose your own doctors, clinics, and hospitals. Many ACA-qualified plans available on the Colorado Connect For Health marketplace are HMOs and PPOs, which restrict your ability to access non-emergency care from any providers outside of their approved networks. These are usually the “lowest bidder” providers, and may not be the best providers in your area. In contrast, you can use your DPC DIRECT benefits with any provider.
- You don’t have any significant pre-existing conditions. DPC Direct may have a waiting period before bills from pre-existing conditions become fully shareable. However, a conventional health insurance policy must cover pre-existing conditions from day one. This is one of the reasons healthsharing is so much more affordable than health insurance!
- It’s outside of the Affordable Care Act Open Enrollment Period (November 15th through January 15th) and you don’t qualify for a special enrollment period, and you need to line up protection. DPC DIRECT does not have any open enrollment periods.
You can sign up at any time!
Healthsharing may not work as well for you if you or someone in your family has pre-existing conditions, is expecting to need surgery shortly, or if you’re eligible for a large premium subsidy for ACA-qualified health plans via Connect for Colorado.
However, you can contact us and we’ll help you enroll in the plan that makes the most sense for you.
No problem! Our experienced team of Personal Benefits Managers is ready to help. Click here to contact us, and we’ll be happy to answer all your questions, help you analyze your options, and get set up in the very best plan or combination of plans for you.
No Questions! I’m Ready! Sign me up!
Great! It’s easy to get enrolled! Just click here, review the basic plan terms, and scroll down to the red “Enroll” button at the bottom of the page.
Answer a few questions on a form, and you can get an exact quote, and get signed up on your own in a matter of minutes!
How DPC DIRECT Works
- Join a DPC plan in your area. There are more than 60 DPC clinics all over Colorado. For help choosing a DPC plan active in your area, click here to make a free, no-obligation appointment with a Personal Benefits Manager who can walk you through the process from front to back. And get you enrolled in the very best plan for you. You can also scout out local DPC clinics by using the Map Finder tool at the bottom of this page.
- Choose an affordable Initial Unshared Amount (IUA). This is the dollar amount that you will need to pay out-of-pocket before you can access cost sharing, similar to a deductible. (IUA options include $1,000, $2,500, or $5,000).
- Participate. Contribute your minimum monthly sharing amount to DPC DIRECT every month. This money overwhelmingly goes to support your fellow plan members in need. A small fraction goes to the non-profit organization itself to fund operations.
- Submit your medical bills for sharing. When you incur a medical bill, simply submit a cost-sharing request to DPC DIRECT. As long as your IUA has been met, and it’s an eligible medical need, the DIRECT Healthshare community will assist with sharing the rest of your bill. Just as you did when you were merely participating with your own monthly contributions.
Meanwhile, you can continue to work with your Personal Benefits Manager year after year to keep your healthcare strategy optimized and up to date.
Your PBM’s services are 100% free to you, for as long as you are enrolled in your plan.
Find Out How Much You’ll Save
Ready to find out how much you could be saving on healthcare with a DPC DIRECT Health Sharing Plan? You can enter your zip code below to compare rates, click here to contact us, or call 1-800-913-6381 to set up a no-cost consultation with one of our expert Personal Benefits Managers.
COLORADO DIRECT PRIMARY CARE FAQs
Does DPC DIRECT help with prescription drugs?
Yes. Medications that are billed by a provider and that are related to a qualified Need are shareable expenses under DPC Direct. However, DPC DIRECT noes NOT cover maintenance medications.
If you need maintenance medications, consider using the RX Share program, which provides deeply-discounted prices on hundreds of commonly-prescribed generic medications.
How are pre-existing conditions handled with DPC DIRECT?
Like most other healthshare programs, DPC DIRECT imposes a waiting period before the cost of treating most pre-existing conditions becomes shareable.
Specifically, there’s a 24-month “lookback” period for pre-existing conditions. If you’ve been treated for a pre-existing condition within the last 24 months, then the following sharing limitations will apply:
- First 12 months of membership: Costs for pre-existing conditions are not shareable.
- Months 13-24: Costs for treating pre-existing conditions are shareable up to $25,000.
- Months 25-36: Costs for treating pre-existing conditions are shareable up to $50,000.
- Months 37 and beyond: Costs for treating pre-existing conditions are shareable up to $125,000.
Exceptions apply for high blood pressure, high cholesterol, and diabetes. For details, contact your Personal Benefits Manager.
Does DPC DIRECT share pregnancy and childbirth (maternity) expenses?
Yes, provided the pregnancy commences after at least 60 days since the membership effective date.
Two initial unshareable amounts (IUAs) are applied to a single maternity need. So if your IUA is $1,000, then you would pay the first $2,000 of maternity-related costs before maternity bills become shareable.
Any pre-birth or post birth need of the child will be considered a separate need from the mother’s maternity care.
Does DPC DIRECT cover mental health expenses?
Yes, but sharing for mental health expenses is limited. Medications and other care is not shareable for the treatment of any mental health related illnesses unless approved by your Medical Cost Sharing provider. Sharing is limited to $3,000.
Is there an annual or lifetime cap on sharing benefits at DPC DIRECT?
No. Except for limitations on pre-existing conditions (described above), there are no annual or lifetime caps on cost sharing assistance at DPC DIRECT. Sharing benefits are potentially unlimited.
I’m a smoker. Can I join DPC DIRECT?
Yes. DPC DIRECT accepts tobacco users, for a surcharge of $50 per month.
Is there an annual membership fee?
Yes. $25 per year. This is in addition to your monthly sharing contribution, plus your DPC plan membership subscription.
Colorado Direct Primary Care Reviews
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Hi! I wanted to put in a good word for Rebecca, at DPC Direct/Zion Healthshare.
Rebecca was very knowledgeable and courteous and was a joy to work with. She helped me out a lot with getting me the right forms and helping me determine what emails I needed to send and to whom to get some medical bills paid.
The call center people overall have been great. Would definitely recommend DPC DIRECT to others.
Very happy with DPC Direct!
I signed up about three years ago, and have had a great experience ever since.
I had a bad experience with giant health insurance corporations. It’s so nice to be able to call with some issue and be able to get somebody on the phone right away.
The customer service is great. And most importantly, they’ve paid promptly on the cost sharing requests my family and I have had. And we’ve saved a good deal of money compared to our former health insurance plan.
Would highly recommend to others.