Direct primary care coverage coming to OKC insurance Marketplace
As thousands of Oklahomans have been dropped from SoonerCare, the state’s Medicaid program, many are looking to the federal insurance marketplace for a new plan.
But in Oklahoma City, many have turned to direct primary care programs, which connect them directly to providers through monthly subscriptions, which foregoes insurance companies altogether.
This works for many families, but others might feel more comfortable having traditional health insurance.
Starting Nov. 1, one insurance company will be Oklahoma’s first to offer direct primary care coverage to OKC-metro area residents on the marketplace.
Maine-based Taro Health will start by offering coverage to residents of Oklahoma, Cleveland and Canadian counties, with hopes to expand, according to co-founder Jeff Yuan.
It includes a regular health insurance plan, in addition to access to a direct primary care physician in Oklahoma City.
What is direct primary care?
Direct primary care, or DPC, began in the days before insurance payments, but the 21st-century direct primary care model came about in the late 2000s with Dr. Garrison Bliss’ founding of Qliance in Seattle.
Under this model, patients get more time with their doctor and can see their provider the same day or the next day because of the lower patient load, said Dr. Kyle Rickner, founder of Primary Health Partners.
Rickner said a typical patient load for his physicians is 600 to 800 patients. Under traditional primary care models, the patient load is often between 2,000 to 3,000, Rickner said.
A busy day for a direct primary care doctor is seeing eight to 10 patients, he said.
“The doctor is never in a rush; they’re not worried about how many people they see in a day,” Rickner said.
With the existing foundation of providers and patients in the metro, Yuan said Oklahoma was the perfect place to start expanding the company.
For those who sign up for Taro Health’s insurance plan, access to a direct primary care doctor is included rather than the patient needing to pay the monthly fee.
“Our whole thing is we really try to focus on keeping people healthy instead of just being there when you’re sick,” Yuan said. “What that translates to is, if people are going to spend their hard earned money paying very high health insurance premiums, they should at least get preventive and primary care with some peace of mind.”
Primary Health Partners, which started in Yukon and is about to open its 11th clinic in the metro, is partnering with Taro in hopes to give more people the option of direct primary care. A total of 26 providers work for the company, Rickner said.
What can I do if I’m taken off of SoonerCare?
After the public health emergency ended, the Oklahoma Health Care Authority in March began reviewing SoonerCare members and disenrolling those who are no longer eligible for coverage.
For Oklahomans included in this mass disenrollment — the OHCA estimated 300,000 adults and children would be removed from SoonerCare over a nine-month renewal process — there is a special enrollment period on the Affordable Care Act Marketplace from March 31, 2023, to July 31, 2024.
If you’ve been dropped from SoonerCare, you have a few options to get coverage, including with a direct provider care plan.
Anyone who is eligible for the Healthcare.gov insurance marketplace and lives in Oklahoma, Canadian or Cleveland counties can choose Taro Health as their provider.
Taro offers three different plans — bronze, silver and gold — which differ in terms of deductible amount, monthly payment, and how much things like labs, drugs, X-rays and specialists will cost the patient.
For those who can’t get insurance through the Marketplace because they have insurance through their employer, Primary Health Partners offers a plan for $99 per month. Children under 25 can be added to an adult membership for $49 per month.
Direct Primary Care of Oklahoma offers similar pricing in Edmond, as does The Little DPC in Oklahoma City.
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