Medicare & Insurance
Do I still need insurance?
We recommend that you do have insurance to comply with Federal Law. Direct Access does not replace insurance, and ideally we encourage our patients to carry a high deductible or major medical plan or a plan with a health savings account, thereby ensuring financial help should hospitalization or referral to a specialist be necessary. You should consult with your insurance provider to help you find a plan that works best with our medical model and that will meet your specific needs.
What if I want to continue my current insurance? Can I use it?
Not for our services, but Direct Access will be able to order your labs, x-rays and medications at the facilities preferred by your insurance if you would like.
If I have Medicare, can I join as a patient?
Yes. However, your monthly membership fee cannot be submitted to Medicare for reimbursement. You must sign a waiver every two years that declares that neither you nor your doctor will directly bill Medicare for your membership fee.
Medicare and medicare supplemental insurance will still cover medical costs that you incur outside of Direct Access. For example, prescriptions that you fill at an outside pharmacy, or labs run at an outside lab, or hospital charges, physical therapy, x-rays and scans are covered, just to name a few. You do not lose your Medicare coverage for other medical needs just because you are a patient of Direct Access.
How can I save on insurance costs by being a patient at Direct Access?
Many times patients purchase expensive “Cadillac” plans that require little or no co-pay and that cover all lab costs and prescription costs. However, with Direct Access your monthly fee covers all office visits, in office basic labs and there are no copays. Our patients may find it worthwhile to change from a “Cadillac” health insurance plan to a basic health insurance plan to save money.
Are Direct Access' monthly fees eligible for HSA/FSA reimbursement?
We recommend discussing this with your financial advisor and CPA as this is a very complex and ever changing issue.