Is One Better Than the Other?

If you are sick of health insurance and looking for a better solution to deal with your medical bills, you’ve probably heard of health sharing (why you ended up here!) and direct primary care memberships. So how do you know which option is best for you? Let’s take a look at some of the pros and cons of both approaches.

Direct Primary Care: Why or why not?

Direct primary care (DPC) is an alternative approach to the traditional fee-for-service healthcare model. In a conventional healthcare setting, you go to the doctor and are charged a fee for the service rendered. With DPC, you pay a monthly membership fee that allows you unlimited access to your primary care physician. 

Not all DPC memberships are created equal. Some offer extensive services including health coaching, body contouring, and advanced cancer screenings. Here are some basic highlights of a DPC membership:

What DPC memberships offer

  • Personalized attention

    The best part about being a DPC member is the personal attention you will get from your primary provider. Since DPC practices limit the number of patients they serve, they can spend more time with each patient. Also, having fewer patients means that it is easy to get an appointment—even on the same day!

    When you are a DPC member, you and your doctor can take the time to really dig into your medical history, your personal circumstances, and your current health issues. You’ll develop a plan to improve or maintain your health that often leads to better patient outcomes and better overall health.

    • Routine care

    Direct primary care is specifically for your routine and preventive care. Many memberships include standard lab tests, imaging, and other preventive appointments (e.g., well-woman exams, sports physicals, and pediatric care).

    Additionally, DPC memberships are ideal for those times when you get sick and need something more than rest and chicken soup. Your DPC provider likely offers same-day virtual or in-office sick visits and can send prescriptions to your preferred pharmacy immediately.

    What DPC memberships don’t offer

    • Large network of providers

    When you have a DPC membership, there is only one place where you can seek care. So, if you need medical attention out-of-town, or you need to go to the hospital for more urgent care, you will be paying out-of-pocket.

    DPC clinics are springing up all around the country, but you may live in an area that does not yet have a DPC clinic. In order to access this type of care you may have to travel a long distance—defeating the convenience bonus of DPC membership.

    • Major Medical Care

    Since DPCs focus on routine and preventive care, you will likely not have any emergent or major medical concerns covered by your membership. Some clinics offer limited urgent care services (e.g., stitches and sick visits). However, if you have an unexpected major medical event or need surgery, you will pay for that out-of-pocket.

    Health Share: Why or why not?

    If you are reading this blog, you are probably more familiar with health shares than DPC memberships. Health shares are becoming the most popular alternative to health insurance. There are a lot of differences between health shares and health insurance, which we cover in other blogs. But the basics are: 1) a health share allows you to share eligible major medical expenses with a community of members, 2) a health share membership costs way less than an insurance policy, and 3) a health share does not guarantee payment for your expenses—even eligible ones.

    Health share membership plans vary widely and dramatically in some cases, but in general, here are the basic highlights of what a health share membership offers.

    What health shares offer

    • Access to provider options

    As a health share member, you will have access to a provider network, or even better, have the freedom to pick any provider you want! Moreover, you can seek care anywhere in the country (sometimes outside the country). Health share memberships do not limit you to one provider, so you don’t have to worry about traveling or moving and needing care away from your home base.

    Flexibility and freedom are the main draws of health share plans. Health sharing is a great way to get the care you need from providers that offer quality and value. 

    • Peace of mind

    Perhaps the best thing that health shares offer is peace of mind. Major medical expenses have bankrupted far too many families. A health share plan is designed to ease the burden of costly illnesses, accidents, and other medical procedures.

    Besides being required to have health insurance, most people have it because they think they need it to help offset expensive medical bills. Health insurance is there just in case you need it, so you don’t have to worry about what will happen “if.” 

    Unfortunately, most people with health insurance still don’t feel that peace of mind due to high deductibles and out-of-pocket maximums. If you join a reputable health share, there is often no limit on how much can be shared by the community. And when there are limits, they are typically generous—more generous than many insurance companies. In addition, many health shares will continue to share expenses as long as you are undergoing treatment or experiencing symptoms related to a medical concern. That means, your member responsibility for the need doesn’t re-set each year. Of course, read your health share’s guidelines. Some health shares do have an annual member responsibility model. 

    What health shares don’t offer

    • Routine care

    Health shares are built to manage large expenses. Your typical member responsibility amount is going to be at least $500, which means that most preventive and routine services won’t ever qualify for sharing with the community. 

    Even though this makes sense with the purpose of health shares, members are typically very interested in making sure their routine care is handled. Some health shares are trying, and offer limited routine services, but none come close to offering the kind of everyday care that a DPC can.

    • Guarantees

    With direct primary care, the transaction is pretty straightforward: you pay membership fees, and in return, you will get x, y, and z. Your DPC won’t pick and choose which flu-like symptoms they can treat you for, or refuse to review your medical history if it involves pre-existing conditions.

    Health shares, on the other hand, have the final say on what they will or won’t let you share with the community. There are member guidelines that outline what is shareable, but health shares still do not guarantee payment for any medical bill (if you are getting a guarantee from your health share, that is a bad sign; reputable health shares do not make insurance-like promises). The whole membership is voluntary, and when you sign up you usually agree that the health share will have ultimate control over what can and cannot be shared. This can leave some room for doubt about what medical concerns may or may not be shared when it comes down to it.

    Of course, reputable health shares want to keep members happy, and the main way they do that is by taking good care of members. And many health shares have very happy members who have been helped with all kinds of major medical issues—just check out some of the reviews on our site!

    Which one is better? Health sharing or direct primary care?

    Our answer: neither. The best solution is really to combine the two, if at all possible. While many health shares are offering some preventive and routine care options, none of them offer what a DPC membership will. And a DPC membership won’t help you with those big, scary medical situations that keep you up at night. 

    If you are lucky enough to have a DPC clinic near you, we highly suggest looking into it. The great news is that some health shares encourage DPC memberships and may offer you a discounted monthly rate or other options that will help consolidate your payments for the separate memberships. 

    The combination of a DPC and health share is a great way to access quality health care at a fraction of the cost of traditional health insurance. 

    If you have to choose just one for financial reasons, we recommend a health share. As we said earlier, those big, unexpected bills can be a source of anxiety. Having a plan to manage large expenses will help you sleep better. There are a few health shares like Altrua and Zion HealthShare that have some decent preventive options built into their plans. So, if you must choose one or the other, shop for a health share that offers the type of care that is most important to you and your family.