2 prescriptions to lower medical bills

  • Alternative health plans fill a need among the jobless and uninsured.
  • Direct-care medical homes offer health services for a monthly fee.
  • Some health care cooperatives provide prepaid services to members.

More than 6 million Americans have lost jobs since the recession began in December 2007, and for many, the loss of a job means the loss of health insurance benefits.

Even for those who still work, many companies are dialing back health benefits for employees. For instance, about 58 percent of small U.S. employers offered health insurance for their workers five years ago, but that number has since fallen to 47 percent, according to the Council of Smaller Enterprises in Cleveland.

While Congress works to reform the health care system, millions of uninsured or underinsured Americans just need cheaper health care. Fortunately, affordable consumer options are expanding. For those who want to take health care matters into their own hands, consider these two unconventional alternatives to the standard employee-sponsored health insurance.

Direct-care medical homes

For several years, boutique medical practices have offered increased access to physicians and round-the-clock care for a premium cost. Now, a new crop of medical practitioners eschew the word "boutique," as well as insurance companies, and offer affordable monthly fees catering to middle-class patients.

"It's like joining a gym where you pay $50 to $75 a month, but instead of exercise machines, there's a doctor and an X-ray machine and other medical equipment," says Chris Free, co-owner of Rapport Benefits Group in Tacoma, Wash., which helps businesses and individuals choose health care options.

One such clinic, Seattle-based Qliance Medical Management, calls itself a direct-primary-care medical home. In lieu of insurance, Qliance members pay a monthly membership fee ranging from $39 to $79, determined on a sliding scale based on age. In return, they receive unrestricted access to all routine care, including blood tests, women's health services, pediatric care, broken bones and ongoing management of chronic illnesses without ever paying a co-pay or receiving a bill in the mail later. The affordable monthly payment could allow consumers to save more for larger health costs, such as unexpected surgery.

While direct-care medical homes like Qliance are fairly new, Norm Wu, president and CEO of Qliance, says his clinic has identified approximately 75 clinics in 17 states that allow direct payments (rather than billing insurance). Of those 75, about half "have very affordable monthly fees, well below $100 per month," he says.

Joining a direct-care medical home can eliminate the need for full-coverage health insurance, but most consumers will still need a health insurance policy for catastrophic care, such as unforeseen surgery or hospitalization. "Instead of buying insurance for $300 a month, you can go to a (direct-care) medical home and buy a cheaper insurance plan with a high deductible," Free says.


Wu estimates that the price of a monthly membership combined with the premium on a high-deductible insurance policy to cover expensive, unforeseeable health events can still be up to 50 percent less than traditional low-deductible health insurance. For example, a 35-year-old male who has a $2,500-deductible health care plan for $500 per month, or $6,000 per year, could join Qliance for $49 per month, or $588 annually. An insurance plan with a higher deductible could carry a premium as low as $250 per month, or $3,000 per year, capping costs at $3,588 per year. That's a 40 percent savings even without including co-pays, which are not a part of the direct-care medical home model.

Relying on a direct-care medical home for primary care can make sense financially, but there are some limitations, says Petra Perkins, co-owner of Rapport Benefits. For instance, a membership often doesn't include prenatal care, so it might not be the best option for a family planning to have children. Before joining such a group, Perkins recommends asking questions and reading the fine print to make sure the services you need will be offered.

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