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Q: What services should we include in the subscription fee?

slide8Q: What services should we include in the subscription fee?

By The National Advisory Board; February 9, 2015 by William Hudec and Cassie Dormond

According to the guidelines of the Affordable Care Act, direct primary care constitutes compliant insurance coverage, but it must be bundled with “wraparound” catastrophic medical policy for emergencies. Depending on the model, subscription fees may cover most primary care procedures, from physicals and EKGs to strep tests and stitches, but medical groups should clearly articulate what services are and are not included within its concierge offering.

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Source: The National Advisory Board; February 9, 2015 by William Hudec and Cassie Dormond

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Categorised in: Business, Direct Care Doctors, DPC News, FAQs

4 Responses »

  1. Can you please share how you know “According to the guidelines of the Affordable Care Act, direct primary care constitutes compliant insurance coverage” I haven’t seen this anywhere. Did the government rule on DPC’s? The high deductible “wraparound” policy is about all the ACA is offering anymore, but DPC’s aren’t usually included in this, as we not considered insurance of any kind (and this is a super important distinction, as we don’t want to have to worry about governance by the insurance commission and it’s ugly laws). I know that the IRS has allowed DPC fees/membership dues to be included in HSA’s which is wonderful.

    DPC pairs wonderfully well with these high deductible policies, as it helps people get the actual care they need for significantly less than their high deductible.

    • Direct Primary Care does not constitute compliant insurance coverage, and there is no such guideline in the Affordable Care Act. Section 1301, the amendment within the ACA that houses the DPC model, only states that DPC Medical Homes can compete on exchanges when paired with a catastrophic wrap plan.

      To my knowledge, the IRS has not yet ruled on whether DPC fees can be applied to HSAs.

  2. I wasn’t aware DPC membership fees were an allowable/reimbursable expense under HSAs, yet.

  3. I thought I had seen that ruling by the IRS on one of these articles. I know the State of Missouri and the State of Kansas have legislation on their agendas right now to consider these ideas. It’s about time.

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