As thousands of Oklahomans have been kicked off SoonerCare, the state’s Medicaid programme, many are looking to the federal insurance marketplace for a new plan.
But in Oklahoma City, many have turned to direct primary care programmes that connect them directly to providers through monthly subscriptions, bypassing insurance companies altogether.
This works for many families, but others may feel more comfortable with traditional health insurance.
Starting 1 November, an insurance company will become the first in Oklahoma to offer direct primary care coverage to residents of the OKC metro area on the marketplace.
Maine-based Taro Health will initially offer coverage to residents of Oklahoma, Cleveland and Canadian counties, with hopes of expanding, according to co-founder Jeff Yuan.
It includes a standard health insurance plan, plus access to a direct primary care doctor in Oklahoma City.
What is direct primary care?
Direct primary care, or DPC, began in the pre-insurance era, but the 21st-century direct primary care model emerged in the late 2000s with the founding of Qliance in Seattle by Dr Garrison Bliss.
In this model, patients get more time with their doctor and can see their provider the same day or the next day because of lower patient loads, said Dr Kyle Rickner, founder of Primary Health Partners.
Rickner said a typical patient load for his doctors is 600 to 800 patients. In traditional primary care models, the patient load is often between 2,000 and 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 hurry; they’re not worried about how many people they see in a day,” Rickner said.
With the existing base of providers and patients in the metro, Yuan said Oklahoma is 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 physician is included, rather than the patient having to pay the monthly fee.
“Our whole thing is that we’re really trying to focus on keeping people healthy instead of just being there when you’re sick,” Yuan said. “What that means is if people are going to spend their hard-earned money paying very high health insurance premiums, they should at least be able to get preventive and primary care with some peace of mind.”
Primary Health Partners, which started in the Yukon and is about to open its 11th clinic in the Metro, is partnering with Taro in hopes of giving 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 dropped from SoonerCare?
After the public health emergency ended, the Oklahoma Health Care Authority began reviewing SoonerCare members in March and disenrolling those who no longer qualify for coverage.
For Oklahomans included in this mass disenrollment – the OHCA estimated that 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 31 March 2023 to 31 July 2024.
If you’ve been kicked off SoonerCare, you have a few options for getting coverage, including 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 – that differ in terms of deductibles, monthly payments and how much things like labs, drugs, X-rays and specialists 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 a month. Children under 25 can be added to an adult membership for $49 per month.
Direct Primary Care of Oklahoma offers similar prices in Edmond, as does The Little DPC in Oklahoma City.
