What Flat-Fee Primary Care Could Mean for Self-Pay Patients

Flat Fee Primary Care

It used to be that people would pay for routine primary care out of pocket, saving their high deductible health insurance plan, if they had one, for emergency situations. While the ACA attempted to create a shift back to value-based care, flat-fee primary care suffered, particularly because of the requirement that everyone have health insurance (and flat-fee primary care is not viewed under the ACA as health insurance). With the recent election of President Trump, the future of healthcare has been uncertain. There are many doctors out there who believe that this type of healthcare can be successful. But how might it impact patients who pay out of pocket?

What is Flat-Fee Primary Care?

Flat-fee primary care, also often called direct primary care (DPC) is a model of healthcare that allows primary care physicians to provide more meaningful care than with the fee-for-service model. Rather than going through insurance, patients pay a “retainer” (monthly, quarterly or annual fee) that covers essentially all primary care services. These services include a set number of office visits, labs, care coordination and comprehensive care management. However, flat-fee primary care does not cover everything, such as specialists or emergency care, so it is often recommended to get a high deductible, or catastrophic, insurance plan.

Unlike fee-for-service, which incentivizes physicians to see as many patients as possible, the goal of flat-fee primary care is to provide quality care, at an affordable cost, to maintain the well-being of patients. Physicians get to spend more time with their patients, see fewer patients, decrease medical errors, have better collection rates and don’t have to worry about the hassle of filing insurance claims.

Flat-Fee Benefits for Self-Pay Patients

Physicians are not the only ones who stand to benefit from flat-fee primary care. This particular type of primary care can be quite beneficial for self-pay patients, too. One of the biggest benefits of flat-fee primary care is that the fees are affordable. The cost of health insurance has skyrocketed in the past few years, making it close to impossible for many to afford plans, even through the marketplace.

Another great benefit is that patients get to spend more time with their doctors. They are not rushed through their appointments. Instead, they have the time they need to discuss any and all of their concerns and be fully evaluated for potential issues. This leads to yet another benefit, the prevention, and/or maintenance, of serious or chronic health issues.

Without insurance, many self-pay patients tend to wait until they feel seriously ill until they seek help, and by that point they have no choice but to go to the emergency room, where they could be diagnosed with a serious health condition that requires extensive testing and invasive procedures. Even patients living with chronic conditions may have trouble paying for the care and medications they need, thereby exacerbating an already serious issue. By paying a low, flat fee, self-pay patients can afford to see a primary care doctor and prevent these problems from occurring.

What Does the Future Hold?

One of President Trump’s plans for healthcare revolves around health savings accounts (or HSAs). Currently, under the ACA, while flat-fee primary care is not seen as an insurance plan, the IRS treats it like one. This means that the annual fees are not considered qualifying medical expenses and therefore cannot be reimbursed by a tax-exempt HSA. If this same regulation were to stay in effect, and Trump expanded HSAs, those who participated in them would not be able to participate in flat-fee primary care services. However, because of the increase in Republicans in Washington, there is a good chance that the regulations will change, and HSAs will expand to include flat-fee primary care, benefitting participating physicians and encouraging self-pay patients to seek primary care. It could even encourage more physicians to offer these services.


For patients who pay out of pocket for all medical expenses, increasing access to primary healthcare services is crucial to preventing serious health complications. This access also helps those patients who do suffer from chronic issues, manage their health to keep it from worsening. However, not all of the kinks have been worked out yet, so the plan will need some tweaking before the system gets to where it needs to be. Despite this, there is a great opportunity to provide quality preventative care to those who can’t afford traditional health insurance.