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All Posts in Category: insurance

August 2018 Newsletter

August Newsletter August 5, 2018 HSA for Clinic Membership Bill HR 6199 was passed in the house and is on its way to the Senate. This bill will enable patients to use their health savings account (HSA) to pay for Direct Primary Care clinic memberships.  As you know HSA is pre-tax dollars, so this bill will…

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The Math of Direct Primary Care

You already are aware by now that by getting membership in our clinic, you maximize your access to care 24/7/365. With relaxed visits that extend up to an hour, we have the time to understand your health concerns deeply and are able to deal with multiple issues at a time. Result is high quality of care. But did you know that your membership is actually saving you a lot of healthcare dollars !!??  Let me explain in this blog how. How, in addition to the great access and quality of care, you are actually SAVING on healthcare dollars by membership in our clinic, bundled with your health insurance.

Your health Insurance is designed to cap the loss in case you have catastrophic health event that would require hospitalizations or other specialty care. Think of your Home owners or Auto Insurance. These Insurance are designed to cap your loss in case of flood / hurricane damage or auto accidents. The similarities end there. You don’t use your auto insurance to replace car tires or home owners insurance to repair a broken sprinkler system. WHY? (Ignore deductibles for now) if you did use it to repair minor damages, you know your premiums would rise! Now contrast it to how health insurance is used. You go to a Physician to treat a flu (minor issue), you use the insurance. If there is a major health issue, you use the same insurance! Just like auto insurance premiums would rise if used frequently for minor issues, your health insurance premiums rise every year!

What should be done then?  There is ONE SIMPLE SOLUTION If you want to have your family covered for the big items and, at the same time, get better access to the doctor with quality care. Follow along – 

Coverage / PlansWhat benefit you get?Explanation
High Deductible Health Plan (HDHP) with HSACaps your losses in case of major health issuesIt is always advisable to have health insurance to prevent losses in case of major health issues. HDHP insurance works like auto or home owners insurance. The higher the deductible (up to the risk you can bear), lower is the premium.
Meridian Springs Primary Care membership (Direct Primary Care model)This is a fixed cost for your family every year regardless of the number of usage of primary care (no per visit fees)For example, suppose you have a HDHP deductible of $4800. You will have to pay the first $4800 out of pocket before insurance kicks in. With our membership, you are effectively capping this deductible spend for primary care usage to a maximum of $1440 (for a family of 4). Ofcourse this applies only to primary care usage. But that is 85% of all healthcare usage anyway.

Next, let us crunch some numbers to see how this kind of coverage actually saves you money in actual dollar terms. You heard it right – You get accessible, quality care and it costs LESS!

Check the numbers in the charts below. These are the average healthcare spend numbers from 2017. Light blue represents worker/individual contribution i.e, your part of the premium in an employer provided healthcare plan. 

Employee premium contribution under the popular health insurance plans are shown below (this is shown as an example only) –

Plan membershipsAnnual Fees / Premiums – contribution per familyAverage DeductiblePossible out of pocket (Premium/fees + deductible)Explanation
Meridian Spring Primary Care membership$14400$1440$120 / mo for a family of 4 – meets all primary care needs
HDHP insurance plan$4599$4800$9399It should be noted that after deductible is met there is also 20% co-insurance requirement
PPO  insurance plan$6850$2500$935020% co-insurance to be added after deductible is met
HMO  insurance plan$6050$2800$885020% co-insurance to be added after deductible is met
HDHP + Meridian Springs membership$4599$1440$6039 +All of Primary care spending (85% of your healthcare requirement) is covered by $1440 membership fees

The common mistake people make in calculating their healthcare spend is either not take their portion of the premium payment into account (since that usually is pre-tax dollars) or they fail to add up both the premium and deductible amounts to calculate possible healthcare spend. We suggest that you use the above example to calculate for your own situation for a clearer picture. The annual savings per family with a HDHP insurance bundled with Meridian Springs memberships will provide significant savings. This is in addition to full access and high quality of Primary Care. This bundle works the best compared to just a HDHP insurance, PPO or HMO plans by themselves.

Contact us in person or via email if you have more questions, we would love to chat with you!

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Can your health insurance prevent financial ruin?

Here is the nightmare scenario – You rush to the ER for severe abdominal pain suspecting it to be appendicitis. ER diagnose it as a stomach bug. HUGE RELIEF?? NO! You find out your insurance company has declined to cover the $12,000 bill, saying the visit was not an emergency because the final diagnosis determined…

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CVS and Walgreens sued on ‘clawbacks’ of prescription drug co-pays

We had first reported about pharmacies doing ‘clawbacks’ on prescription drug co-pays in our blog -http://springsmd.com/prescription-drug-costs. Bloomberg now reports that California customers are suing CVS pharmacy and Walgreens over the ‘clawbacks’. It is further reported that the customers paid $166 with insurance when the cash price was $92.  The price of drug was expensive with…

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What Prescription Drug costs 1237% more in Walgreen than Costco??

Walgreens is charging $198.80 out-of-pocket for a thirty-day supply of Donepezil – a medication used to treat Alzheimer’s. The same medication at Costco costs $14.87. Why? We asked the companies. Prescription drug prices are another one of those black holes in our healthcare system. I was taught pricing is a signal, but this wide variation…

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Health coverage from hell!!

This is a real bill. Can you guess what procedure this is for? !! We live in the illusion that health coverage is healthcare! But this example will prove otherwise. A person may have good health coverage through insurance but still land up paying an arm and a leg. This is an incident where a…

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